Saturday , December 16 2017
Home / Conditions / Type 2 Diabetes / Basal Bolus Insulin Treatment for Type 2 Diabetes

Basal Bolus Insulin Treatment for Type 2 Diabetes

How effective is basal/bolus insulin treatment for type 2 diabetes?…

A recent observational study examined the safety and efficacy of beginning combination therapy with insulin aspart plus basal insulin in type 2 diabetics. Data was drawn from the A1chieve observational study, which included observation of type 2 diabetic patients (N=66,726) in routine clinic care for a period of 24 weeks.

Researchers conducted a sub-group analysis of the A1chieve study to determine safety, blood glucose control, hypoglycemia, body weight, lipids, blood pressure, and health-related quality of life (HRQoL) associated with insulin analogs.

Four patient groups were examined, including those who started on insulin aspart plus basal insulin (n=519), those who switched from biphasic insulin to basal plus aspart (n=947), those who switched from NPH insulin plus human mealtime insulin to basal plus aspart (n=586), and those patients who were insulin-naïve and switched to basal plus aspart (n=1594). At baseline, percent use of oral antidiabetic drug therapy among groups was 55, 51, 50, and 45, respectively.

Results found that overall glycemic control was poor at baseline. The HbA1c, FFG and PPPG were found to significantly improve among all patient groups; Mean HbA1c changes from baseline were -2.8 to -1.8%, mean FPG -4.9 to -2.9 mmol/L, and PPPG -6.7 to -3.9 mmol/L, p<0.001. It was found that hypoglycemia was increased for patients who began insulin, but decreased among other groups.

The authors concluded that the sub-analysis data support the recommendation of basal plus prandial insulin use in patients with type 2 diabetes lacking adequate glycemic control.

Practice Pearls:

  • HbA1c, FFG and PPPG were found to significantly improve with addition of insulin aspart to existing basal insulin.
  • Hypoglycemia risk was associated with insulin therapy start.
  • The data support the recommendation of basal plus prandial insulin use in patients with type 2 diabetes lacking adequate glycemic control

Home, P.D. et al. The effectiveness and safety of beginning insulin aspart together with basal insulin in people with type 2 diabetes in non-Western nations: Results from the A1chieve observational study. Diabetes Research and Clinical Practice. 2013;101:326-332