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Benefits of Switching from Premixed Insulin to Basal Insulin with OAD

Patients with type 2 diabetes may have additional glycemic benefits from switching from premixed insulin to a combination of basal insulin plus an oral anti-diabetic agent (OAD)…. 

In this open-label, single-arm, observational study, researchers assessed the safety, efficacy and treatment satisfaction of insulin glargine with oral anti-diabetic agents.

A total of 70 individuals with type 2 diabetes, inadequately controlled with premixed insulin, were switched to insulin glargine plus oral anti-diabetic drugs. Researchers then measured multiple variables including: glycaemic control, incidence of hypoglycemia, satisfaction with treatment, serum superoxide dismutase, and serum 8-iso-prostaglandin.

Individuals switched to insulin glargine plus an oral anti-diabetic drug had their average HbA1c levels decrease from a mean of 8.28 to 6.83 (P<0.001). Fasting blood glucose levels decreased from an average of 7.64 mmol/L to 5.57 mmol/L (P<0.001). Further, 2-hour postprandial blood glucose also decreased by 3.13 (12.07 mmol/L to 8.94 mmol/L; P<0.001).

In addition to the noted benefits on glycemic control, this was accomplished using a smaller total daily dose of insulin. The average daily dose of insulin decreased by 14 units between baseline and week 20. Patient satisfaction also significantly increased.

Significant increases in SOD were observed among study participants (90.00 to 108.81 u/mL, P < 0.01) as well as reductions in 8-iso-PG (2.15 to 1.64 pg/mL, P < 0.05).

Among the HbA1c ≤ 6.5% group and the HbA1c > 7.0% group, significant differences were found in regards to baseline HbA1c values, duration of diabetes, and baseline postprandial C-peptide values (HbA1c: 7.25% verse 9.32%; duration of diabetes: 7.84 years verse 13.96 years; and postprandial C-peptide: 4.83 verses 2.54 nmol/L ) with a P < 0.05 for all.

A total of 3 symptomatic hypoglycemic episodes occurred with no significant reductions in body weight.

Practice Pearls:
  • Insulin glargine in combination with oral anti-diabetic drugs may result in better glycemic control than premixed insulin as well as a lower daily dose of insulin
  • Using less insulin to achieve glycemic control may result in greater weight loss in the long term – since insulin one of the most potent energy-storing hormones

Zhang Y, Xie YJ, Meng DD, Zhang HH, Chen H, Liu E. Clinical study of treatment switching from premixed insulin to basal insulin combined with oral hypoglycemic drugs in patients with type 2 diabetes. Diabetol Metab Syndr. 2014;6(1):37. http://www.dmsjournal.com/content/6/1/37