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When Combined With Metformin, Premixed Insulin Analogue Is More Effective

Than Glargine

Reduction in A1c was significantly better in the premixed insulin aspart group then in the glargine group In a treat-to-target study on insulin initiation Raskin et al. compared the effectiveness of premixed insulin aspart (30% rapid-acting – 70% protaminated aspart) – metformin combination vs insulin glargine – metformin in 276 patients (3).

At the end of the 6-month follow-up period the primary endpoint – reduction in HbA1c was significantly better in the premixed insulin aspart group (HbA1c 6.91% vs 7.41%; reduction from baseline 2.79% vs 2.36%, p<0.01). This effect was largely due to the fact that the group on premixed insulin aspart targeted effectively both postprandial and basal hyperglycemia as there was no secretagogue included in the study. Premixed insulin aspart group achieved same fasting plasma glucose reduction as insulin glargine (125 mg/dl / 7.0 mmol/l), while significantly reducing the overall postprandial glycemic exposure (sum of the three mealtime plasma glucose increments: 97.4 mg/dl vs 129.6 mg/dl / 5.4 mmol/l vs 7.2 mmol/l).

The overall hypoglycemia rate was lower in the glargine group, and similarly to all insulin initiation studies in type 2 diabetes severe hypoglycemia was uncommon in both treatment groups (one severe hypoglycemic event with insulin glargine). Weight gain was less with insulin glargine (5.4 kg vs 3.5 kg, p<0.01) but similar between treatments when dividing by dose given.
Diabetes Care 2005; 28: 260-265

Data from the state’s diabetes disease management program was presented Saturday, June 11, during the American Diabetes Association’s 65th Scientific Sessions in San Diego.