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Glycemic Control With Insulin and No Weight Gain

Sep 5, 2006

The GAME regimen gives glucose control and stabilization of weight Weight gain appears to be unavoidable in patients with type 2 diabetes who are switched from oral agents to insulin therapy. Peripheral hyperinsulinism induced by the use of long-acting insulin may be the key to explain this adverse effect.

The aim of this study was to investigate whether a regimen free of long-acting insulin can provide long-term glycemic control without causing weight gain. This is an uncontrolled, 1-year study comprising 58 patients with type 2 diabetes and secondary failure, age 30-75 years, BMI 25-35 kg/m(2), HbA1c > 7.5% and fasting C-peptide level > 0.3 mmol/l.


All patients were treated with the GAME regimen, a combination of glimepiride administered at 20:00 hours for nocturnal glycemic control, insulin aspart three times daily for meal-related glucose control and metformin. Seventy-one per cent of the patients were considered evaluable. HbA1c decreased from 10.0 +/- 0.3 to 7.4 +/- 0.1% (p < 0.001). Fifty-nine per cent reached HbA1c levels </= 7.5%. Symptomatic nocturnal hypoglycemia was not reported. Body weight tended to decrease during the first 3 months (-1.0 +/- 0.5 kg, p = 0.06), but then gradually rose to a value 0.8 +/- 0.5 kg higher than at baseline (p = 0.12). This is 4.4 +/- 0.6 kg less than predicted for conventional regimens employing long-acting insulin (p < 0.001).

The GAME regimen provides long-term glycemic control as well as stabilization of body weight in about 60% of type 2 patients presenting with secondary failure.

Diabetes Obes Metab. 2006 Sep;8(5):517-23.