When Basal Insulin Is Not Enough to Achieve Glycemic Targets

When basal insulin cannot achieve target glucose levels, can simple intensification with a modern premixed insulin help? Results from a subanalysis of the PRESENT study.

The aim of this analysis was to assess the efficacy and safety of intensifying insulin therapy from a basal-only regimen to biphasic insulin aspart 30/70 in patients with type 2 diabetes previously failing to reach glycemic targets.

The analysis is based on data from a subpopulation of the Physicians’ Routine Evaluation of Safety and Efficacy of NovoMix((R)) 30 Therapy (PRESENT) study, which was a 6-month observational study in 15 countries. This subanalysis included patients previously receiving long-acting analogue insulin (AB; n = 348), or human basal insulin (long and intermediate acting) (HB; n = 3414), who were transferred to BIAsp 30. Efficacy end-points included change in HbA1c, fasting plasma glucose (FPG) and postprandial plasma glucose (PPG), from baseline to the end of the study. Episodes of hypoglycemia, adverse events, and physician and patient satisfaction were also recorded. End-points were considered separately by previous basal regimen (AB or HB).

After 6 months’ treatment with BIAsp 30/70, HbA(1c) was significantly lowered in both groups (-1.60% and -1.42% in the AB and HB groups; compared with baseline). Reductions in FPG and PPG were also statistically significant in both groups. The rate (events/patient/year) of overall hypoglycemia remained relatively constant in patients switching from AB, but it was statistically lower in patients switching from HB (change from baseline -3.8).

From the results it was concluded that in routine clinical practice, patients with type 2 diabetes who are failing to reach glycemic targets on basal insulin can achieve better glycemic control without an increase in overall hypoglycemia by intensifying with BIAsp 30/70

Int J Clin Pract. 2008 May 9. Diabetes Care. 2008 May 16.

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