Efficacy of treatment with a basal-prandial insulin regimen in patients with type 2 diabetes mellitus previously treated with premixed insulin

Introduction: Premixed insulins are a common treatment for type 2 diabetes mellitus (DM). However, their limitations and the lack of achieving glycaemic control in some patients reinforce the need to find therapeutic alternatives. Objectives: To assess whether basal-prandial therapy (basal insulin, and additional pre-prandial rapid insulin boluses, when required) improves glycaemic control in patients with type 2 DM and glycosylated haemoglobin (HbA1c) >53 mmol/mol (7%) treated with premixed insulin in the primary care setting. Material and methods: A retrospective observational study in which 116 patients with type 2 DM switched from premixed insulin to basal-prandial therapy. Data on demographics, anthropo-metrics, laboratory results, and antidiabetic treatment were collected from the medical charts of the patients, prior to switching the treatment (baseline) and 4 months thereafter. Results: HbA1c significantly decreased from baseline to month 4 (65.1 +/- 5.7 mmol/mol [8.1 +/- 0.5%] versus 51.9 +/- 7.2 mmol/mol [6.9 +/- 0.7%]; p < .005), and 70 patients (60.9%) had an HbA1c <= 53 mmol/mol (7%). Additionally, fasting blood glucose (FBG) significantly decreased (9.7 +/- 1.7 mmol/l [175.4 +/- 31.2 mg/dl] versus 6.9 +/- 1.4 mmol/l [124.4 +/- 25.8 mg/dl]; p < .005), and the number of patients with FBG < 5.6 mmol/l (100 mg/dl) (2 patients [1.7%] versus 21 patients [18.3%]; p < .005), and with post-prandial blood glucose <= 10 mmol/l (180 mg/dl) (14 patients, [12.1%] versus 87 patients [76.3%]; p < .05) significantly increased. There were also significant decreases in body weight (76.3 +/- 12.9 kg versus 74.8 +/- 12.5 kg; p < .001) and waist circumference (96.1 +/- 16.0 cm versus 94.4 +/- 14.5 cm; p < .005). Only 4 patients (3.5%) had hypoglycaemia. Conclusions: Basal-prandial therapy improved glycaemic control in patients with type 2 DM, with a low incidence of hypoglycaemia, and decreased body weight. (C) 2012 Sociedad Espanola de Diabetes. Published by Elsevier Espana, S.L. All rights reserved.