Clinical Practice Analysis of Type 2 Diabetes Patients with Premixed Insulin Switched to Basic Insulin plus Oral Antidiabetic Drugs_West China Medical Journal

Authors：

 LIULi-mei ,  ZHANGXue-jun , BAOMing-jing , YANGYan , LIPeng-qiu , XIANYang , WUJi-chuan

Department of Endocrinology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

ZHANGXue-jun, Email: zxj9819@163.com

Keywords：

Diabetes mellitus; Non-insulin dependent; Insulin

DOI：

10.7507/1002-0179.20140004

Video：

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Objective To explore the efficacy and safety of basal insulin plus oral antidiabetic drugs (OADs) treatment switched from premixed insulin therapy in type 2 diabetes patients. Methods Patients with type 2 diabetes with glycosylated hemoglobin (A1C) lower than 10%, taking stable dose of premixed insulin twice daily for at least 12 weeks, and treated between February 2010 and August 2011 were identified from our outpatient service, and their treatment was switched to glargine plus OADs. After 24 weeks of treatment, we analyzed the changes of the patients' weight, fasting and postprandial blood glucose (FBG and PBG), A1C, hypoglycemic events and insulin dose. Results A total of 36 patients were followed up and received glargine plus OADs. After glargine treatment, the patients' weight[(63.77±10.34) vs. (62.31±9.98)kg, P=0.002] and total insulin dose[(23.56±6.15) vs. (10.28±4.04)kg, P=0.000] were declined obviously. The A1C level had further declined in the group of premixed insulin therapy with A1C approaching or reaching 7% from start to end point (6.70±0.81)% vs.(6.34±0.55)kg, P=0.007], and the insulin dose was (0.16±0.06) U/(kg·d). However, no significant difference of the incidence of hypoglycemic events was discovered compared with non-standard group (33.33% vs. 55.56%, P=0.267). Compared with premixed insulin group, glargine group usually had 1 or 2 kinds of OADs, and the most widely used drug was glucophage (17/36). Conclusion In type 2 diabetes patients whose A1C level approaches or reaches 7%, switching premixed insulin therapy to glargine plus OADs is associated with significant improvement in glycemic control, as well as sound safety and other benefits.

Citation： LIULi-mei, ZHANGXue-jun, BAOMing-jing, YANGYan, LIPeng-qiu, XIANYang, WUJi-chuan. Clinical Practice Analysis of Type 2 Diabetes Patients with Premixed Insulin Switched to Basic Insulin plus Oral Antidiabetic Drugs. West China Medical Journal, 2014, 29(1): 11-14. doi: 10.7507/1002-0179.20140004 Copy

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1. IDF Clinical Guidelines Task Force. Global guideline for type 2 diabetes:recommendations for standard, comprehensive, and minimal care[J]. Diabet Med, 2006, 23(6):579-593.
2. Shank ML, Del PS, DeFronzo RA. Bedtime insulin/daytime glipizide. Effective therapy for sulfonylurea failures in NIDDM[J]. Diabetes, 1995, 44(2):165-172.
3. Riddle MC. Evening insulin strategy[J]. Diabetes Care, 1990, 13(6):676-686.
4. Taskinen MR, Sane T, Helve E, et al. Bedtime insulin for suppression of overnight free-fatty acid, blood glucose, and glucose production in NIDDM[J]. Diabetes, 1989, 38(5):580-588.
5. 卜石, 郭晓惠, 杨文英, 等. 预混胰岛素转为基础胰岛素联合口服降糖药治疗方案的2型糖尿病患者临床特征分析[J]. 中华医学杂志, 2007, 87(44):3115-3118.
6. 杨文英, 纪立农, 陆菊明, 等. 中国α型糖尿病防治指南(2010年版)[J]. 中国糖尿病杂志, 2012, 20(1):S1-S37.
7. Mulnier HE, Seaman HE, Raleigh VS, et al. Mortality in people with type 2 diabetes in the UK[J]. Diabet Med, 2006, 23(5):516-521.
8. Ridderstråle M, Gudbjörnsdottir S, Eliasson B, et al. Obesity and cardiovascular risk factors in type 2 diabetes:results from the Swedish National Diabetes Register[J]. J Intern Med, 2006, 259(3):314-322.
9. Hammer H, Klinge A. Patients with type 2 diabetes inadequately controlled on premixed insulin:effect of initiating insulin glargine plus oral antidiabetic agents on glycaemic control in daily practice[J]. Int J Clin Pract, 2007, 61(12):2009-2018.
10. JRaskin P, Allen E, Hollander P, et al. Initiating insulin therapy in type 2 diabetes:a comparison of biphasic and basal insulin analoges[J]. Diabetes Care, 2005, 28(2):260-265.
11. Janka HU, Plewe G, Riddle MC, et al. Comparison of basal insulin added to oral agents versus twice-daily premixed insulin as initial insulin therapy for type 2 diabetes[J]. Diabetes Care, 2005, 28(2):254-259.

West China Medical Journal

Clinical Practice Analysis of Type 2 Diabetes Patients with Premixed Insulin Switched to Basic Insulin plus Oral Antidiabetic Drugs

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