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Subcutaneous administration of insulin aspart causes a more rapid and intense maximal effect compared with regular insulin during euglycemic clamp studies in nondiabetic subjects. Abdominal administration of insulin aspart has a shorter duration of glucose-lowering effect compared with administration in the deltoid or thigh.

OBJECTIVE -To evaluate the efficacy and safety of add-on insulin glargine versus rosiglitazone in insulin-naïve patients with type 2 diabetes inadequately controlled on dual oral therapy with sulfonylurea plus metformin. randomized, parallel trial, 217 patients (HbA 1c [A1C] 7.5-11%, BMI Ͼ25 kg/m 2 ) on Ն50% of maximal-dose sulfonylurea and metformin received add-on insulin glargine 10 units/day or rosiglitazone 4 mg/day. Insulin glargine was forced-titrated to target fasting plasma glucose (FPG) Յ5.5-6.7 mmol/l (Յ100 -120 mg/dl), and rosiglitazone was increased to 8 mg/day any time after 6 weeks if FPG was Ͼ5.5 mmol/l. RESULTS -A1C improvements from baseline were similar in both groups (Ϫ1.7 vs. Ϫ1.5% for insulin glargine vs. rosiglitazone, respectively); however, when baseline A1C was Ͼ9.5%, the reduction of A1C with insulin glargine was greater than with rosiglitazone (P Ͻ 0.05). Insulin glargine yielded better FPG values than rosiglitazone (Ϫ3.6 Ϯ 0.23 vs. Ϫ2.6 Ϯ 0.22 mmol/l; P ϭ 0.001). Insulin glargine final dose per day was 38 Ϯ 26 IU vs. 7.1 Ϯ 2 mg for rosiglitazone. Confirmed hypoglycemic events at plasma glucose Ͻ3.9 mmol/l (Ͻ70 mg/dl) were slightly greater for the insulin glargine group (n ϭ 57) than for the rosiglitazone group (n ϭ 47) (P ϭ 0.0528). The calculated average rate per patient-year of a confirmed hypoglycemic event (Ͻ70 mg/dl), after adjusting for BMI, was 7.7 (95% CI 5.4 -10.8) and 3.4 (2.3-5.0) for the insulin glargine and rosiglitazone groups, respectively (P ϭ 0.0073). More patients in the insulin glargine group had confirmed nocturnal hypoglycemia of Ͻ3.9 mmol/l (P ϭ 0.02) and Ͻ2.8 mmol/l (P Ͻ 0.05) than in the rosiglitazone group. Effects on total cholesterol, LDL cholesterol, and triglyceride levels from baseline to end point with insulin glargine (Ϫ4.4, Ϫ1.4, and Ϫ19.0%, respectively) contrasted with those of rosiglitazone (ϩ10.1, ϩ13.1, and ϩ4.6%, respectively; P Ͻ 0.002). HDL cholesterol was unchanged with insulin glargine but increased with rosiglitazone by 4.4% (P Ͻ 0.05). Insulin glargine had less weight gain than rosiglitazone (1.6 Ϯ 0.4 vs. 3.0 Ϯ 0.4 kg; P ϭ 0.02), fewer adverse events (7 vs. 29%; P ϭ 0.0001), and no peripheral edema (0 vs. 12.5%). Insulin glargine saved $235/patient over 24 weeks compared with rosiglitazone. RESEARCH DESIGN AND METHODS -In thisCONCLUSIONS -Low-dose insulin glargine combined with a sulfonylurea and metformin resulted in similar A1C improvements except for greater reductions in A1C when baseline was Ն9.5% compared with add-on maximum-dose rosiglitazone. Further, insulin glargine was associated with more hypoglycemia but less weight gain, no edema, and salutary lipid changes at a lower cost of therapy. Diabetes Care 29:554 -559, 2006O ver 60% of Americans with type 2 diabetes have HbA 1c (A1C) levels Ͼ7% following stepwise treatments that fail to address the dual defects of insulin secretion and action responsible for the relentless disease course (1-3). Despite evidence that single-agent therapy for type 2 diabetes seldom maintains glycemi...

Differential interferometric synthetic aperture radar (DInSAR) is a recognized remote sensing method for measuring the land motion occurring between two satellite radar acquisitions. Advanced DInSAR techniques such as persistent scatterers (PS) and small baseline methods are excellent over urban and rocky environments but generally poor over more rural and natural terrain where the signal can be intermittently good and bad. Here, we describe the ISBAS (Intermittent Small Baseline Subset) method, which appears to improve results over natural, woodland and agricultural terrain. This technique uses a multilooked, low-resolution approach, which is particularly suitable for deriving the linear components of subsidence for large-scale deformations. Application of the ISBAS method over a coal mining area in the UK indicates that it is able to significantly improve upon a standard small baseline approach.

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