Comparison of Insulin Regimens in Patients with Non-Insulin Dependent Diabetes Mellitus

Insulin pump therapy vs. multiple daily injections in obese Type 2 diabetic patients

“…Intensive insulin therapy can be successful in Type 2 diabetic patients who fail to achieve good glycaemic control under conventional insulin therapy; however, reduction of blood glucose concentrations to near-normal levels often requires large doses of exogenous insulin, leading to increased plasma insulin levels and associated hyperinsulinaemia and weight gain. Several studies have demonstrated that treating Type 2 diabetic patients with exogenous insulin results in an average weight gain of 3-9% over pre-treatment weight [8][9][10]. In addition, intensive insulin therapy may influence other variables that are responsible for weight gain.…”

“…One approach to preventing weight gain is combination therapy, with oral hypoglycaemic agents during the day and long-acting insulin at night. This therapy has been shown to be as effective as MDI while associated with less weight gain [10]. Reduced weight gain despite effective blood glucose control may be attributable to elevated fasting blood glucose values, which contribute more to daytime hyperglycaemia than postprandial excursions [16].…”

“…To prevent weight gain secondary to insulin treatment, different forms of combination therapy have been investigated [8][9][10]. It has been shown that adding neutral protamine Hagedorn (NPH) insulin in the evening to therapy with oral hypoglycaemic agents improves glycaemic control in a similar manner to a twoinsulin injection regimen or a multiple-insulin injection regimen [10] and seems to induce less weight gain and hyperinsulinaemia. The most favourable outcome from combination therapy involved patients who still had some response to sulphonylureas or had evidence of relative endogenous secretion ability [8][9][10].…”

Premixed insulin aspart 30 vs. premixed human insulin 30/70 twice daily: a randomized trial in Type 1 and Type 2 diabetic patients

“…The use of premixed insulins is increasing world-wide. Under normal out-patient conditions, overall blood glucose control attained with twice-daily regimens may in some patients be as good as with multiple injection therapy [21][22][23].…”

Analysis of glycaemic control and weight change in patients initiated with human or analog insulin in an US ambulatory care setting

“…Intensive insulin therapy is associated with weight gain which is generally an undesirable outcome [11,12]. In the UK Prospective Diabetes Study (UKPDS), intensive blood glucose control with insulin therapy was associated with a 6.5 kg weight gain [13].…”