Responders to insulin therapy at 18 months in adults with newly diagnosed diabetes: which insulin regimen?

Abstract

The use of premixed insulin regimen among newly diagnosed patients with diabetes appears to be most effective in reaching HbA(1c) target values, independent of other confounders. The appropriate choice of insulin regimen at initiation should therefore take into account various metabolic and psychosocial factors.

Biphasic vs basal bolus insulin regimen in Type 2 diabetes: a systematic review and meta‐analysis of randomized controlled trials

“…To date, this is the most comprehensive systematic review comparing the two insulin regimens. The observation of the subgroup analysis on insulin na€ ıve patients showing that biphasic insulin produced similar HbA 1c outcomes when compared with the basal bolus insulin regimen support findings from our previous studies in newly diagnosed, insulin-requiring patients with diabetes [34] as well as in patients with Type 2 diabetes newly started on insulin therapy [35]. We observed that in patients with Type 2 diabetes, the basal bolus regimen leads to greater improvement in glycaemic control in the majority of patients compared with the biphasic regimen.…”

Factors Associated With Weight Gain in People With Type 2 Diabetes Starting on Insulin

“…In agreement with our study, they also found that baseline A1C was associated with weight gain. In the Health Improvement Network database study, the average weight gain over the 18 months was 2.4 kg, again with a greater weight gain in those with lower BMI (18).…”

“…Table 3-b coefficients to predict weight gain from multivariable linear models, after stepwise selection of variables measured at baseline before prescription of insulin, and when including measures at 1 year, both adjusted for the investigational site as a random factor b coefficient (95% CI) P Baseline variables only A1C, per log e %* 4.371 (17), in people with type 2 diabetes newly treated with insulin, weight gain was greater on premixed insulin than on other regimens, but there is no information provided on insulin dose. The Health Improvement Network database studied 1,492 people newly diagnosed with diabetes .18 years of age who required insulin treatment within the first 6 months after diagnosis, and who responded to insulin treatment (A1C ,7.5% [,58 mmol/mol]) within the first 18 months of treatment (18). These people would probably be classified as having latent autoimmune diabetes of adults or slow-onset type 1 diabetes.…”

Association between insulin‐induced weight change and CVD mortality: Evidence from a historic cohort study of 18,814 patients in UK primary care

“…In the United Kingdom Prospective Diabetes Study, patients in the intensive intervention cohort gained in excess of 5 kg during the 10 year follow‐up period, with most of this gain occurring in the first 12 months . In routine clinical practice, however, we have previously shown that the effectiveness of insulin therapy to lower HbA 1c levels is variable and dependent on patients' baseline weight . This is because insulin‐induced weight gain results in an increase in the amount of insulin required to control hyperglycaemia, at the expense of further weight gain, possible poor treatment compliance, and increased insulin resistance.…”