Twice‐daily pre‐mixed insulin rather than basal insulin therapy alone results in better overall glycaemic control in patients with Type 2 diabetes

Abstract

In patients with Type 2 diabetes and inadequate glucose control while on insulin or insulin and oral agent(s) combination therapy, treatment with a twice-daily insulin lispro mixture plus metformin, which targets both post-prandial and pre-meal BG, provided clinically significant improvements in A1c, significantly reduced post-prandial BG after each meal, and reduced nocturnal hypoglycaemia as compared with once-daily glargine plus metformin, a treatment that targets fasting BG.

Optimal insulin regimens in type 2 diabetes mellitus: systematic review and meta-analyses

“…Three found a significant reduction in mean PPG for all meals with biphasic insulin [36,43,44] and four showed a reduced PPG rise that was statistically significant for breakfast (0.8 vs 2.5 mmol/l, p<0.001 [37] [41]). One reported a greater proportion of biphasic arm patients reaching PPG targets after lunch and supper [45] and one reported no significant difference in PPG values [42].…”

“…Heterogeneity was not explained by fasting glucose target or baseline diabetic control. Of the remaining unpooled trials, two showed higher fasting glucose values in the biphasic group (in combined crossover data [38] or without reporting measures of dispersion [41]), one did not quote fasting values [40], one found no difference in fasting measures [43] and two with patients already taking insulin reported a higher percentage of the basal group reaching a target fasting value [44,45].…”

“…Three trials, which did not quote measures of dispersion [41][42][43], showed either a small HbA 1c reduction in favour of biphasic or no significant difference. Two trials [44,45], which recruited patients already using insulin, showed greater reductions with biphasic insulin (0.5% and 0.4%, respectively). Eight trials reported either mean or median final insulin doses with all trials reporting larger amounts for biphasic than basal insulin.…”

“…Two trials did not report change in weight [41,42]. One reported weight loss with basal insulin in non-naive patients [45] and three crossover trials reported reduced weight gain with basal insulin without within-person differences [38,43,44]. Hypoglycaemia Pooled analysis was not possible due to variation in definitions of hypoglycaemia and lack of measures of dispersion.…”

Optimal glucose control in type 2 diabetes mellitus—a guide for the family practitioner

“…51,52,53 The disadvantage of this strategy is that a fixed meal schedule needs to be followed. The two advantages of the newer analogue insulin mixtures is that a much less pronounced insulin peak is present in the basal component of the dosage 54 and the second is that only two injections need to be given daily. The newer insulin analogue mixed insulins seem, however, to give even better results if given three times per day immediately before meals.…”