Efficacy and Safety of Prandial Premixed Therapy Using Insulin Lispro Mix 50/50 3 Times Daily Compared With Progressive Titration of Insulin Lispro Mix 75/25 or Biphasic Insulin Aspart 70/30 Twice Daily in Patients With Type 2 Diabetes Mellitus: A Randomi

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• 作者：Eugenia Farcasiu MD ; PhD¹ ; Tibor Ivanyi MD² ; Barbara Mozejko-Pastewka MD³ ; Zita Birkus MD⁴ ; Jozsef Csog MD⁴ ; Irina Kowalska MD ; PhD⁵ ; Thomas Frederic Coetzer MD⁶ ; Sami Bulgurlu MD⁷ ; Birgit Schinzel MSc⁸ ; Jacek Kiljanski MD ; PhD³ ;   ; ^{KILJANSKI_JACEK@lilly.com}
• 关键词：metformin ; prandial premix therapy ; premixed insulin analogs ; type 2 diabetes
• 刊名：Clinical Therapeutics
• 出版年：2011
• 出版时间：November 2011
• 年：2011
• 卷：33
• 期：11
• 页码：1682-1693
• 全文大小：1179 K

文摘

Background

Prandial premixed therapy 3 times daily has been proposed recently for type 2 diabetes mellitus (T2DM) patients who fail to achieve glycemic control with commonly used premixed insulin analogs, insulin lispro mix 75/25 (LM75/25) and biphasic insulin aspart 70/30 (BIAsp70/30) BID.

Objective

The aim of this work was to compare the efficacy and safety of 3-times daily insulin lispro mix 50/50 (TID group) with progressive titration of twice-daily LM75/25 or BIAsp70/30 (BID group) administered along with metformin in T2DM patients.

Methods

This was an open-label, 16-week, multicenter, randomized, parallel trial. End point glycosylated hemoglobin (HbA_1c) was the primary efficacy measure; HbA_1c reduction from baseline to end point, percentage of patients reaching target HbA_1c (<7.0 % and ?.5 % ), postprandial blood glucose (BG), and BG excursions after lunch were secondary measures. Safety was evaluated by collecting adverse events.

Results

A total of 302 patients with mean (SD) age 57.7 (9.27) years, diabetes duration 11.2 (6.47) years, HbA_1c 8.5 % (1.23), fasting BG 184.0 (53.04) mg/dL, body weight 86.8 (14.79) kg, body mass index 31.7 (4.23) kg/m², and daily insulin dose ?8 IU were randomized. No significant difference was observed in end point HbA_1c between the 2 groups. Seven-point BG profiles showed lower fasting and postbreakfast BG in the BID group but lower postlunch BG in the TID group. Daily insulin dose change was similar in both groups, with more weight gain in the TID group (P = 0.0009). Overall hypoglycemic rates were similar in both groups, but nocturnal hypoglycemia was more frequent in the BID group (P = 0.0063).

Conclusions

In patients with T2DM who have not achieved adequate glycemic control with LM75/25 and BiAsp70/30 BID plus metformin and who are not candidates for basal bolus therapy, switching either to treatment with LM50/50 TID or to progressive titration of premix insulin analogs BID did not produce sufficient evidence of a difference of overall glycemic control between the 2 treatment groups. Short study duration and less intensive dose adjustments might have contributed to these results.