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Comparison of insulin lispro mixture 25/75 with insulin glargine during a 24‐h standardized test‐meal period in patients with Type 2 diabetes
Author(s) -
Roach P.,
Malone J. K.
Publication year - 2006
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.2006.01895.x
Subject(s) - medicine , postprandial , insulin lispro , insulin , insulin glargine , endocrinology , type 2 diabetes , morning , metformin , meal , crossover study , diabetes mellitus , evening , triglyceride , cholesterol , placebo , physics , alternative medicine , pathology , astronomy
Abstract Aims To compare insulin lispro mixture (25% insulin lispro and 75% NPL; Mix 25/75) twice‐daily plus oral glucose‐lowering medications (metformin and/or sulphonylurea) with once‐daily insulin glargine plus oral agents with respect to postprandial glycaemic control and other glucose and lipid parameters in patients with Type 2 diabetes inadequately controlled with insulin and/or oral glucose‐lowering agents. Methods This was a randomized, open‐label, crossover study. Prestudy oral agents were continued and patients not already on oral agents were treated with metformin. Mix 25/75 and insulin glargine were adjusted over 3 months to attain premeal plasma glucose (PG) < 6.0 mmol/l and were then given during a 24‐h in‐patient test meal period with frequent PG, serum triglyceride (TG) and free fatty acid (FFA) measurements. Results Twenty patients (10 F/10 M; mean ± sd age 54.0 ± 10.7 years, body mass index 37.0 ± 8.6 kg/m 2 , HbA 1c 8.4 ± 1.01%) participated. Mean doses were 23 U before the morning and 37 U before the evening meal for Mix 25/75 and 44 U for insulin glargine. The combined 2‐h morning and evening meal postprandial plasma glucose (PPG) was not different between groups (9.2 ± 2.04 vs. 9.9 ± 1.66 mmol/l, P = 0.161). Mix 25/75 was associated with a lower mean 2‐h PPG for all meals combined (9.0 ± 1.88 vs. 9.9 ± 1.80 mmol/l, P < 0.05) and lower mean 24‐h PG (6.7 ± 1.00 vs. 7.5 ± 1.32 mmol/l, P < 0.01). Eight patients experienced mild hypoglycaemia (PG < 3.5 mmol/l) with Mix 25/75 and 3 with insulin glargine. The endpoint HbA 1c was lower with Mix 25/75 (6.9 ± 0.52% vs. 7.3 ± 0.81%, P < 0.05). Conclusions In a 24‐h test‐meal setting in 20 patients, Mix 25/75 insulin plus oral glucose‐lowering agents was associated with lower mean PPG and 24‐h PG, more mild hypoglycaemia and similar TG, FFA and fasting PG concentrations. HbA 1c was lower with Mix 75/25 plus oral agents, although it may not have reached steady state due to ongoing dose adjustment.