Comparison of thrice‐daily lispro 50/50 vs thrice‐daily lispro in combination with sulfonylurea as initial insulin therapy for type 2 diabetes

Aims/Introduction:  Basal–bolus intensive insulin therapy has been believed to achieve best the glycemic control, but is also complicated as a result of the number of injections required and the type of insulin. This study compared the effect of thrice‐daily lispro 50/50 (prandial premixed therapy [PPT]) with thrice daily lispro given in combination with sulfonylureas (prandial bolus therapy with sulfonylurea [PBTS]) as initial insulin therapy for type 2 diabetes. Materials and Methods:  This 24‐week, observational, parallel trial comprised a 12‐week screening period and a 24‐week intervention period for 31 diabetes patients who were poorly controlled with submaximal sulfonylurea. At the start of the intervention period, we commenced thrice‐daily insulin injections and divided the 31 patients into either lispro 50/50 with discontinuation of sulfonylurea (PPT, n  = 15) or lispro added to sulfonylurea (PBTS, n  = 16). The same dose‐adjustment algorithm was used for analyzing both groups; HbA 1c , plasma glucose, insulin daily dose, bodyweight and number of hypoglycemic episodes were evaluated. Results:  At the end of the study, HbA 1c was significantly improved in both groups ( P  < 0.00001), but no difference was apparent between the groups. The daily doses of PPT were more than those of PBTS, albeit the difference was statistically insignificant ( P  = 0.051). There were significantly fewer hypoglycemic episodes encountered with PPT than with PBTS. Conclusions:  Thrice‐daily injections of lispro 50/50 provide an effective and safe regimen as initial insulin therapy for type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00025.x, 2010)