Prospective randomized study for optimal insulin therapy in type 2 diabetic patients with secondary failure

Yumi Miyashita, Rimei Nishimura, Masami Nemoto, Toru Matsudaira, Hideaki Kurata, Tamotsu Yokota, Kuninobu Yokota, Katsuyoshi Tojo, Kazunori Utsunomiya, Naoko Tajima, Yumi Miyashita, Rimei Nishimura, Masami Nemoto, Toru Matsudaira, Hideaki Kurata, Tamotsu Yokota, Kuninobu Yokota, Katsuyoshi Tojo, Kazunori Utsunomiya, Naoko Tajima

Abstract

Background: The large clinical trials proved that Basal-Bolus (BB) insulin therapy was effective in the prevention of diabetic complications and their progression. However, BB therapy needs multiple insulin injections per a day. In this regard, a biphasic insulin analogue needs only twice-daily injections, and is able to correct postprandial hyperglycemia. Therefore it may achieve the blood glucose control as same as that of BB therapy and prevent the diabetic complications including macroangiopathy.

Methods: In PROBE (Prospective, Randomized, Open, Blinded-Endpoint) design, forty-two type 2 diabetic patients (male: 73.8%, median(inter quartile range) age: 64.5(56.8-71.0)years) with secondary failure of sulfonylurea (SU) were randomly assigned to BB therapy with a thrice-daily insulin aspart and once-daily basal insulin (BB group) or to conventional therapy with a twice-daily biphasic insulin analogue (30 Mix group), and were followed up for 6 months to compare changes in HbA1c, daily glycemic profile, intima-media thickness (IMT) of carotid artery, adiponectin levels, amounts of insulin used, and QOL between the two groups.

Results: After 6 months, HbA1c was significantly reduced in both groups compared to baseline (30 Mix; 9.3(8.1-11.3) --> 7.4(6.9-8.7)%, p < 0.01, vs BB;8.9(7.7-10.0) --> 6.9(6.2-7.3)%, p < 0.01), with no significant difference between the groups in percentage change in HbA1c (30 Mix; -14.7(-32.5- (-)7.5)% vs BB -17.8(-30.1- (-)11.1)%, p = 0.32). There was a significant decrease in daily glycemic profile at all points except dinner time in both groups compared to baseline. There was a significant increase in the amount of insulin used in the 30 Mix group after treatment compared to baseline (30 Mix;0.30(0.17-0.44) --> 0.39(0.31-0.42) IU/kg, p = 0.01). There was no significant difference in IMT, BMI, QOL or adiponectin levels in either group compared to baseline.

Conclusion: Both BB and 30 mix group produced comparable reductions in HbA1c in type 2 diabetic patients with secondary failure. There was no significant change in IMT as an indicator of early atherosclerotic changes between the two groups. The basal-bolus insulin therapy may not be necessarily needed if the type 2 diabetic patients have become secondary failure.

Trial registration: Current Controlled Trials number, NCT00348231.

Figures

Figure 1
Figure 1
Trial profile.
Figure 2
Figure 2
Median percentage Change from Baseline to 6 months in HbA1c, BMI, Insulin dose/BW, Max IMT, Adiponectin, QOL. The box-and-whisker plots represented medians and inter quartile ranges and ranges. The medians of each data were compared using Wilcoxon rank-sum test. BMI; body mass index, BW; body weight, Max IMT; maximum intima media thickness, QOL; quality of life.
Figure 3
Figure 3
Median percentage Change from Baseline to 6 months in daily profile of self-measured capillary glucose. The box-and-whisker plots represented medians and inter quartile ranges and ranges. No significant difference was found between the both group in any time.

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Source: PubMed

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