Share This Article:

Comparison of glycemic variability between basal-bolus and premixed insulin therapy

Abstract Full-Text HTML Download Download as PDF (Size:260KB) PP. 45-51
DOI: 10.4236/jdm.2013.32008    3,494 Downloads   6,083 Views   Citations

ABSTRACT

Background: Several studies have shown that twice-daily injections of premixed insulin analogs (MIX) could achieve comparable HbA1c levels to basal-bolus (BB) therapy. However, HbA1c does not necessarily reflect short-term glycemic fluctuations that may contribute to the onset or progression of diabetic complications. Therefore, in this study, we compared MIX and BB therapies in terms of their effects on glycemic variability. Methods: We performed a crosssectional observational study of patients attending our outpatient clinics to compare the effects of two insulin regimens on glycemic variability. We recruited patients treated with MIX or BB with HbA1c < 8.4%. A total of 27 patients (11 treated with BB and 16 treated with MIX) were enrolled and wore a continuous glucose monitor (CGM) for 72 h, while continuing their usual lifestyle and insulin doses. Results: No significant differences in CGM-determined glycemic markers were observed between the two groups. However, the post-lunch duration of glucose levels > 180 mg/dL (t > 180) was significantly shorter with BB therapy (88 ± 76 min) than with MIX therapy (145 ± 54 min; p < 0.05). After classification according to HbA1c levels, markers of glycemic variability were better in patients treated with BB than in those treated with MIX in better control group. Conclusion: These results suggest that BB therapy achieves better glucose profiles than MIX therapy in patients with type 2 diabetes, particularly after lunch.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Yamada, S. , Hirai, R. , Inoue, G. , Yamada, Y. , Irie, J. , Atsuda, K. and Yamanouchi, T. (2013) Comparison of glycemic variability between basal-bolus and premixed insulin therapy. Journal of Diabetes Mellitus, 3, 45-51. doi: 10.4236/jdm.2013.32008.

References

[1] The Diabetes Control and Complications Trial Research Group. (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine, 329, 977-986. doi:10.1056/NEJM199309303291401
[2] Ohkubo, Y., Kishikawa, H., Araki, E., et al. (1995) Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: A randomized prospective 6-year study. Diabetes Research and Clinical Practice, 28, 103-117. doi:10.1016/0168-8227(95)01064-K
[3] Hirsch, I.B., Bergenstal, R.M., Parkin, C.G., et al. (2005) A real-world approach to insulin therapy in primary care practice. Clinical Diabetes, 23, 78-86. doi:10.2337/diaclin.23.2.78
[4] Golden, M.P. (1998) Incorporation of quality-of-life considerations into intensive diabetes management protocols in adolescents. Diabetes Care, 21, 885-886. doi:10.2337/diacare.21.6.885
[5] Hirao, K., Arai, K., Yamauchi, M., et al. (2008) Sixmonth multicentric, open-label, randomized trial of twicedaily injections of biphasic insulin aspart 30 versus multiple daily injections of insulin aspart in Japanese type 2 diabetic patients (JDDM 11). Diabetes Research and Clinical Practice, 79, 171-176. doi:10.1016/j.diabres.2007.08.011
[6] Miyashita, Y., Nishimura, R., Nemoto, M., et al. (2008) Prospective randomized study for optimal insulin therapy in type 2 diabetic patients with secondary failure. Cardiovascular Diabetology, 7, 16-23. doi:10.1186/1475-2840-7-16
[7] Masuda, H., Sakamoto, M., Irie, J., et al. (2008) Comparison of twice-daily injections of biphasic insulin lispro and basal-bolus therapy: Glycaemic control and qualityof-life of insulin-na?ve type 2 diabetic patients. Diabetes, Obesity and Metabolism, 10, 1261-1265.
[8] Monnier, L., Mas, E., Ginet, C., et al. (2006) Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. The Journal of the American Medical Association, 295, 1681-1687. doi:10.1001/jama.295.14.1681
[9] Beisswenger, P.J., Szwergold, B.S. and Yeo, K.T. (2001) Glycated proteins in diabetes. Clinical Laboratory Medicine, 21, 53-78.
[10] Del Prato S. (2002) In search of normoglycaemia in diabetes: Controlling postprandial glucose. International Journal of Obesity, 26, S9-S17. doi:10.1038/sj.ijo.0802172
[11] Sakamoto, M., Inoue, G., Tsuyusaki, K., et al. (2010) Comparison of oxidative stress markers in type 2 diabetes: Basal bolus therapy versus twice daily premixed insulin analogs. Internal Medicine, 49, 355-359. doi:10.2169/internalmedicine.49.2725
[12] Schlichtkrull, J., Munck, O. and Jersild, M. (1965) The m-value, an index of blood-sugar control in diabetes. Acta Medica Scandinavica, 177, 95-102. doi:10.1111/j.0954-6820.1965.tb01810.x
[13] Service, F.J., Molnar, G.D., Rosevear, J.W., et al. (1970) Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes, 19, 644-655.
[14] Avignon, A., Radauceanu, A. and Monnier, L. (1997) Nonfasting plasma glucose is a better marker of diabetic control than fasting plasma glucose in type 2 diabetes. Diabetes Care, 20, 1822-1826. doi:10.2337/diacare.20.12.1822
[15] Kashiwagi, A., Kasuga M., Araki, E., et al. (2012) International clinical harmonization of glycated hemoglobin in Japan: From Japan Diabetes Society to National Glycohemoglobin Standardization Program values. Diabetology International, 3, 8-10.
[16] The DECODE Study Group. (1999) Glucose tolerance and mortality: Comparison of WHO and American Diabetes Association diagnostic criteria. Lancet, 354, 617-621. doi:10.1016/S0140-6736(98)12131-1
[17] Hanefeld, M., Koehler, C., Schaper, F., et al. (1999) Postprandial plasma glucose is an independent risk factor for increased carotid intima-media thickness in non-diabetic individuals. Atherosclerosis, 144, 229-235. doi:10.1016/S0021-9150(99)00059-3
[18] Hanefeld, M., Fischer, S., Julius, U., et al. (1996) Risk factors for myocardial infarction and death in newly detected NIDDM: The diabetes intervention study, 11-year follow-up. Diabetologia, 39, 1577-1583. doi:10.1007/s001250050617
[19] Tominaga, M., Eguchi, H., Manaka, H., et al. (1999) Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care, 22, 920-924. doi:10.2337/diacare.22.6.920
[20] The Diabetes Control and Complications Trial (DCCT) Research Group. (1995) The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the diabetes control and complications trial. Diabetes, 44, 968-983. doi:10.2337/diabetes.44.8.968
[21] Monnier, L., Colette, C. and Owens, D.R. (2008) Glycemic variability: The third component of the dysglycemia in diabetes. Is it important? How to measure it? Journal of Diabetes Science and Technology, 2, 1094-1100.
[22] Giugliano, D., Maiorino, M.I., Bellastella, G., et al. (2011) Efficacy of insulin analogs in achieving the hemoglobin A1c target of <7% in type 2 diabetes: Meta-analysis of randomized controlled trials. Diabetes Care, 34, 510-517. doi:10.2337/dc10-1710
[23] Coniff, R.F., Shapiro, J.A., Seaton, T.B., et al. (1995) A double-blind placebo-controlled trial evaluating the safety and efficacy of acarbose for the treatment of patients with insulin-requiring type II diabetes. Diabetes Care, 18, 928-932. doi:10.2337/diacare.18.7.928
[24] Mitrakou, A., Tountas, N., Raptis, A.E., et al. (1998) Long-term effectiveness of a new alpha-glucosidase inhibitor (BAY m1099-miglitol) in insulin-treated type 2 diabetes mellitus. Diabetic Medicine, 15, 657-660. doi:10.1002/(SICI)1096-9136(199808)15:8<657::AID-DIA652>3.0.CO;2-7
[25] Chiasson, J.L., Josse, R.G., Hunt, J.A., et al. (1994) The efficacy of acarbose in the treatment of patients with noninsulin-dependent diabetes mellitus. A multicenter controlled clinical trial. Annals of Internal Medicine, 121, 928-935. doi:10.7326/0003-4819-121-12-199412150-00004
[26] The Committee of Japan Diabetes Society on the diagnostic criteria of diabetes mellitus. (2010) Report of the Committee on the classification and diagnostic criteria of diabetes mellitus. Journal of the Japan Diabetes Society, 53, 450-467.

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.