Diabetes Metab J.  2012 Jun;36(3):230-236. 10.4093/dmj.2012.36.3.230.

Glycemic Effects of Once-a-Day Rapid-Acting Insulin Analogue Addition on a Basal Insulin Analogue in Korean Subjects with Poorly Controlled Type 2 Diabetes Mellitus

• Choe EY
• Lee YH
• Lee BW
• Kang ES
• Cha BS
• Lee HC

• KMID: 2281404
• DOI: http://doi.org/10.4093/dmj.2012.36.3.230

Abstract

BACKGROUND
The present study investigates the efficacy in glycemic control by adding once-a-day glulisine to glargine as a basal plus regimen and factors influencing glycemic control with the basal plus regimen in Korean subjects with type 2 diabetes.
METHODS
In the present retrospective study, subjects previously treated with the basal plus regimens for at least 6 months were reviewed. Changes in glycemic profiles and clinical parameters were evaluated.
RESULTS
A total of 87 subjects were ultimately enrolled in this study. At baseline, mean glycated hemoglobin (A1c) and glycated albumin were 8.5% (8.0% to 9.6%) and 25.2+/-7.6%, respectively. After treatment with the basal plus regimen, patients had significant reductions of A1c at 6 months (0.8+/-0.1%, P<0.001) and their postprandial glucose levels were decreased by 48.7+/-10.3 mg/dL (P<0.001). Multiple logistic regression showed old age (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02 to 1.55), high initial A1c (OR, 22.21; 95% CI, 2.44 to 201.78), and lower amounts of glargine (OR, 0.85; 95% CI, 0.76 to 0.99), and glimepiride (OR, 0.23; 95% CI, 0.06 to 0.93) at baseline were independently associated with good responders whose A1c reduction was more than 0.5%.
CONCLUSION
The authors suggest a basal plus regimen may be effective in reducing glucose levels of subjects with old age, high initial A1c, and patients on low doses of glimepiride and glargine. Despite the use of high doses of hypoglycemic agents, elderly patients with poorly-controlled diabetes are preferred for early initiation of the basal plus regimen.

Keyword

Basal insulin; Diabetes mellitus, type 2; Insulin, rapid-acting

MeSH Terms

Aged
Diabetes Mellitus, Type 2
Glucose
Hemoglobins
Humans
Hypoglycemic Agents
Insulin
Insulin, Long-Acting
Insulin, Short-Acting
Logistic Models
Retrospective Studies
Serum Albumin
Sulfonylurea Compounds
Insulin Glargine
Glucose
Hemoglobins
Hypoglycemic Agents
Insulin
Insulin, Long-Acting
Insulin, Short-Acting
Serum Albumin
Sulfonylurea Compounds

Figure

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  Fig. 1 Glucose-lowering effect of basal bolus regimen during 6 months. (A) Changes in glycated hemoglobin (A1c) during 6 months of treatment between Group I and Group II. (B) Changes in glycated albumin (GA) during 6 months of treatment between Group I and Group II.

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  Fig. 2 Multiple logistic regression models for the variables independently associated with better response to basal plus regimen in patients. The reference group for calculation of the OR was Group I. OR, odds ratio; CI, confidence interval; A1c, glycated hemoglobin; DM, diabetes mellitus; BMI, body mass index.

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