Pre-publication from NEJM. Passed on for those type 2's
considering
insulin use or those thinking of varying
regimens.
http://content.nejm.org/cgi/content/...5392?query=TOC
"September 21, 2007 (10.1056/NEJMoa075392)
Addition of Biphasic, Prandial, or Basal Insulin to Oral
Therapy in Type 2 Diabetes
ABSTRACT
Background
Adding insulin to oral therapy in type 2 diabetes mellitus
is customary when glycemic control is suboptimal, though
evidence supporting specific insulin regimens is limited.
Methods
In an open-label, controlled, multicenter trial, we
randomly assigned 708 patients with a suboptimal glycated
hemoglobin level (7.0 to 10.0%) who were receiving maximally
tolerated doses of
metformin and sulfonylurea to receive
biphasic insulin aspart twice daily, prandial insulin aspart
three times daily, or basal insulin detemir once daily
(twice if required). Outcome measures at 1 year were the
mean glycated hemoglobin level, the proportion of patients
with a glycated hemoglobin level of 6.5% or less, the rate
of hypoglycemia, and weight gain.
Results At 1 year, mean glycated hemoglobin levels were
similar in the biphasic group (7.3%) and the prandial group
(7.2%) (P=0.08) but higher in the basal group (7.6%, P<0.001
for both comparisons). The respective proportions of
patients with a glycated hemoglobin level of 6.5% or less
were 17.0%, 23.9%, and 8.1%; respective mean numbers of
hypoglycemic events per patient per year were 5.7, 12.0, and
2.3; and respective mean weight gains were 4.7 kg, 5.7 kg,
and 1.9 kg. Rates of adverse events were similar among the
three groups.
Conclusions A single analogue-insulin formulation added to
metformin and sulfonylurea resulted in a glycated hemoglobin
level of 6.5% or less in a minority of patients at 1 year.
The addition of biphasic or prandial insulin aspart reduced
levels more than the addition of basal insulin detemir but
were associated with greater risks of hypoglycemia and
weight gain. (Current Controlled Trials number,
ISRCTN51125379 [controlled-trials.com] .)"
Full version at the link address.
Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraldiabetes.blogspot.com
Comparison of Insulin Regimens for Type 2 
Linear Mode
