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Paper of the Day - Basal-bolus insulin preferred after glargine

Patients with type 2 diabetes are more likely to hit a HbA1c target of 7% if they move on to a basal/bolus therapy – rather than prandial premixed therapy – after initial treatment with glargine.

US researchers randomly assigned 374 patients previously treated with glargine plus oral agents to receive either bedtime glargine plus mealtime lispro or 50/50 lispro mix three times a day with meals.

After 24 weeks average HbA1c was lower with the basal/bolus regime – 6.78% versus 6.95% with the prandial premixed. Significantly more patients achieved a target of less than 7% with the basal/bolus therapy – 69% versus 54%. But the difference was not significant for 6% or 7.5% targets. Rates of hypoglycamia were similar for both groups.

The authors say that although noninferiority of prandial premixed therapy to basal/bolus therapy was not demonstrated, findings for HbA1c reduction, percentage of patients achieving HbA1c targets, hypoglycemia, and number of required injections should be considered in the individual decision-making process of advancing insulin replacement in type 2 diabetes

Diabetes Care 2008; 31: 20-25.

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