Inside Insulin: 5 Sets of Facts, Figures, and Findings

October 10, 2014

Optimizing the use of insulin for treatment of hyperglycemia in patients with diabetes is an ongoing research endeavor. Here, several recent developments you should know about.

Most patients with type 2 diabetes evenutally require insulin to manage hyperglycemia and insulin intensification is the norm as beta cell function continues to decline. Prescribing insulin effectively is nuanced medicine. These 5 slides look at signs your patient is ready for insulin, and research on reduced risk of nocturnal hypoglycemia, GLP-1 agonists with basal insulin, obesity and response to biphasic insulin 50/50, and the pros and cons of premixed vs multidose insulin.

In patients with type 2 diabetes, progressive beta cell failure leads to near universal need for insulin replacement therapy. Oral antidiabetic agents may stall insulin initiation, but the signs that a patient is ready are clear. Details here.

In patients with type 2 diabetes who require basal and mealtime insulin, glycemic control achieved in the multinational EDITION-1 study was similar for investigational U300 glargine (Gla-300; Sanofi) and U100 glargine (Gla-100; Lantus [Sanofi]).Study details here.

When compared specifically to basal-bolus insulin, the combination of basal insulin and GLP-1 agonists led to a greater reduction in A1c, although the proportion of patients achieving A1c goals was similar. The combination of GLP-1 + basal insulin showed no significant differences in the risk of hypoglycemia when compared to other treatments; however, when specifically compared to basal-bolus insulin the GLP-1/insulin combination showed a significantly lower risk of hypoglycemia. Details here.

Hyperglycemia in patients taking insulin is difficult to manage. Treatment intensification often targets postprandial glucose excursions and premixed biphasic insulin formulations (30/70, 25/75) are used. Independent predictors of decrease in A1c using premixed insulin 50/50 were BMI =/> 30; =/> 9 months of intensified treatment, and baseline A1c. Details here.

Twice-daily analog premixed insulin (biphasic insulin aspart 30) was shown superior to once-daily basal insulin (glargine) in the INITIATE Trial. A1C was 0.5% lower with 2 doses of premixed compared to intensifying the once-daily dose of basal insulin. Difference is attributed to lower postprandial glucose values at breakfast and dinner achieved with the short-acting component of the premixed insulin.Details here.