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Int J Clin Pract. 2012 Oct;66(10):959-968. doi: 10.1111/j.1742-1241.2012.03000.x.

Glycaemic control in patients with type 2 diabetes switching from premixed
insulin to long-acting basal insulin analogue plus oral antidiabetic drugs: an
observational study.

Gómez-Peralta F, Carramiñana-Barrera F, Félix-Redondo FJ, Fraile-Gómez J; on
behalf of the Extreme Rescue Study Group.

Unit of Endocrinology and Nutrition, Hospital General de Segovia, Segovia, Spain
Department of General Medicine, Centro de Salud San Roque, Badajoz, Spain
Department of General Medicine, Centro de Salud Villanueva de la Serena 1,
Villanueva de la Serena, Spain Department of Endocrinology and Nutrition, Clínica
San Francisco, Cáceres, Spain.

Aim:  To evaluate whether administration of long-acting basal insulin analogue plus oral antidiabetic drugs (OADs) improves glycaemic control in type 2 diabetic patients with glycosylated haemoglobin (HbA1c) > 7% (53 mmol/mol) under premixed  insulin therapy.

Methods:  This is a multicentre, observational, retrospective study performed in type 2 diabetic patients switching from premixed insulin to long-acting basal insulin analogue plus OADs. Data on patients' medical history and assessments were retrieved from patients' medical charts prior to switching the treatment and 6 months thereafter. Results:  A total of 131 evaluable patients were enrolled (mean age, 68.2 ± 9.4 years; female, 65.6%; mean diabetes duration, 12.7 ± 6.9 years; mean time on insulin therapy, 53.2 ± 41.9 months). Patients were receiving premixed insulin (once-daily, 4.7%; twice-daily, 85.0%; thrice-daily, 10.2%), 82.4% of whom in combination with OADs (metformin, 79.4%).  After the treatment was switched, only 14.5% required intensification of treatment with additional preprandial insulin. HbA1c decreased -1.4% [mean ± SD, 8.4 ± 1.0% (68.7 ± 11.4  mmol/mol) vs. 7.0 ± 1.0% (53.6 ± 10.9 mmol/mol), p < 0.001] and the proportion of patients achieving HbA1c < 7% (53 mmol/mol) increased to 52.7% (p < 0.001). The percentage of patients with hypoglycaemia decreased (19.2% vs. 10.8%, p < 0.05; symptomatic, 17.6% vs. 4.6%, p < 0.01) and  body weight diminished by -1.9 kg (mean ± SD, 78.5 ± 14.7 kg vs. 76.6 ± 13.9 kg,   p < 0.05). Basal insulin plus OADs was considered more convenient and flexibly adapted to patients' life in 98.4% and 99.2% of patients, respectively. Additionally, 96.9% of patients reported being more satisfied and 96.9% would recommend it.

Conclusions:  Switching the treatment from premixed insulin to long-acting basal insulin analogue plus OADs is a feasible and convenient approach to improve glycaemic control of type 2 diabetic patients poorly controlled with premixed insulin under routine clinical practice conditions.

© 2012 Blackwell Publishing Ltd.

Enlace:

http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2012.03000.x/abstract;jsessionid=7B8C78C23D8F369BF368A4048D6739DD.d03t04