The Impact of Adding Prandial Insulin to a Basal Based Regimen with Insulin Glargine in Type 2 Diabetic Patients

Mohammad Ebrahim Khamseh; Zahra Abbasi Ranjbar; Zahra Banazadeh; Mani Mirfeizi; Manouchehr Mohammadbeiki; Zohreh Mozafari; Kamnoosh Razazian; Mojtaba Malek

doi:10.47176/mjiri.35.177

The Impact of Adding Prandial Insulin to a Basal Based Regimen with Insulin Glargine in Type 2 Diabetic Patients

Med J Islam Repub Iran. 2021 Dec 27:35:177. doi: 10.47176/mjiri.35.177. eCollection 2021.

Authors

Mohammad Ebrahim Khamseh¹, Zahra Abbasi Ranjbar², Zahra Banazadeh³, Mani Mirfeizi⁴, Manouchehr Mohammadbeiki⁵, Zohreh Mozafari⁶, Kamnoosh Razazian⁷, Mojtaba Malek⁸

Affiliations

¹ Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
² Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran.
³ Lolagar Hospital, Iran University of Medical Sciences, Tehran, Iran.
⁴ Department of Midwifery, College of Nursing & Midwifery, Karaj Branch, Islamic Azad University, Karaj, Iran.
⁵ Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁶ Sanofi Iran, Tehran, Iran.
⁷ Sohrabi Clinic, Tehran, Iran.
⁸ Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Background: Type 2 diabetes (T2D) is a progressive disease that should be managed with insulin in case of oral glucose lowering drugs (OGLDs) failure. If basal insulin is not sufficient, rapid acting insulin will be added before the largest meal. We assessed the impact of adding one prandial insulin to a basal based regimen and insulin glargine in patients with type 2 diabetes to measure the percentage of subjects achieving the HbA1c target by the end of 24 weeks of treatment in routine clinical practice. Methods: This study was a 24-week observational study of patients with T2D not adequately controlled with OGLDs and basal insulin, for whom the physician had decided to initiate prandial insulin. The study endpoint was assessed at visit 1 (baseline), visit 2 at week 12 (±1 week) and visit 3 at week 24 (±1 week). The percentage of patients who achieved HbA1c targets was assessed at week 24. Statistical analyses were performed using IBM SPSS for Windows v 19 (IBM, Armonk, New York, USA). Logistic regression analysis was used to detect predicting factors of achieving the HbA1c target by week 24. P<0.05 was considered as significant level. Results : Four hundred and eighteen patients with a mean±SD age of 56.24±9.85 years and a mean±SD duration of diabetes of 12.50±7.16 years were included. The median total daily dose of basal insulin was 24 units, while prandial insulin was started with 6 (4, 10) U/day, titrating up to 10 (8, 18) U/day at week 24. The daily dose of prandial insulin was the only factor that could significantly predict achieving targeted HbA1c by week 24 [OR: 1.04; 95% CI: 1.007,1.079; p-value: 0.019]. At week 24, 96 (22.9%) subjects achieved the HbA1c target with one prandial insulin. Conclusion : The results of our study suggest that "basal plus therapy" can lead to good glycemic control with a low risk of hypoglycemia and weight gain in patients with type 2 diabetes.

Keywords: Diabetes Mellitus type 2; Glycated Hemoglobin A; Insulin, Short-Acting; Safety; Treatment Outcome.