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Comparison of insulin regimens in patients with non-insulin-dependent diabetes mellitus

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Yki-Järvinen, Hannele, Kauppila, Marjut, Kujansuu, Eila, Lahti, Jorma, Marjanen, Tapani, Niskanen, Leo, Rajala, Sulo, Ryysy, Leena +6 more·1992·New England Journal of Medicine
DOI 10.1056/nejm199211123272005
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Abstract

BACKGROUND: Insulin is widely used to improve metabolic control in patients with non-insulin-dependent diabetes mellitus (NIDDM), but there is no consensus about the optimal regimen of insulin treatment. METHODS: We treated 153 patients with NIDDM for three months with five regimens: (1) oral hypoglycemic drug therapy plus NPH insulin given at 7 a.m. (the morning-NPH group), (2) oral hypoglycemic drug therapy plus NPH insulin given at 9 p.m. (the evening-NPH group), (3) NPH and regular insulin (ratio, 70 units to 30 units) given before breakfast and dinner (the two-insulin-injection group), (4) NPH insulin at 9 p.m. and regular insulin before meals (the multiple-insulin-injection group), and (5) continued oral hypoglycemic drug therapy (the control group). RESULTS: The mean (+/- SE) value for glycosylated hemoglobin decreased similarly in all four insulin-treatment groups (1.7 +/- 0.3, 1.9 +/- 0.2, 1.8 +/- 0.3, and 1.6 +/- 0.3 percent, respectively). The decrease was significantly greater in these four groups than in the control group (0.5 +/- 0.2 percent; P < 0.001 vs. all insulin-treated groups). Weight gain was significantly less (1.2 +/- 0.5 kg) in the evening-NPH group than in the other insulin-treatment groups (2.2 +/- 0.5 kg in the morning-NPH group, 1.8 +/- 0.5 kg in the two-insulin-injection group, and 2.9 +/- 0.5 kg in the multiple-injection group; P < 0.05). In addition, the increment in the mean diurnal serum free insulin concentration was 50 to 65 percent smaller in the evening-NPH group than in the other insulin-treatment groups. Subjective well-being improved significantly more in the insulin-treatment groups than in the control group (P < 0.001). CONCLUSIONS: In patients with NIDDM who are receiving oral hypoglycemic drug therapy, the addition of NPH insulin in the evening improves glycemic control in a manner similar to combination therapy with NPH insulin in the morning, a two-insulin-injection regimen, or a multiple-insulin-injection regimen, but induces less weight gain and hyperinsulinemia. The data thus suggest that patients with NIDDM do not benefit from multiple insulin injections and that nocturnal insulin administration appears preferable to daytime administration.

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Crossref · 10.1056/nejm199211123272005

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  • Insulin glargine U300 and insulin degludec are associated with less hypoglycemia than insulin glargine U100.

    “Newer “ultra-long-acting” basal insulin analogues, insulin glargine U300, and insulin degludec have been shown to be associated with less hypoglycemia than insulin glargine U100.1072,1073”

    From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1072]

    The Randomization section (p. 2) describes regimens using NPH and regular insulin, not glargine U300, glargine U100, or degludec. The Symptomatic Hypoglycemia section (p. 4) compares episodes across those regimens. Searches for the named analogues and their hypoglycemia comparison found no passage addressing the claim. (LLM, conf=0.78)

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Research works printed but not linked: 6

  1. [5]5. Andrews WJ, Vasquez B, Nagulesparan M, et al. Insulin therapy in obese, non o s s s a --nd secretion that are maintained for two weeks after insulin withdrawal. Diabetes 1984;33:634-42.
  2. [11]11. Bonifacio E, Lernmark Å, Dawkins RL. Serum exchange and use of dilutmsei l is mosd i. J Immunol Methods 1988;106:83-8.
  3. [12]12. Dixon WJ, ed. BMDP statistical software. Berkeley: University of California Press, 1983.
  4. [17]17. Osei K, O'Dorisio TM, Falko JM. Concomitant insulin and sulfonylurea this o l us s ut s pid metabolism. Am J Med 1984;77:1002-9.
  5. [26]26. Pfeifer MA, Brunzell JD, Best JD, Judzewitsch RG, Halter JB, Porte D Jr. The response of plasma triglyceride, cholesterol, and lipoprotein lipase to uead t t s u per triglyceridemia. Diabetes 1983;32:525-31.
  6. [27]27. Lindström T, Arnqvist HJ, Olsson AG. Effect of different insulin regimntnn on nan a an tnn n ns with non-insulin-dependent diabetes mellitus. Atherosclerosis 1990;81:13744.

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Authors
Yki-Järvinen, H., Kauppila, M., Kujansuu, E., Lahti, J., Marjanen, T., Niskanen, L., Rajala, S., Ryysy, L., Salo, S., Seppälä, P., Tulokas, T., Viikari, J., Karjalainen, J., & Taskinen, M.-R.
Affiliations
  • University of Turku (FI)
  • Hatanpää Hospital (FI)
  • Kuopio University Hospital (FI)
  • Kymenlaakson keskussairaala (FI)
  • Lapland Central Hospital (FI)
  • University of Oulu (FI)
  • University of Helsinki (FI)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1992-11-12
Volume
327
Issue
20
Pages
1426-1433
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejm199211123272005
OpenAlex
W1964413807
Cited by
324
References
29
Citations by year
2024: 1 · 2023: 3 · 2022: 4 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 7 · 2017: 9 · 2016: 5 · 2015: 7 · 2014: 5 · 2013: 12 · 2012: 8
FWCI
6.09
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, insulin regimens, NPH insulin, regular insulin, oral antidiabetic drugs, glycemic control, HbA1c, weight gain, subjective well-being, insulin therapy comparison, combination therapy, multiple daily insulin injections
MeSH terms
Administration, Oral, Adult, Aged, Blood Glucose, Blood Pressure, Diabetes Mellitus, Type 2, Drug Administration Schedule, Drug Therapy, Combination, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Injections, Intravenous, Insulin, Lipoproteins, Male, Middle Aged, Monitoring, Physiologic, Patient Acceptance of Health Care, Weight Gain

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