Cited by 324Diabetes Management and ResearchDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

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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, Salo, Seppo, Seppälä, Pentti, Tulokas, Timo, Viikari, Jorma, Karjalainen, Jukka, Taskinen, Marja-Riitta·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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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: Kujansuu, Eila
Niskanen, Leo
Viikari, Jorma
Taskinen, Marja-Riitta
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: bronze
doi.org
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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Comparison of Insulin Regimens in Patients with Non-Insulin-Dependent Diabetes Mellitus

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