The DOI matches its Crossref record; 31 of the 31 references it cites were found in a registry or an index.
Comparison of Insulin Regimens in Patients with Non-Insulin-Dependent Diabetes Mellitus
Open accessAbstract
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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“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]
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Metadata
- 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)
- 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
- 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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