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Initiating Insulin Therapy in Type 2 Diabetes

Raskin, Philip, Allen, Elsie, Hollander, Priscilla, Lewin, Andrew, Gabbay, Robert A., Hu, Peter, Bode, Bruce, Garber, Alan +1 more·2005·Diabetes Care
DOI 10.2337/diacare.28.2.260
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Abstract

OBJECTIVE—Safety and efficacy of biphasic insulin aspart 70/30 (BIAsp 70/30, prebreakfast and presupper) were compared with once-daily insulin glargine in type 2 diabetic subjects inadequately controlled on oral antidiabetic drugs (OADs). RESEARCH DESIGN AND METHODS—This 28-week parallel-group study randomized 233 insulin-naive patients with HbA1c values ≥8.0% on >1,000 mg/day metformin alone or in combination with other OADs. Metformin was adjusted up to 2,550 mg/day before insulin therapy was initiated with 5–6 units BIAsp 70/30 twice daily or 10–12 units glargine at bedtime and titrated to target blood glucose (80–110 mg/dl) by algorithm-directed titration. RESULTS—A total of 209 subjects completed the study. At study end, the mean HbA1c value was lower in the BIAsp 70/30 group than in the glargine group (6.91 ± 1.17 vs. 7.41 ± 1.24%, P < 0.01). The HbA1c reduction was greater in the BIAsp 70/30 group than in the glargine group (−2.79 ± 0.11 vs. −2.36 ± 0.11%, respectively; P < 0.01), especially for subjects with baseline HbA1c >8.5% (−3.13 ± 1.63 vs. −2.60 ± 1.50%, respectively; P < 0.05). More BIAsp 70/30–treated subjects reached target HbA1c values than glargine-treated subjects (HbA1c ≤6.5%: 42 vs. 28%, P < 0.05; HbA1c <7.0%: 66 vs. 40%, P < 0.001). Minor hypoglycemia (episodes/year) was greater in the BIAsp 70/30 group than in the glargine group (3.4 ± 6.6 and 0.7 ± 2.0, respectively; P < 0.05). Weight gain and daily insulin dose at study end were greater for BIAsp 70/30–treated subjects than for glargine-treated subjects (weight gain: 5.4 ± 4.8 vs. 3.5 ± 4.5 kg, P < 0.01; insulin dose: 78.5 ± 39.5 and 51.3 ± 26.7 units/day, respectively). CONCLUSIONS—In subjects with type 2 diabetes poorly controlled on OADs, initiating insulin therapy with twice-daily BIAsp 70/30 was more effective in achieving HbA1c targets than once-daily glargine, especially in subjects with HbA1c >8.5%.

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Crossref · 10.2337/diacare.28.2.260

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  • The very rapid-acting and long-acting insulin analogues have not been shown to lower A1C levels more effectively than the older, rapid-acting or intermediate-acting formulations.

    “The very rapid-acting and long-acting insulin analogues have not been shown to lower A1C levels more effectively than the older, rapid-acting or intermediate-acting formulations (71–73).”

    From Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy (2009) · cites this paper as [72]

  • Glargine was also associated with a lower frequency of hypoglycemia than premixed insulins.

    “Glargine was also associated with a lower frequency of hypoglycemia than premixed insulins (136,137).”

    From Hypoglycemia in Type 2 Diabetes (2005) · cites this paper as [137]

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Authors
Raskin, P., Allen, E., Hollander, P., Lewin, A., Gabbay, R. A., Hu, P., Bode, B., Garber, A., & for the INITIATE Study Group
Affiliations
  • The University of Texas Southwestern Medical Center (US)
  • Princeton University (US)
  • Baylor University Medical Center (US)
  • National Research Institute (US)
  • Pennsylvania State University (US)
  • Atlanta Diabetes Association, Atlanta, Georgia
  • Baylor College of Medicine (US)
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2005-02-01
Volume
28
Issue
2
Pages
260-265
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.28.2.260
OpenAlex
W2114369760
Cited by
560
References
20
Citations by year
2026: 2 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 6 · 2021: 3 · 2020: 11 · 2019: 8 · 2018: 9 · 2017: 10 · 2016: 13 · 2015: 10 · 2014: 23 · 2013: 38 · 2012: 24
FWCI
50.15
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
Novo Nordisk
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes, insulin initiation, insulin glargine, multiple daily insulin injections, metformin, inadequate glycemic control, HbA1c reduction, hypoglycemia, insulin dose adjustment, oral antidiabetic drugs, insulin-naive patients, glycemic control
MeSH terms
Insulin Glargine, Adult, Blood Glucose, Body Weight, Diabetes Mellitus, Type 2, Drug Therapy, Combination, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Insulin, Male, Metformin, Middle Aged, Treatment Outcome, Insulin, Long-Acting, Insulin Aspart

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