Effects of different regimens of insulin on body mass index commonly used in type 2 diabetes mellitus

Abstract

Background: Weight gain is an ongoing challenge when initiating insulin therapy in patients with Type 2 diabetes mellitus. The aim of this study is to observe and compare the effect of commonly used regimens of insulin on body mass index (BMI) among Type 2 diabetes patients. Methods: An observational study was conducted in two diabetic centers in Dhaka starting from July 2018 to June 2019. During the 12 weeks of the data collection period, a total of 100 patients were included according to selection criteria and then divided into two equal groups. Patients who were prescribed with premixed (conventional or analog) 30/70 insulin twice daily with or without oral Antidiabetic drugs were included in Group I (n = 50) and the patients who were prescribed with insulin glargine once daily with a bolus insulin (conventional or analog) three times before large meals with or without oral Antidiabetic drugs were included in Group II (n = 50). BMI was calculated from the height and weight of the patients initially as baseline data and again after 12 weeks of treatment in both groups. Fiber Bragg grating, 2 h ABF, and hemoglobin A1C (HbA1c) change were also observed among the patients of both insulin groups from diagnostic reports during the study period. Results: After 12 weeks of treatment, mean body weight (±standard deviation [SD]) was increased significantly from 59.82 ± 12.33 kg to 60.40 ± 13.38 kg in Group I (P = 0.01) and from 59.00 ± 12.36 kg to 60.33 ± 12.97 kg in Group II (P = 0.02). Mean BMI (±SD) increased significantly from 23.71 ± 4.69 kg/m2 to 24.10 ± 4.17 kg/m2 in Group I (P = 0.01) and from 24.00 ± 4.30 kg/m2 to 24.43 ± 4.59 kg/m2 in Group II (P = 0.02) during the study period. The mean BMI compared between two study groups (24.10 ± 4.17 vs. 24.43 ± 4.59) kg/m2 m+ after 12 weeks of treatment was not statistically significant (P = 0.816). About 64.0% of patients in Group I and 68.0% in Group II have shown weight gain and BMI change after 12 weeks. Mean HbA1c (±standard deviation [SD]) reduced significantly from 10.40% ± 2.17% to 7.76% ± 1.41% in Group I and from 10.41% ± 1.80% to 7.63% ± 1.37% in Group II. About 48.0% of patients in Group I and 56.0% of patients in Group II achieved glycemic target <7%. About 28.0% of patients in Group I and 20.0% of patients in Group II had hypoglycemia. Conclusion: From the current study, it can be concluded that both insulin regimens significantly cause weight gain, BMI change and also significantly effective in glycemic control. However, in comparison between the two groups, there was no significant difference. Hence, both premixed and glargine-based basal-bolus regimen can be prescribed as per patient need. This result may provide some preliminary information for further investigation