Abstract
BackgroundInitiation and titration of human regular U-500 insulin (U-500R) with a dosing algorithm of either thrice daily (TID) or twice daily (BID) improved glycemic control with fewer injections in patients with type 2 diabetes treated with high-dose, high-volume U-100 insulin. The objective of this analysis was to compare patient-reported outcomes between U-500R TID and BID treatment groups in this titration-to-target randomized, clinical trial.MethodsIn this 24-week, open-label, parallel trial, 325 patients were randomized to TID (n = 162) or BID (n = 163) U-500R after a 4-week lead-in period (screening). The Treatment Related Impact Measure-Diabetes (TRIM-D) and EQ-5D-5L questionnaires were administered at screening, baseline/randomization, and endpoint (24 weeks). The Visual Analog Scale-Injection Site Pain (VAS-ISP) was assessed at baseline/randomization, 12 weeks, and endpoint.ResultsThe TRIM-D showed statistically significant improvements in overall scores from baseline to endpoint for both BID and TID groups, most domains in the TID group, and all domains in the BID group. The BID group achieved better scores than the TID patients in overall and in treatment burden, daily life, and compliance domains (p < .05). EQ-5D-5L index scores showed no statistically significant differences for TID and BID groups (and no differences between TID and BID groups) from baseline to endpoint. VAS-ISP scores improved for both treatment groups (−5.60 TID; −6.47 BID; p < .05 for both) from baseline to endpoint.ConclusionsU500 can be successfully titrated for improved glycemic control using BID and TID regimens with diabetes-specific Patient-Reported Outcomes showing improvements in both arms; however, BID had better scores than TID in overall, treatment burden, daily life, and compliance domains.Trial registrationThese secondary analyses are based on the study first received January 22, 2013 and reported in Clinical Trial Registry No.: NCT01774968.
Highlights
Initiation and titration of human regular U-500 insulin (U-500R) with a dosing algorithm of either thrice daily (TID) or twice daily (BID) improved glycemic control with fewer injections in patients with type 2 diabetes treated with high-dose, high-volume U-100 insulin
Concentrated human regular U-500 insulin (U-500R; Humulin® R U-500, Eli Lilly and Company) is a treatment option that may alleviate some of these barriers
For a patient transitioning from a high-dose, high-volume regimen of U-100 insulin (100 units/mL) to one using U-500R, there is a reduction in the volume and the number of daily injections [3], in addition to the potential for decreased costs and improved adherence [4, 7]
Summary
Initiation and titration of human regular U-500 insulin (U-500R) with a dosing algorithm of either thrice daily (TID) or twice daily (BID) improved glycemic control with fewer injections in patients with type 2 diabetes treated with high-dose, high-volume U-100 insulin. 325 severely insulin-resistant patients with type 2 diabetes on high-dose U-100 insulin (>200 units of insulin/day) with or without oral antihyperglycemic agents were randomized to receive U-500R thrice daily (TID) or twice daily (BID), which was initiated and titrated over a 24-week period in place of U-100 insulins [3] The objective of this analysis within the primary study was to compare patient-reported outcomes in the form of a diabetes treatment-specific questionnaire (Treatment Related Impact Measure-Diabetes [TRIM-D]), a quality of life questionnaire (EQ-5D-5L), and a pain scale, the Visual Analog Scale-Injection Site Pain (VASISP), before and after initiation of U-500R in TID and BID treatment groups. The hypothesis was that all instruments would improve with treatment on concentrated U-500R given the expected reduction in number of daily injections and insulin volume and anticipated glycated hemoglobin (HbA1c) improvement
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