Premixed Insulin Research Articles

Interactions of short-acting, intermediate-acting and pre-mixed human insulins with free radicals—Comparative EPR examination

Electron paramagnetic resonance (EPR) spectroscopy was used to examine insulins interactions with free radicals. Human recombinant DNA insulins of three groups were studied: short-acting insulin (Insuman Rapid); intermediate-acting insulins (Humulin N, Insuman Basal), and pre-mixed insulins (Humulin M3, Gensulin M50, Gensulin M40, Gensulin M30). The aim of an X-band (9.3GHz) study was comparative analysis of antioxidative properties of the three groups of human insulins. DPPH was used as a stable free radical model. Amplitudes of EPR lines of DPPH as the paramagnetic free radical reference, and DPPH interacting with the individual tested insulins were compared. For all the examined insulins kinetics of their interactions with free radicals up to 60min were obtained. The strongest interactions with free radicals were observed for the short-acting insulin – Insuman Rapid. The lowest interactions with free radicals were characteristic for intermediate-acting insulin – Insuman Basal. The pre-mixed insulins i.e. Humulin M3 and Gensulin M50 revealed the fastest interactions with free radicals.The short acting, intermediate acting and premixed insulins have been found to be effective agents in reducing free radical formation in vitro and should be further considered as potential useful tools in attenuation of oxidative stress in diabetic patients.

Abstract #236: Comparison of Insulin Glargine with Human Premix Insulin in Patients with Type 2 Diabetes Inadequately Controlled on Oral Hypoglycemic Drugs in a 24 Week Randomized Study

Abstract #236: Comparison of Insulin Glargine with Human Premix Insulin in Patients with Type 2 Diabetes Inadequately Controlled on Oral Hypoglycemic Drugs in a 24 Week Randomized Study

Erratum to: Injectable Coformulations in Diabetology.

The second paragraph beginning on page 2 reads: In this review, we define injectable pharmaceutical coformulations as preparations, and which also maintain their distinct pharmacological properties. These are distinct from the pre-mixed insulins that have been available over the last 50 years (Table 1). It should instead read: In this review, we define injectable pharmaceutical coformulations as preparations composed of combinations of two or more than two drugs, which maintain their distinct pharmacokinetic and pharmacodynamic properties. These are distinct from the pre-mixed insulins that have been available over the last 50 years (Table 1).

Is the current standard of care leading to cost-effective outcomes for patients with type 2 diabetes requiring insulin? A long-term health economic analysis for the UK

AimsThe aim of the analysis was to investigate whether insulin intensification, based on the use of intensive insulin regimens as recommended by the current standard of care in routine clinical practice, would be cost-effective for patients with type 2 diabetes in the UK. MethodsClinical data were derived from a retrospective analysis of 3185 patients with type 2 diabetes on basal insulin in The Health Improvement Network (THIN) general practice database. In total, 48% (614 patients) intensified insulin therapy, defined by adding bolus or premix insulin to a basal regimen, which was associated with a reduction in HbA1c and an increase in body mass index. Projections of clinical outcomes and costs (2011 GBP) over patients’ lifetimes were made using a recently validated type 2 diabetes model. ResultsImmediate insulin intensification was associated with improvements in life expectancy, quality-adjusted life expectancy and time to onset of complications versus no intensification or delaying intensification by 2, 4, 6, or 8 years. Direct costs were higher with the insulin intensification strategy (due to the acquisition costs of insulin). Incremental cost-effectiveness ratios for insulin intensification were GBP 32,560, GBP 35,187, GBP 40,006, GBP 48,187 and GBP 55,431 per QALY gained versus delaying intensification 2, 4, 6 and 8 years, and no intensification, respectively. ConclusionsAlthough associated with improved clinical outcomes, insulin intensification as practiced in the UK has a relatively high cost per QALY and may not lead to cost-effective outcomes for patients with type 2 diabetes as currently defined by UK cost-effectiveness thresholds.

Factores predictores del control glucémico promedio y de su variabilidad en pacientes diabéticos ingresados en el hospital

IntroductionThis study was intended to assess the effectiveness and predictors factors of inpatient blood glucose control in diabetic patients admitted to medical departments. Material and methodsA retrospective, analytical cohort study was conducted on patients discharged from internal medicine with a diagnosis related to diabetes. Variables collected included demographic characteristics, clinical data and laboratory parameters related to blood glucose control (HbA1c, basal plasma glucose, point-of-care capillary glucose). The cumulative probability of receiving scheduled insulin regimens was evaluated using Kaplan-Meier analysis. Multivariate regression models were used to select predictors of mean inpatient glucose (MHG) and glucose variability (standard deviation [GV]). ResultsThe study sample consisted of 228 patients (mean age 78.4 (SD 10.1) years, 51% women). Of these, 96 patients (42.1%) were treated with sliding-scale regular insulin only. Median time to start of scheduled insulin therapy was 4 (95% CI, 2-6) days. Blood glucose control measures were: MIG 181.4 (SD 41.7) mg/dL, GV 56.3 (SD 22.6).The best model to predict MIG (R2: .376; P<.0001) included HbA1c (b=4.96; P=.011), baseline plasma glucose (b=.056; P=.084), mean capillary blood glucose in the first 24hours (b=.154; P<.0001), home treatment (versus oral agents) with basal insulin only (b=13.1; P=.016) or more complex (pre-mixed insulin or basal-bolus) regimens (b=19.1; P=.004), corticoid therapy (b=14.9; P=.002), and fasting on admission (b=10.4; P=.098). ConclusionPredictors of inpatient blood glucose control which should be considered in the design of DM management protocols include home treatment, HbA1c, basal plasma glucose, mean blood glucose in the first 24hours, fasting, and corticoid therapy.

What happens when patients require intensification from basal insulin? A retrospective audit of clinical practice for the treatment of type 2 diabetes from four Australian centres

AimsLittle is known about clinical practices beyond the initiation of basal insulin in patients with type 2 diabetes mellitus (T2DM) in Australia. To determine the proportion of patients who progressed from basal insulin to each of three possible therapy groups: Group 1 addition of rapid-acting insulin, Group 2 switch to pre-mixed insulin, Group 3 addition of another therapy (incretin, glitazone, sulphonylurea, metformin, acarbose). MethodsRetrospective audit across four Australian hospital clinics. Patients had a diagnosis of T2DM, basal insulin had been initiated and a subsequent treatment intensification/change had occurred during the analysis period (September 2007–March 2012). ResultsPatients were classified into one of three intensification groups for analysis: Group 1, 56.1% (111/198); Group 2, 22.7% (45/198) and Group 3, 21.2% (42/198). Prior to basal insulin initiation, mean T2DM duration was 11 years. Between starting basal insulin and treatment intensification, 42/183 (22.9%) patients achieved the HbA1c target of <7.0% (53mmol/mol).Initiation of basal insulin provided temporary improvement in glycaemic control followed by subsequent deterioration. With further treatment intensification, only 40/180 (22.2%) patients achieved the HbA1c target of <7.0% (53mmol/mol). Patients in the insulin groups gained weight (Group 1, rapid acting insulin, 1.9±7.4kg; Group 2, premixed insulin 2.3±4.8kg); those in Group 3 lost weight (−0.9±13.54kg). Hypoglycaemic episodes were uncommon irrespective of group. ConclusionsThere is continued need for improved patient management; individualised strategies should focus on when to initiate insulin, how to adjust and optimise doses over time and, when required, the introduction of intensification regimens.

Starting insulin in type 2 diabetes: real-world outcomes after the first 12months of insulin therapy in a new zealand cohort.

AimsCurrently, there is no consensus on which form of insulin to use when initiating insulin in type 2 diabetes (T2D). Our aim was to compare glycated hemoglobin (HbA1C) reduction, weight change and severe hypoglycemia rates during the first year after initiation of intermediate-acting insulin isophane, insulin glargine and pre-mixed insulin in patients with T2D.MethodsElectronic clinical records of patients with T2D, starting insulin at a tertiary referral center in Auckland, New Zealand, from January 1 to December 31, 2012, were retrospectively evaluated. Primary outcomes were HbA1C reduction at 12 months and number of hospital admissions for hypoglycemia.ResultsOf 339 eligible patients, 273 (80.5%) started on intermediate insulin, 24 started on insulin glargine and 42 started on pre-mixed insulin. The mean HbA1C at insulin initiation was 89–95 mmol/mol, but had decreased at 12 months by 26.6 mmol/mol with insulin glargine, 23.4 mmol/mol with pre-mixed insulin and 16.6 mmol/mol with insulin isophane (p < 0.05 vs. baseline for all groups). Patients on insulin glargine were more likely to achieve the HbA1C target of <55 mmol/mol compared with patients on insulin isophane (16.7% vs. 4.8%; p = 0.04). Persistence rates were higher in patients initiated on pre-mixed insulin vs. insulin isophane (90.5% vs. 69.6%; p = 0.01). After controlling for confounding variables, glargine was more likely to achieve an HbA1C target of <55 (p = 0.05).ConclusionsAll insulin types caused a significant reduction in HbA1C, but very few met HbA1C targets. Insulin isophane was the most common type of insulin prescribed at initiation, with comparable outcomes to other types of insulin. More observational studies are needed to explore the possible impact of using other insulin types at initiation.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-015-0100-8) contains supplementary material, which is available to authorized users.

High-mix insulins.

Premix insulins are commonly used insulin preparations, which are available in varying ratios of different molecules. These drugs contain one short- or rapid-acting, and one intermediate- or long-acting insulin. High-mix insulins are mixtures of insulins that contain 50% or more than 50% of short-acting insulin. This review describes the clinical pharmacology of high-mix insulins, including data from randomized controlled trials. It suggests various ways, in which high-mix insulin can be used, including once daily, twice daily, thrice daily, hetero-mix, and reverse regimes. The authors provide a rational framework to help diabetes care professionals, identify indications for pragmatic high-mix use.

Etiologija, terapija i ishod dijabetesne ketoacidoze i hiperosmolarne kome

Diabetic ketoacidosis (DKA) and nonketotic hyperosmolar hyperglycemic state (NHOK) are acute complications of diabetes mellitus (DM). The aim was to investigate precipitating factors, therapy and the result of the treatment of DKA and NHOK. The study included all the people who were admitted to the Clinical Department of Endocrinology, Diabetes and metabolism disease KBC "Zvezdara" in the state of DKA and NHOK between 2007 and 2010. During this period we treated 56 people, aged 51.8 ± 18.8 years. DKA was diagnosed in 54 patients, whereas NHOK was diagnosed in two patients. Type 1 DM was present in 26 (46.42%) patients and type 2 in 30 (53.57%) patients. In DKA average values of glucose were 32±8,85mmol / l, HbA1c-11.6±2,52%, pH 6.89±0,17, HCO3-7.40±5,03. In patients with NHOK average glucose was 60.35±15,14mmol / l, HbA1c-11.2±1,7%,pH 7.43±0,1, HCO3-19, 8±5,23. There was a significant difference in the glucose level (t(54) =6.03,p&lt;0.01) as well as in bicarbonate level (t(54)=3.72,p=0.01) between DKA and NHOK. The most common precipitating factors were: infection in 26 (46.42%) cases, inadequate therapy in 24 (42.85%) cases, myocardial infarction and cerebral stroke in 2 (3.57%) cases. All the patients with NHOK and 16 with DKA had previously been on oral antihy-perglycemic drugs, while 29 patients with DKA had previously been on insulin therapy. Upon admission, the previous therapy was not in relation with the level of glucose and pH. Bicarbonate level was significantly higher in the group treated with oral therapy (t (43) = 2.16,p &lt;0.05). The therapy was considered because of rehydration, fractionally giving boluses HM insulin, potassium compensation and treatment precipitating factors. Rehydration was achieved with an average of 5.6±1,65 liters on the first day,4.08±0,87l on the second day, and 3±0,01 liters on the third day of infusion solutions. The total daily dosage of insulin bolus HM on the first day was 81.04±27,97i.j, 59.64±17,60i.j. on the second day and 58.06±19,70i.j. on the third day. Maximum daily supplementation of potassium in the form of 7.4% KCL solution was 61±18,70mmol / l. Upon the end of the treatment, the total of 26 (46.42%) was discharged on basal-bolus human insulin therapy, 18 (32.14%) on the treatment of basal-bolus analogues, 11 (19.64%) on therapy insulin premix and metformin, while two (3.57%) were discharged on oral antihyperglycemic medications. The treatment outcome was successful in 50 people (89.3%), while death occurred in 6 (10.7%) cases. The most common complication was hypokalemia, present in 29 (51.78%) patients. Other complications were acute renal failure (3 people), acute respiratory distress syndrome (2 people), pulmonary edema (2 people) and gastrointestinal bleeding (1 person). Despite education and available medications for diabetes, acute complications of diabetes can still occur and are sometimes accompanied by dangerous complications.

Effectiveness and safety of Humalog Mix 50/50 versus Humalog Mix 75/25 in Chinese patients with type 2 diabetes

Humalog Mix 75/25 insulin analog is widely used in the People’s Republic of China to treat type 2 diabetes mellitus, but the Humalog Mix 50/50 analog is not as yet widely used or assessed. The purpose of this 12-week, parallel-group, randomized, treat-to-target study was to evaluate the difference in clinical efficacy, safety, and outcome of treatment between Humalog Mix 50/50 and Humalog Mix 75/25 analogs in Chinese patients with type 2 diabetes mellitus. In total, 146 insulin-naïve patients with type 2 diabetes mellitus and aged 18–75 years were randomized and treated twice a day with either Humalog Mix 50/50 (group A) or Humalog Mix 75/25 (group B). We monitored levels of fasting blood glucose, 2-hour postprandial blood glucose, and glycosylated hemoglobin (HbA1c) in patients in both groups prior to and 3 months post treatment, the average time to achieve target blood glucose level, and frequency of hypoglycemic episodes during treatment. We found that group A showed better glycemic control as per fasting blood glucose and 2-hour postprandial blood glucose than group B. Moreover, HbA1c levels in group A (5.5%±1.4%) were lower by 1.0%±0.1% (P<0.05) compared with those in group B (6.5%±1.5%). The time to achieve glucose control was shorter (P<0.05) in group A (12.6±3.6 days) than in group B (22.3±4.7 days). Regarding safety, no significant adverse events or severe hypoglycemia on treatment was observed in either group. Additionally, the 1:1 ratio of Humalog Mix 50/50 showed a trend towards fewer episodes of nocturnal hypoglycemia. Thus, compared with Humalog Mix 75/25, the high-proportion premix insulin analog, Humalog Mix 50/50 showed better glycemic control, achieved target blood glucose levels more rapidly and without an increase in hypoglycemic episodes in Chinese type 2 diabetic individuals and is recommended for use in clinical practice.

PO070 HOW TO PRESERVE INSULIN? & WHAT WE LEARNED FROM THE ENERGY-SAVING LIFESTYLE AFTER THE DISASTER

Background: We experienced the earthquake and Tsunami in northeast Japan 3 years ago. We never had enough natural resources, but are an enormous consuming society. Because of the influence of the atomic energy plant shutdown and reflection, we began to save more electricity and turn off air conditioners even in hot humid summer in Tokyo. We are working at a pharmacy next to a diabetes clinic. We felt the necessity to discuss with our patients the preparation of their drugs in case of disasters. Method: We administered a questionnaire in August 2011 asking about their preparation and preservation of their drugs and medication lists of their own. 421 answered (98.6%). Male 232, female 189, average age, 58.9 (SD: 15.0), duration of insulin injection, 7.1 (7.1) years, HbA1c, 7.3 (1.2)%. Result: (1)Where they kept new unopenedmedicine; themost (81.1%) frequent answer was “in the refrigerator”, however, 16.1% was “in the room”. “In the room” patients tended to have the illness longer (p< 0.05 by Wilcoxon test), and older (p = 0.07). (2) Where they kept opened medicine; 77.8% answered “in the room”, and 10.8% answered “in the refrigerator”. Between the two groups, age and length of illness was not significantly different, but GLP-1 and only basal insulin injection patients tended to store in the refrigerator (p< 0.01 by chi-squire test). (3) How they carried medicine when went out; 72.1%, “in the bag”, and 20.3% answered that they “don’t carry injection drugs”. The “don’t carry medicine” group mostly injected GLP-1 or basal insulin only, still 12 patients injected pre-mixed insulin 3 times a day. (4) How often they changed needles; 87.1% answered “every time”, on the other hand, 12.9% answered “changed occasionally” and “using the same needles constantly”. (5) The troubles during injection; 8.3% answered “big bubble in the liquid”. 6 out of 33 were injecting GLP-1. (6) Preparation of the bags whenmedicine was carried outside in an emergency was 55.2%. They tended to be female (p< 0.01), there were no relationships to age, nor duration of injection. (7) 8.2% put injections into an emergency bag. They rotated the drugs every10 days to 5 months. (8) Carrying a medication list in a pocket size notebook we handed out; 26.7% answered that they always did. They were older (p< 0.01). Conclusion: GLP-1 patients kept already opened pens in the refrigerator and experienced gas bubbles more. Comparing with insulin, less frequent injection and differences of devices can be the cause. Who were older and have been injecting longer tended to be unsure about preservation of injection medications. Because of today’s hot weather in Tokyo, even already opened injection devices probably should be kept in a refrigerator (We used to tell our patients not to put an opened device in a refrigerator to protect the precision of the device). We may have to advice patients to check the temperature of their rooms and to carry insulation tools such as small bags. We also recognize the skipping of injections when patients go out. The patients who frequently inject (supposed to be more insulin-dependent) did not always prepare for an emergency. We should advice the necessity of the “emergency bag” and also about storing insulin in many places to access easily. Carrying “medication list” rate was still lower than we expected. We have to convince them of the usability of it in reality of the last disaster. We also have to consider more convenient and easy ways of sharing medication information.

PO083 PRACTICAL GUIDANCE ON THE USE OF PREMIX INSULIN ANALOGUES FOR INITIATING, INTENSIFYING OR SWITCHING INSULIN REGIMENS IN TYPE 2 DIABETES

Introduction Premix insulin analogs are a well-established treatment for type 2 diabetes (T2D). However, there is a lack of simple, clear guidance on some aspects of their use. These include choosing a regimen for insulin initiation, recognizing when patients need intensification of therapy, and switching from basal–bolus to a premix insulin analog when appropriate.

DB3 - Treatment Profile And Insulin Dose as a Factor Impacting Glycaemia Control Among Premix Insulin Users with T2DM in China

DB3 - Treatment Profile And Insulin Dose as a Factor Impacting Glycaemia Control Among Premix Insulin Users with T2DM in China

Least Glucose Variability Is Observed with the Combination of a GLP-1 Receptor Agonist and Basal Insulin Among Four Commonly Used Insulin Regimen in Type 2 Diabetes (VARIATION Study)

Few reports comparing glucose variability between different insulin regimens in type 2 diabetes (T2DM) exist in published literature. This cohort study compares glucose variability in patients with well-controlled T2DM among 4 commonly used insulin regimen (A= basal insulin + oral drugs, B= basal insulin + GLP-1R agonist, C=pre-mix insulin and D= basal-bolus insulin).

Evolution of Insulin: From Human to Analog

The development of insulin analogs has made improved treatment of type 2 diabetes possible. In this article, structural alterations, pharmacokinetics and pharmacodynamics, clinical end points, and safety issues are reviewed for the currently available basal insulins, rapid-acting insulins, and premixes. The flatter activity profiles of insulin glargine and insulin detemir translate into good clinical efficacy with a lower risk of hypoglycemia relative to neutral protamine Hagedorn insulin. Weight gain is consistently lower with insulin detemir than with neutral protamine Hagedorn insulin. Insulin degludec, licensed in Europe and Japan but not yet in the United States, has a mean half-life of 25.4 hours, a duration of action of >42 hours, and low variability. In trials in type 2 diabetes, rates of nocturnal hypoglycemia were lower with insulin degludec than with insulin glargine, and more flexible; once-daily dose timing was shown to be possible. Insulin lispro, insulin aspart, and insulin glulisine are rapidly absorbed after injection and thus provide better coverage of the post-prandial glucose surge compared with human insulin. Trials and meta-analyses show that reductions in glycated hemoglobin are similar and control of postprandial glucose is better with the rapid-acting analogs versus human insulin. Convenience is greater for patients because the analogs can be injected just before a meal. In premix or biphasic insulins, a proportion of the rapid-acting analog is protaminated, providing both rapid-acting and intermediate-acting components in one formulation, thus reducing the number of injections required. Alterations to human insulin have resulted in improvements in safety, efficacy, tolerability, and convenience for patients.

PDB74 - Cost-effectiveness of switching to biphasic insulin aspart from human premix insulin in people with type 2 diabetes in China

PDB74 - Cost-effectiveness of switching to biphasic insulin aspart from human premix insulin in people with type 2 diabetes in China

Efficacy of switching from premix analog insulin twice daily injection to insulin glargine once daily injection with sitagliptin

Forty-four patients with type 2 diabetes receiving twice daily injections of premix analog insulin were randomly allocated to Group A in which patients were switched to long-acting insulin glargine at 80 % of the insulin dose in the previous treatment regimen (23 patients), or Group B (21 patients) given 50 % of the previous dose, concurrently with the oral dipeptidyl-4 inhibitor sitagliptin. After patients had received their designated treatments without dose changes for 12 weeks, the insulin dose was adjusted and its usefulness was examined for 24 weeks. In the overall evaluation, significant improvement was observed in glycosylated hemoglobin (HbA1c), 1,5-anhydro-d-glucitol, fasting blood glucose, and low density lipoprotein cholesterol levels. The insulin glargine dose at 24 weeks was 65.0 % of the mixed formulation used in the previous treatment regimen. Although no significant change was observed in HbA1c levels in Group B during the study period, the level of 1,5-anhydro-d-glucitol increased significantly, while continuous glucose monitoring also showed improvement in postprandial hyperglycemia and nocturnal hypoglycemia. The change from baseline in HbA1c levels during the 24 weeks showed a significant negative correlation with C-peptide levels at the start of treatment, suggesting the usefulness of this regimen, particularly in patients maintaining endogenous insulin secretion capacity.

Effects of switching from prandial premixed insulin therapy to basal plus two times bolus insulin therapy on glycemic control and quality of life in patients with type 2 diabetes mellitus

BackgroundThe effects of switching from prandial premixed insulin therapy (PPT) injected three times a day to basal plus two times bolus insulin therapy (B2B) on glycemic control and quality of life were investigated in patients with type 2 diabetes mellitus.MethodsThe clinical course was prospectively observed during the first 16 weeks after switching to B2B (insulin glargine plus insulin glulisine before breakfast and dinner) in 27 subjects previously treated with PPT using 50/50 premixed insulin. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was administered at the start and end of the study.ResultsThe glycated hemoglobin (HbA1c) level (8.3%±1.8% to 8.2%±1.1%) and the DTSQ score did not change between the start and end of the study. An improvement in HbA1c level was found in nine (33%) subjects. The change in HbA1c showed a significant negative correlation with baseline HbA1c, and was significantly better in patients with a baseline HbA1c >8.0% than in those with an HbA1c ≤8.0% (−0.9±2.0 versus 0.3±0.6, respectively, P=0.02). The change in DTSQ score representing treatment satisfaction was significantly greater in patients whose HbA1c level was improved than in those in whom it was not (2.7±3.6 versus −0.8±3.5, P=0.04).ConclusionB2B was noninferior to PPT with regard to HbA1c levels in patients with type 2 diabetes mellitus. B2B should be considered particularly for subjects whose glycemic control is poor despite PPT.

Clinical factors associated with absolute and relative measures of glycemic variability determined by continuous glucose monitoring: An analysis of 480 subjects

AimFactors associated with absolute and relative measures of glycemic variability have not been determined by continuous glucose monitoring (CGM) and concurrent measurement of fasting C-peptide levels. MethodsWe analyzed CGM data for subjects with type 1 diabetes (T1D; n=81) and type 2 diabetes (T2D; insulin-treated, n=168; not insulin-treated, n=231) who underwent CGM between October 2009 and September 2011 at Samsung Medical Center. Correlations between clinical factors and both standard deviation (SD) and coefficient of variance (CV) in CGM were analyzed by multiple regression. ResultsRegardless of the type of diabetes and insulin therapy, higher CV, but not SD, was significantly associated with a minimum glucose level of <70mg/dL (3.9mmol/l) in CGM (p<0.001). In T1D, fasting C-peptide levels inversely correlated with SD while BMI inversely correlated with CV, and duration of diabetes, and HDL levels positively correlated with CV. Use of pre-mixed insulin increased both SD and CV. In insulin-treated T2D, fasting C-peptide levels inversely correlated with both SD and CV while HbA1c correlated with SD, and duration of diabetes positively correlated with CV. In T2D without insulin therapy, age, BMI, HbA1c, HDL, triglyceride levels and use of sulfonylurea positively correlated with SD while HDL levels and use of sulfonylurea positively correlated with CV, and LDL levels inversely correlated with CV. ConclusionsRelative glycemic variability (CV) was determined by factors different from those that affect absolute glycemic variability (SD). Some of these factors were indicators of higher insulin sensitivity and residual insulin secretion.

Frequency of blood glucose testing among insulin-treated diabetes mellitus patients in the United Kingdom

Background:Through a retrospective database analysis, this study seeks to provide an understanding of the utilization of SMBG by insulin therapy and diabetes type and to estimate healthcare costs of blood glucose monitoring in the UK diabetes population.Methods:Data were obtained from the IMS LifeLink Electronic Medical Record-Europe (EMR-EU) Database, a longitudinal database containing anonymized patient records from physician–practice data systems of office-based physicians in the UK. Depending on the insulin types used for type 1 and type 2 diabetes, patients were sub-categorized into one of four insulin regimen groups (basal, bolus, pre-mixed, or basal-bolus). Frequency of blood glucose testing was assessed descriptively throughout the 12-month post-index period, and generalized linear models were used to evaluate the effect of baseline characteristics, including insulin type, on the likelihood of blood glucose test utilization. Healthcare resource utilization and costs for all-cause services were assessed by insulin type.Results:This study identified 8322 type 1 and type 2 diabetes patients with two insulin pharmacy records between January 1, 2009 and December 31, 2010. After applying study inclusion and exclusion criteria, a total of 2676 (32.2%) insulin-treated diabetes mellitus patients in the UK were identified, with the number of pharmacy blood glucose test strips averaging 771.1 (median 600). The glucose testing frequency was lowest among basal-only insulin patients and pre-mixed insulin patients (mean = 576.2 [median = 450] and mean = 599.5 [median = 500], respectively; non-significantly different) compared to other insulin types.Conclusion:Although the data did not capture the glucose frequency comprehensively, it varied significantly by insulin types, and was higher than what is recommended in the guidelines for patients with type 2 diabetes.