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

Abstract

Background

The 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.

Methods

The 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.

Results

The glycated hemoglobin (HbA_1c) 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 HbA_1c level was found in nine (33%) subjects. The change in HbA_1c showed a significant negative correlation with baseline HbA_1c, and was significantly better in patients with a baseline HbA_1c >8.0% than in those with an HbA_1c ≤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 HbA_1c level was improved than in those in whom it was not (2.7±3.6 versus −0.8±3.5, P=0.04).

Conclusion

B2B was noninferior to PPT with regard to HbA_1c levels in patients with type 2 diabetes mellitus. B2B should be considered particularly for subjects whose glycemic control is poor despite PPT.

Keywords:

• type 2 diabetes mellitus
• insulin therapy
• basal plus two times bolus insulin therapy
• prandial premixed insulin therapy
• Diabetes Treatment Satisfaction Questionnaire

Acknowledgments

The authors thank Tomoko Koyanagi in the secretarial section of Edogawa Hospital for her valuable help with data collection.

Disclosure

HI has received consulting fees from Sanofi KK, Eli Lilly Japan KK, Novo Nordisk Pharma Ltd, MSD KK, Novartis Pharma KK, Takeda Pharmaceutical Company, Astellas Pharma, Daiichi Sankyo Company, Boehringer Ingelheim, Terumo Corporation, Mochida Pharmaceuticals, Teijin Pharma, Kissei Pharmaceuticals, Kowa Pharmaceuticals, Mitsubishi Tanabe Pharma Corporation, Sanwa Kagaku Kenkyusho, Dainippon Sumitomo Pharma, AstraZeneca KK, Kyowa Hakko Kirin, Shionogi and Co, and Bayer Yakuhin. MA has received consulting fees from Sanofi KK, Eli Lilly Japan KK, Novo Nordisk Pharma Ltd, and MSD KK. SA has received consulting fees from Boehringer Ingelheim. SN has received consulting fees from Novartis Pharma KK. MM has received consulting fees from Eli Lilly Japan KK, Novo Nordisk Pharma Ltd, and Daiichi Sankyo Company. TO, MS, and MT report no conflicts of interest in this work.