Identifying and meeting the challenges of insulin therapy in type 2 diabetes

Figures & data

Table 1 Effects of different insulin formulations on glycemic control and hypoglycemia in patients with type 2 diabetes

Insulin formulation	Background medication	Comparator	Δ HbA1c (%)	Δ FPG (mmol/L)	Δ 2-hr PPG (mmol/L)	Hypoglycemic episodes	Conclusion	Reference
Rapid-acting insulin analogs
Insulin lispro	Basal insulin	RHI	Equal reduction	NR	48% decreasea	Reduced rateb	Insulin lispro improves postprandial control in diabetes	Anderson et al 1997^Citation62
Insulin aspart	Metformin	RHI	Significant changea,b	No significant change with lispro or RHI	Trend toward reduction	No serious events reported for the two groups	Results support use of mealtime insulin aspart plus metformin in patients with T2DM and inadequately controlled postprandial hyperglycemia	Pala et al 2007^Citation93
Insulin glulisine	NPH plus prestudy OADs	RHI	Slight reductionb	Significant reductionb	Significant reductionb	Comparable between two groups	Glulisine plus NPH can provide small improvements in glycemic control compared with RHI in patients with T2DM who are relatively well-controlled on insulin alone or insulin plus OADs	Dailey et al 2004^Citation92
Long-acting insulin analogs (basal insulin)
Glargine	Prestudy OADs	NPH	Similar reduction for glargine and NPH; significant reduction from baseline	Significant reductiona	Significant reductionb	Significant reductiona	Insulin glargine is associated with less nocturnal hypoglycemia and lower PPG levels compared with NPH	Yki-Järvinen et al 2000^Citation96
Detemir	Prestudy OADs	NPH	Similar reduction; more patients reached HbA1c ≤7.0% without hypoglycemia with detemira	Similar reduction	Similar reduction	Significant reductiona	Insulin detemir compared with NPH achieves guidelines’ glycemic control with reduced hypoglycemia and less weight gain	Hermansen et al 2006^Citation97
LY2605541	Metformin and/or sulfonylurea	Insulin glargine	Similar reduction	Similar reduction	Significant reductionb	Similar rates	LY2605541 and insulin glargine had comparable glycemic control and total hypoglycemia rates	Bergenstal et al 2012^Citation114
Insulin premixes
Biphasic insulin aspart (30/70)	Metformin	NPH, biphasic human insulin (30/70)	Similar reduction	Similar reduction	Similar reduction, with lower values with NPH	Similar rates	Once-daily injections of three formulations in combination with metformin achieve glycemic control	Kilo et al 2003^Citation105
	NR	Human insulin premix (30%)	Similar reduction	Similar reduction	Significant reduction (90 minutes)a	Similar rates	Biphasic insulin aspart demonstrated significantly better post-prandial blood glucose control	Boehm et al 2002^Citation101
Future ultra-rapid-acting insulin analogs
Degludec	Insulin aspart	Insulin glargine	Similar reduction	Similar reduction	Similar reduction	Significant reductionb	Optimal glycemic control might be attained with insulin degludec, which is associated with lower risks of hypoglycemia than insulin glargine	Garber et al 2012^Citation109
Insulin degludec/insulin aspart (70/30)	Metformin	Biphasic insulin aspart (30%)	Similar reduction	Significant reductiona	Twice as many subjects reached PPG control with insulin degludec/aspart	Significant reductiona	Insulin degludec/aspart provided comparable overall glycemic control to biphasic insulin aspart, with a significantly lower rate of hypoglycemia	Niskanen et al 2012^Citation110
	Metformin	Insulin glargine	Similar reduction	Similar reduction	Lower with insulin degludec/aspart	Similar rates	Once-daily insulin degludec/aspart provided comparable overall glycemic control to insulin glargine and similar low rates of hypoglycemia, but better PPG	Heise et al 2011^Citation98

Notes:

a Significant change in favor of drug compared with comparator

b significant change compared with baseline.

Abbreviations: HbA_1c, hemoglobin A_1c; FPG, fasting plasma glucose; PPG, postprandial glucose; NPH, neutral protamine Hagedorn; NR, not reported; T2DM, Type 2 diabetes mellitus; OADs, oral antidiabetic drugs; RHI, regular human insulin.

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