title: Postprandial versus preprandial dosing of biphasic insulin aspart in elderly type 2 diabetes patients.
abstract: Preprandial dosing (within 5 min before meal) and postprandial dosing (15-20 min after meal onset) of NovoLog Mix 70/30 (BIAsp 30, a biphasic formulation of insulin aspart, 30% soluble and 70% protamine-crystallized) were compared in elderly (> or =65 years) type 2 diabetes patients in this open-label, 12-week, crossover study. Ninety-three patients were treated with b.i.d. preprandial injections of BIAsp 30 during a 2-week run-in period and subsequently randomized to a 4-week treatment with either pre- or postprandial b.i.d. BIAsp 30, followed by crossover to the other regimen for 4 weeks. Mean plasma glucose values during a 4-h mealtest at the end of each treatment were similar for pre- and postprandial BIAsp 30 (153 +/- 58 mg/dl and 161 +/- 59 mg/dl, respectively, difference not significant). However, the mean blood glucose increment from self-measured blood glucose values was slightly but significantly greater after postprandial injection than after preprandial injection (treatment difference: 16.3mg/dl; 95% CI: [0.5, 29.3]). Fifty-six percent of patients reported a hypoglycemic episode; postprandial injection did not increase the incidence of hypoglycemia as compared to preprandial injection (113 episodes versus 125 episodes, respectively). For some elderly type 2 diabetes patients, postprandial injection of BIAsp 30 may be an acceptable alternative to standard preprandial injection.
authors.affiliation: Department of Endocrinology and Metabolism, Physicians East, PA, 1850 W. Arlington Blvd., Greenville, NC 27834, USA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Warren
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Conway
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Klaff
authors.forename: Julio
authors.initials: J
authors.lastname: Rosenstock
authors.forename: Elsie
authors.initials: E
authors.lastname: Allen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D061265:Biphasic Insulins; D001786:Blood Glucose / Q000378:metabolism; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004435:Eating; D005260:Female; D019270:Fructosamine / Q000097:blood; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D061267:Insulin Aspart; D007336:Insulin, Isophane; D007700:Kinetics; D019518:Postprandial Period; D044469:Racial Groups; D012449:Safety
chemical_list: D015415:Biomarkers; D061265:Biphasic Insulins; D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; C557564:insulin aspart, insulin aspart protamine drug combination 30:70; D019270:Fructosamine; D007336:Insulin, Isophane; D061267:Insulin Aspart