[Intensified insulin therapy of type 2 diabetes mellitus: pre- or postprandial injection of aspart insulin?].
OBJECTIVE
Intensified insulin therapy using rapid acting insulin analogues is advocated in younger type 2 diabetic patients at risk of developing diabetic complications. Most patients prefer postprandial insulin injections. So far, however, there were no data on glycemic control by postprandial aspart insulin in patients with type 2 diabetes.


METHODS
To compare blood glucose responsiveness to preprandial vs. postprandial aspart injections, a randomised open intraindividual cross-over trial was carried out. Blood glucose was measured before and one hour after the three main meals and at bedtime. 18 insulin-naive patients with type 2 diabetes (age, 60 +/- 3 years (mean +/- SEM), known duration of the disease, 7 +/- 2 years) participated at this study.


RESULTS
Both with preprandial and postprandial injections of aspart insulin, the averages of the 7-point blood glucose profiles (8.27 +/- 0.50 vs. 8.5 +/- 0.61 mmol/l) were similar. With postprandial aspart insulin, however, 84 % of the blood glucose levels measured one hour after breakfast exceeded > 10 mmol/l in comparison to 38 % with preprandial aspart insulin (p < 0.05). Patients injected similar amounts of basal and aspart insulin on both experimental days (insulin glargin, 11 +/- 3 U, aspart insulin, 23 +/- 2 vs. 25 +/- 2 U/day, p = 0.4843).


CONCLUSIONS
Both preprandial and postprandial insulin aspart can be allowed to well-controlled type 2 diabetic patients. However, patients will benefit from the recommendation to inject insulin aspart immediately before meal if food with a high glycemic index such as the continental breakfast is to be consumed.
Jungmann
E
E
St. Vinzenz-Hospital Rheda-Wiedenbrück. ProfEJungmann@aol.com
D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004435:Eating; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D061267:Insulin Aspart; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D019518:Postprandial Period; D013997:Time Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D061267:Insulin Aspart; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting