title: Recognition of fasting or overall hyperglycaemia when starting insulin treatment in patients with type 2 diabetes in general practice.
abstract: OBJECTIVE
  The efficacy of various regimens of initial insulin treatment in poorly controlled type 2 diabetes was compared with regard to diurnal glucose variation.
  
  
  METHODS
  Randomized controlled trial. Setting. Insulin therapy initiated on hospital wards, follow-up as outpatients for 12 months.
  
  
  METHODS
  Fifty-two type 2 diabetic patients (HbA1c >7.5%, mean 9.8%) on maximal oral therapy. Interventions. Insulin only (IO), bedtime insulin with sulphonylurea (glipizide) (IS), or bedtime insulin with metformin (IM).
  
  
  METHODS
  HbA1c and body weight.
  
  
  RESULTS
  HbA1c decreased on average by 1.8, 1.0 and 1.5 percentage points in the IO, IS, and IM groups, respectively (p always <0.025). Body weight increased, most in the IO patients (+6.2 kg), least in the IM patients (+3.4 kg). Analysing all treatment groups combined, a similar HbA1c reduction was observed in patients with overall hyperglycaemia (low fasting plasma glucose/HbA1c ratio) and in patients with fasting hyperglycaemia (high fasting plasma glucose/HbA1c ratio). Within the overall hyperglycaemia group, the IS and IM patients had smaller decreases in HbA1c (-1.5 and -1.3 percentage points, respectively) than the IO patients (-2.7 percentage points). On the other hand, within the fasting hyperglycaemia group HbA1c reductions were -1.2, -0.8 and -1.5 percentage points, in the IO, IS, and IM groups, respectively.
  
  
  CONCLUSIONS
  Not all poorly controlled type 2 diabetic patients should automatically be treated with an oral agent and bedtime insulin. Two daily insulin injections is a valid choice, particularly if the patient has overall hyperglycaemia.
authors.affiliation: City of Turku Health Centre, Turku, Finland. vahatalo@iki.fi
authors.forename: Markku
authors.initials: M
authors.lastname: Vähätalo
authors.forename: Tapani
authors.initials: T
authors.lastname: Rönnemaa
authors.forename: Jorma
authors.initials: J
authors.lastname: Viikari
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002940:Circadian Rhythm; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005215:Fasting; D005500:Follow-Up Studies; D005913:Glipizide / Q000008:administration & dosage / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000627:therapeutic use*; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000627:therapeutic use*; D008687:Metformin / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D005913:Glipizide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007336:Insulin, Isophane; D049528:Insulin, Long-Acting; D008687:Metformin