Targeting postprandial hyperglycaemia in patients with recently diagnosed type 2 diabetes with a fixed, weight-based dose of insulin Aspart.
OBJECTIVE
To assess the effect of substitution of early insulin release with a small weight-based dose of the rapid acting insulin analogue, insulin Aspart (IAsp), on postprandial hyperglycaemia in patients with recently diagnosed type 2 diabetes.


METHODS
In a randomized, double-blind, double-dummy design, 20 patients underwent three 3-day periods with injection of IAsp 0.06 IU/kg BW or placebo 30 min before main meals. The effect on blood glucose fluctuations was evaluated using a continuous glucose monitoring system. Efficacy endpoints were time with glucose values above 8 mmol/L and glucose area above 8 mmol/L; safety endpoint was time with glucose values below 4 mmol/L in the last 24 h in the treatment periods.


RESULTS
IAsp significantly reduced the duration of blood glucose values above 8 mmol/L compared with placebo during 24 h (8.1+/-1.4 h versus 12.7+/-1.3 h), (p<0.03). Glucose areas above 8 mmol/L were 0.6+/-0.2 mmol/lxh and 1.2+/-0.2 mmol/lxh for IAsp and placebo, respectively (p<0.001). Two patients (one in each of the IAsp and placebo periods) had two asymptomatic episodes of glucose registration below 4 mmol/L. Patients with HbA(1c) below 7.4 % obtained the greatest reduction in duration of blood glucose values above 8 mmol/L, whereas the decrease in blood glucose increments for patients with HbA(1c) above 7.4 % was not significantly different from placebo.


CONCLUSIONS
A fixed dose of IAsp injected 30 min before mealtimes reduced the postprandial glucose increment in patients with recently diagnosed type 2 diabetes without the risk of hypoglycaemia. Glucose fluctuations in patients with HbA(1c) below 7.4 % improved to near normal level.
Gredal
Charlotte
C
Department of Internal Medicine and Clinical Pharmacology, Gentofte University Hospital, Hellerup, Denmark.
Rosenfalck
Anne Mette
AM
Dejgaard
Anders
A
Hilsted
Jannik
J
D001786:Blood Glucose / Q000032:analysis; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D061267:Insulin Aspart; D008297:Male; D008875:Middle Aged; D010919:Placebos
D001786:Blood Glucose; D007328:Insulin; D010919:Placebos; D061267:Insulin Aspart