Effects of switching from prandial premixed insulin therapy to basal plus two times bolus insulin therapy on glycemic control and quality of life in patients with type 2 diabetes mellitus.
BACKGROUND
The effects of switching from prandial premixed insulin therapy (PPT) injected three times a day to basal plus two times bolus insulin therapy (B2B) on glycemic control and quality of life were investigated in patients with type 2 diabetes mellitus.


METHODS
The clinical course was prospectively observed during the first 16 weeks after switching to B2B (insulin glargine plus insulin glulisine before breakfast and dinner) in 27 subjects previously treated with PPT using 50/50 premixed insulin. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was administered at the start and end of the study.


RESULTS
The glycated hemoglobin (HbA1c) level (8.3% ± 1.8% to 8.2% ± 1.1%) and the DTSQ score did not change between the start and end of the study. An improvement in HbA1c level was found in nine (33%) subjects. The change in HbA1c showed a significant negative correlation with baseline HbA1c, and was significantly better in patients with a baseline HbA1c >8.0% than in those with an HbA1c ≤ 8.0% (-0.9 ± 2.0 versus 0.3 ± 0.6, respectively, P = 0.02). The change in DTSQ score representing treatment satisfaction was significantly greater in patients whose HbA1c level was improved than in those in whom it was not (2.7 ± 3.6 versus -0.8 ± 3.5, P = 0.04).


CONCLUSIONS
B2B was noninferior to PPT with regard to HbA1c levels in patients with type 2 diabetes mellitus. B2B should be considered particularly for subjects whose glycemic control is poor despite PPT.
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Hiroyuki
H
Ito
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Mariko
M
Abe
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Shinichi
S
Antoku
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Takashi
T
Omoto
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Masahiro
M
Shinozaki
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Shinya
S
Nishio
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Mizuo
M
Mifune
Department of Diabetes, Metabolism and Kidney Disease, Edogawa Hospital, Tokyo, Japan.
Michiko
M
Togane
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human; C479079:insulin glulisine
Diabetes Treatment Satisfaction Questionnaire; basal plus two times bolus insulin therapy; insulin therapy; prandial premixed insulin therapy; type 2 diabetes mellitus