Comparison of thrice-daily lispro 50/50 vs thrice-daily lispro in combination with sulfonylurea as initial insulin therapy for type 2 diabetes.
Aims/Introduction:  Basal-bolus intensive insulin therapy has been believed to achieve best the glycemic control, but is also complicated as a result of the number of injections required and the type of insulin. This study compared the effect of thrice-daily lispro 50/50 (prandial premixed therapy [PPT]) with thrice daily lispro given in combination with sulfonylureas (prandial bolus therapy with sulfonylurea [PBTS]) as initial insulin therapy for type 2 diabetes.


METHODS
This 24-week, observational, parallel trial comprised a 12-week screening period and a 24-week intervention period for 31 diabetes patients who were poorly controlled with submaximal sulfonylurea. At the start of the intervention period, we commenced thrice-daily insulin injections and divided the 31 patients into either lispro 50/50 with discontinuation of sulfonylurea (PPT, n = 15) or lispro added to sulfonylurea (PBTS, n = 16). The same dose-adjustment algorithm was used for analyzing both groups; HbA1c, plasma glucose, insulin daily dose, bodyweight and number of hypoglycemic episodes were evaluated.


RESULTS
At the end of the study, HbA1c was significantly improved in both groups (P < 0.00001), but no difference was apparent between the groups. The daily doses of PPT were more than those of PBTS, albeit the difference was statistically insignificant (P = 0.051). There were significantly fewer hypoglycemic episodes encountered with PPT than with PBTS.


CONCLUSIONS
Thrice-daily injections of lispro 50/50 provide an effective and safe regimen as initial insulin therapy for type 2 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00025.x, 2010).
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Keiko
K
Yamashiro
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Fuki
F
Ikeda
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine ; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine.
Yoshio
Y
Fujitani
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine.
Hirotaka
H
Watada
Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine ; Center for beta-cell biology and degeneration, Juntendo University Graduate School of Medicine ; Sportology Center, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Ryuzo
R
Kawamori
Department of Medicine, Metabolism and Endocrinology, Juntendo University Graduate School of Medicine ; Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine ; Center for beta-cell biology and degeneration, Juntendo University Graduate School of Medicine.
Takahisa
T
Hirose
Hypoglycemia; Insulin lispro; Mid‐mix insulin