title: Individualizing treatment of type 2 diabetes by targeting postprandial or fasting hyperglycaemia: Response to a basal vs a premixed insulin regimen by HbA1c quartiles and ethnicity.
abstract: OBJECTIVE
  This study evaluated the proportions of prandial (PHG) vs fasting hyperglycaemia (FHG) over 24h in a group of patients with type 2 diabetes (overall and for Caucasian vs Asian patients), and tested the hypothesis that an insulin regimen with a prandial component allows a greater response than basal insulin at low glycated haemoglobin (HbA1c) levels with a higher proportion of PHG than FHG.
  
  
  METHODS
  Relative contributions of PHG and FHG to overall hyperglycaemia were analyzed by baseline HbA1c quartiles and by ethnicity at baseline and after 24-week treatment with either insulin glargine or insulin lispro mix 25 in the DURABLE study.
  
  
  RESULTS
  With increasing baseline HbA1c, the mean relative contribution of PHG to the total area under the curve decreased (from 41% to 27%) while FHG was increased (from 59% to 73%). Both insulins decreased FHG, but only insulin lispro mix 25 decreased PHG. More patients with baseline HbA1c < 9%, where PHG was more relevant, achieved the target HbA1c of < 7% at endpoint with insulin lispro mix 25 compared with glargine. On average, Asians had a 10% larger contribution of PHG at all HbA1c quartiles, and a lower proportion of Asians reached the HbA1c target of < 7% with either insulin treatment compared with Caucasians.
  
  
  CONCLUSIONS
  At baseline, the contribution of FHG to overall hyperglycaemia predominated at all HbA1c quartiles, whereas PHG was more clinically relevant at lower HbA1c levels and with a greater response to insulin lispro mix 25. Asians had a greater proportion of PHG and a lesser response to either insulins compared with Caucasians. Thus, responses to diabetes drugs by baseline HbA1c and ethnicity are worth investigating to better target and individualize treatment.
authors.affiliation: Division of Diabetes, Nutrition and Metabolic, Disorders and Clinical Pharmacology Unit, Department of Medicine, CHU Sart Tilman, University Hospital Center, University of Liège, 4000 Liège, Belgium. Electronic address: andre.scheen@chu.ulg.ac.be.
authors.forename: A J
authors.initials: AJ
authors.lastname: Scheen
authors.affiliation: Eli Lilly and Company, Brussels, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Schmitt
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, USA.
authors.forename: H H
authors.initials: HH
authors.lastname: Jiang
authors.affiliation: Eli Lilly and Company, Budapest, Hungary.
authors.forename: T
authors.initials: T
authors.lastname: Ivanyi
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D044466:Asian People / Q000706:statistics & numerical data; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D057285:Precision Medicine; D044465:White People / Q000706:statistics & numerical data
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Basal insulin; Ethnicity; HbA(1c); Premixed insulin; Type 2 diabetes