title: People with type 2 diabetes on premixed insulin therapy: how is the daily insulin dose partitioned and are there effects on the metabolic control?
abstract: OBJECTIVE
  To investigate the correctness of the recommendation for dose distribution in premixed insulin therapy, with two thirds of daily insulin dose before breakfast and one third of daily insulin dose before dinner.
  
  
  METHODS
  The individual insulin dose distribution and metabolic control of people with Type 2 diabetes treated with premixed insulin therapy were studied in a cross sectional study involving 199 patients in a university outpatient department and 2 general practices in 2010.
  
  
  RESULTS
  All 199 patients were treated with premixed human insulin. The mean pre-breakfast dose was 57% (min. 32%, max. 83%) and the mean pre-dinner dose 43% (17-67%) of the total daily insulin. A pre-breakfast dose of exactly two thirds of total daily insulin was used by 6.5% (n=13), about two thirds, i. e., 60-70%, was injected by 27.6% of the patients. The diurnal insulin distribution<60%, 60% up to 70% and > 70% pre-breakfast insulin did not make any difference in HbA1c, which was 7.3% (56 mmol/mol) each.
  
  
  CONCLUSIONS
  The quite common recommendation in German and Austrian medical textbooks, that premixed insulin therapy should consists of a dose distribution with two thirds before breakfast and one third before dinner, is not observed in daily practice. Diurnal insulin dose distribution and HbA1c are not associated in this cohort. Novelty statement: The circadian insulin dose distribution of 2/3 before breakfast and 1/3 before dinner could not be confirmed for patients with diabetes type 2 and conventional insulin therapy. No correlation between metabolic control and insulin circadian insulin dose distribution was detected.
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Roth
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Milke
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Müller
authors.affiliation: Practice for General Medicine, Kranichfeld, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Zitterbart
authors.affiliation: Practice for General Medicine, Saalfeld, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Rechtacek
authors.affiliation: Practice for General Medicine, Saalfeld, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Rechtacek
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kloos
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Wolf
authors.affiliation: Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: U A
authors.initials: UA
authors.lastname: Müller
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin