title: Metabolic control and hypoglycaemia in people with type 2 diabetes on conventional or intensified insulin therapy: a 22 year retrospective single centre survey.
abstract: Multiple insulin injection therapy can easily be adapted to the patient's needs. Therefore, it is supposed that more intensive insulin therapy is associated with better metabolic control and less hypoglycaemia compared with a conventional insulin strategy in patients with type 2 diabetes.
  
  
  
  HbA1c and incidence of non-severe and severe hypoglycaemia were analysed with regard to the strategy of insulin therapy [multiple insulin injection therapy with preprandial insulin with or without basal insulin or conventional insulin therapy with twice-daily premix insulin] from 20 943 visits of 1417 people treated with insulin with type 2 diabetes in a university outpatient department for endocrinology and metabolic diseases over a period of 22 years.
  
  
  
  Multiple insulin injection therapy was used in 13 896 (66.4%) of all 20 942 visits. Compared with conventional insulin therapy, these patients were younger (62.0 vs 68.7 years; p < 0.001), had a slightly longer diabetes duration (16.5 vs 15.8 years; p < 0.001) and higher body mass index (32.8 vs 30.9 kg/m(2) ; p < 0.001), a higher insulin dose (76.4 vs 46.5 IU/day; p < 0.001), more frequent blood glucose monitorings/week (24.2 vs 14.8; p < 0.001), a slightly lower HbA1c [7.7 (61.2) vs 7.9% (62.9 mmol/mol); p < 0.001] but more non-severe hypoglycaemic incidences per week (0.3 vs 0.2; p = 0.01). Episodes of severe hypoglycaemia were rare and comparable (0.01/patient/year) with both insulin therapy strategies.
  
  
  
  Multiple insulin injection therapy and conventional insulin therapy yielded comparable metabolic control with HbA1c below 8% (63.9 mmol/mol), but multiple insulin injection therapy is associated with higher body mass index and higher incidence of non-severe hypoglycaemia. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Kramer
authors.affiliation: Department Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Kuniss
authors.affiliation: Department Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Kloos
authors.affiliation: Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lehmann
authors.affiliation: Department Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Müller
authors.affiliation: Department Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Sämann
authors.affiliation: Department Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Wolf
authors.affiliation: Department Internal Medicine III, Jena University Hospital, Jena, Germany.
authors.forename: U A
authors.initials: UA
authors.lastname: Müller
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008659:Metabolic Diseases / Q000517:prevention & control*; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human
keywords: HbA1c; conventional insulin therapy; multiple injection therapy; type 2 diabetes