1
|
Zeng T, Yuan H, Ren J, Li Y, Hou J, Du L, Zhu J, Chen L, Ji L. A Pragmatic Study of Basal and Mid-Mixture Insulins as Starter Insulins in Chinese Patients With Type 2 Diabetes: Observations From Long-Term, Real-World Experience. Diabetes Ther 2021; 12:931-941. [PMID: 33616875 PMCID: PMC7947078 DOI: 10.1007/s13300-021-01007-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION According to Chinese guidelines, basal insulin (BI) or premixed insulins are recommended insulin starters following the failure of oral antihyperglycemic medication (OAM) in Chinese patients with type 2 diabetes (T2D). This pragmatic study investigated the long-term effectiveness, safety, and cost of add-on BI and mid-mixture insulin analog (MMI) regimens in Chinese patients with T2D. METHODS This multicenter, open-label, pragmatic study randomized patients 1:1 to receive either BI or MMI with OAMs adjusted according to current standards of care. We evaluated the change in glycated hemoglobin (HbA1c) from baseline, safety parameters, and antidiabetic medication costs. RESULTS Change in HbA1c from baseline showed a statistically greater decrease at week 48 in the MMI group (MMI: - 2.03% [0.06] vs. BI: - 1.82% [0.06]; P < 0.05). Both groups showed decreases in fasting plasma glucose (mmol/L) (MMI: - 2.53 [0.14] vs. BI: - 3.19 [0.14]; P < 0.01) and postprandial glucose (mmol/L) (MMI: - 4.35 [0.22] vs. BI: - 4.33 [0.23]). More patients in the BI group showed increases in OAM use, while OAM use decreased in the MMI group. Both groups showed stable glycemic control with a very limited insulin dose change from week 24 to week 48. The incidence of total hypoglycemia was higher in the MMI group (MMI: 124% [30.7] vs. BI: 76% [18.5], P < 0.0001), but no incidence of severe hypoglycemia was reported in either group. Treatment costs, in terms of average daily cost and cost of glycemic control, were higher in the BI group. CONCLUSION In long-term real-world use, the MMI and BI groups demonstrated improved glycemic control, with the MMI group showing more significant improvement than the BI group. Hypoglycemia incidence was higher in the MMI group, with no major safety issues through week 48. MMI is likely to provide better price value than BI for the treatment of T2D in Chinese patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03018938.
Collapse
Affiliation(s)
- Tianshu Zeng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China
| | - Huijuan Yuan
- Department of Endocrinology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Jiangong Ren
- Department of Endocrinology, Lanzhou University Second Hospital, Gansu, China
| | - Yuanyuan Li
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Jianing Hou
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Liying Du
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Jiankun Zhu
- Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Lulu Chen
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
- Department of Endocrinology, Hubei Provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China.
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| |
Collapse
|
2
|
Yu X, Zhang L, Yu R, Yang J, Zhang S. Discharge pharmacotherapy for Type 2 diabetic inpatients at two hospitals of different tiers in Zhejiang Province, China. PLoS One 2020; 15:e0230123. [PMID: 32267843 PMCID: PMC7141672 DOI: 10.1371/journal.pone.0230123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/21/2020] [Indexed: 11/19/2022] Open
Abstract
Objects To look into the discharge pharmacotherapy for type 2 diabetics admitted to two general hospitals of different ranks and inspect current real-world management of discharge pharmacology and its related factors. Methods Type 2 diabetics admitted to a tertiary general hospital (Ningbo Medical Treatment Centre Lihuili Hospital, LHLH) or a secondary general hospital (Simen Hospital, SMH) for intensification of their anti-diabetics were included for retrospective analysis. Patients’ demographics, clinical characteristics, admission diabetes therapy and discharge diabetes pharmacology were analyzed and compared among patients in each hospital as well as between two hospitals. Results 391 patients from LHLH and 164 patients from SMH were included for analyzing. Compared with patients from LHLH, patients from SMH were older, more illiterate and had higher HbA1c concentrations. While there was a nearly equal split of oral anti-diabetes drugs (OADs)-only and Insulin treatment in LHLH’s discharge pharmacotherapy, insulin treatment dominated SMH’s. Basal-and-bolus insulin assumed the majority of SMH’s insulin regimens but only accounted for less than 20% of LHLH’s. The principal discrepancy in OADs-only treatment existed in the utilization of newer classes of OADs. Cost and body mass index (BMI) were the main differentiating factors among OADs-only treatments while duration, BMI and HbA1c differ among insulin treatments at LHLH. Clinical characteristics didn’t significantly differ among OADs-only treatments and HbA1c was the only differentiating factor among insulin treatments at SMH. Overall, hospital, duration, HbA1c, and vascular diseases were main factors that affect discharge pharmacology. Conclusions Great disparities exist in the discharge pharmacotherapy at two hospitals. Diabetes management is mostly glucose-oriented at SMH while multifactorial considerations were reflected in LHLH’s discharge pharmacotherapy. Besides differences in patients’ demographics, medication availability and diagnosis of early-stage vascular complications, lack of practical algorithm for discharge management in T2DM may be the underlying deficiency and a key part for future improvement.
Collapse
Affiliation(s)
- Xiaofang Yu
- Department of Endocrinology in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
- * E-mail:
| | - Long Zhang
- Department of Endocrinology in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
| | - Rongbin Yu
- Department of Preventive Care and Medical Insurance in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
| | - Jiao Yang
- Medical Department in Simen Hospital, Yuyao City, Ningbo, Zhejiang Province, China
| | - Saifei Zhang
- Department of Endocrinology in Ningbo Medical Treatment Centre Lihuili Hospital, Ningbo, Zhejiang Province, China
| |
Collapse
|
3
|
Li W, Ping F, Xu L, Zhang H, Dong Y, Yu K, Li Y. The Effect of LM25 and LM50 on Hypoglycemia in Chinese T2DM Patients: Post Hoc Analysis of a Randomized Crossover Trial. Diabetes Ther 2020; 11:643-654. [PMID: 31981211 PMCID: PMC7048899 DOI: 10.1007/s13300-020-00766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION To investigate the safety of insulin lispro Mix 25 and 50 (LM25 and LM50) in hypoglycemia in patients with type 2 diabetes mellitus (T2DM). METHODS This was a post hoc analysis of a phase IV, randomized, crossover clinical trial in Chinese patients with T2DM switching from premixed human insulin 70/30 (PHI70/30) to LM25 or LM50. Eighty-one subjects received a two-stage crossover protocol of either LM25 or LM50 twice daily for 16 weeks. Habitual diet was taken, and self-monitoring of blood glucose (SMBG) was performed throughout the study period. High-carbohydrate diet (HCD), high-fat diet (HFD) and habitual diet patterns were taken, and 72 h continuous glucose monitoring (CGM) was performed at the last 3 days of each treatment stage. RESULTS The frequencies of nocturnal hypoglycemia in LM50 were lower than those in LM25 under a Chinese habitual diet pattern. The related factors of hypoglycemia in patients with T2DM treated with a LM25 or LM50 regimen were the weight-based daily mean insulin dose and the type of combined oral hypoglycemic agents. Under both HCD and habitual diet patterns, the optimal cut point values of bedtime glucose predicting nocturnal hypoglycemia in LM50 were lower than those in LM25. CONCLUSIONS The risk of nocturnal hypoglycemia in the LM50 regimen was lower than that in the LM25 regimen under the HCD pattern, and the safety range of bedtime glucose for the LM50 regimen was wider than that of the LM25 regimen in Chinese T2DM patients. Premixed insulin analogs combined with acarbose were more helpful to reduce the incidence of hypoglycemia. TRIAL REGISTRATION http://www.chictr.org.cn #ChiCTR-TTRCC-12002516.
Collapse
Affiliation(s)
- Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaxiu Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kang Yu
- Department of Clinical Nutrition, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
4
|
Liu BL, Liu XM, Ren YF, Sun YX, Luo MH, Ye L, Ma JH, Li FF. Sexual Differences in response to Mid- or Low-Premixed Insulin Analogue in Patients with Type 2 Diabetes. J Diabetes Res 2020; 2020:8152640. [PMID: 32090123 PMCID: PMC7029302 DOI: 10.1155/2020/8152640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/19/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To observe whether there are sexual-related differences in response to mid- or low-premixed insulin in type 2 diabetic patients. METHODS This was an analysis of CGM data of a previous study. After screening, patients with longstanding T2D receive a 7-day continuous subcutaneous insulin infusion (CSII) therapy, and then subjects were randomly assigned 1 : 1 into two groups receiving Novo Mix 30 or Humalog Mix 50 regimen for a 2-day phage, followed by a 4-day cross-over period. A 4-day continuous glucose monitoring (CGM) was performed during the cross-over period. The primary endpoint was the differences in glycemic control between male and female patients receiving mid- or low-premixed insulin therapy. RESULTS A total of 102 patients (52 men and 50 women) completed the study. Our data showed that male patients had significant decrease in mean glucose levels monitored by CGM after three meals during Humalog Mix 50 treatment period compared to those received Novo Mix 30 regimen (0900: 11.0 ± 2.5 vs. 12.2 ± 2.8, 1000: 9.9 ± 2.9 vs. 11.3 ± 3.1, 1200: 8.0 ± 1.9 vs. 9.1 ± 2.5, 1400: 9.2 ± 2.3 vs. 10.3 ± 2.5, and 2000: 7.3 ± 2.1 vs. 8.2 ± 2.4 mmol/L, p < 0.05, respectively). In addition, male patients receiving Novo Mix 30 experienced a significantly increased hypoglycemic duration compared to those of receiving Humalog Mix 50 (0 (0, 4.8) vs. 0 (0, 0), p < 0.05, respectively). In addition, male patients receiving Novo Mix 30 experienced a significantly increased hypoglycemic duration compared to those of receiving Humalog Mix 50 (0 (0, 4.8) vs. 0 (0, 0). CONCLUSION Our data indicate that male patients with T2D receiving mid-premixed insulin analogue regimen may have a potential benefit of improvement in glycemic control compared to female patients. This trial is registered with ClinicalTrials.gov ChiCTR-IPR-15007340.
Collapse
Affiliation(s)
- Bing-li Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-mei Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yi-fei Ren
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yi-Xuan Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Meng-hui Luo
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Jian-hua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng-fei Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| |
Collapse
|
5
|
Shi C, Sun L, Bai R, Wang H, Liu D, Du J. Comparison of a twice daily injection of insulin aspart 50 with insulin aspart 30 in patients with poorly controlled type 2 diabetes. Curr Med Res Opin 2019; 35:1091-1096. [PMID: 30550344 DOI: 10.1080/03007995.2018.1558853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare the efficacy and safety of a twice daily injection of insulin aspart (BIAsp) 30 and BIAsp50 in patients with type 2 diabetes mellitus (T2DM) poorly controlled with oral hypoglycemic agents (OHAs). METHODS In this 12 week prospective, randomized, parallel trial, a total of 80 T2DM patients, 59 ± 10 years old with a disease duration of 9.3 ± 6.6 years and HbA1c >7% despite large doses of metformin and sulfonylurea administration, were randomized to receive BIAsp30 (n = 40) or BIAsp50 (n = 40). The primary endpoint was a change in HbA1c at week 12. RESULTS The changes in HbA1c from baseline were -2.5% ± 1.0% in the BIAsp50 group and -2.5% ± 1.2% in the BIAsp30 group (p = .897). No difference was observed in the rate of HbA1c target achievement (<7.0%) between BIAsp50 (42.5%) and BIAsp30 (32.5%) (p = .495). The change in fasting plasma glucose (FPG) in the BIAsp50 group was lower than that in the BIAsp30 group (p < .001), while the change in two-hour postprandial blood glucose (2hPBG) was higher and blood glucose excursion was lower in the BIAsp50 group than that in the BIAsp30 group (p < .001, p < .001). A significant improvement in HbA1c was observed with BIAsp50 in subgroups with baseline blood glucose excursion >7.8 mmol/L or 2hPBG >17.6 mmol/L compared with BIAsp30. There were no differences in hypoglycemia or body weight between groups. CONCLUSIONS Compared with BIAsp30, BIAsp50 showed greater efficacy in patients with baseline BG excursion >7.8 mmol/L or 2hPBG >17.6 mmol/L as well as good safety for hypoglycemia. CLINICAL TRIAL REGISTRATION ChiCTR-IIR-16008958.
Collapse
Affiliation(s)
- Chunhong Shi
- a Department of Endocrinology , The First Affiliated Hospital of Dalian Medical University , Dalian , PR China
| | - Luyan Sun
- a Department of Endocrinology , The First Affiliated Hospital of Dalian Medical University , Dalian , PR China
| | - Ran Bai
- a Department of Endocrinology , The First Affiliated Hospital of Dalian Medical University , Dalian , PR China
| | - Hao Wang
- a Department of Endocrinology , The First Affiliated Hospital of Dalian Medical University , Dalian , PR China
| | - Dan Liu
- a Department of Endocrinology , The First Affiliated Hospital of Dalian Medical University , Dalian , PR China
| | - Jianling Du
- a Department of Endocrinology , The First Affiliated Hospital of Dalian Medical University , Dalian , PR China
| |
Collapse
|
6
|
Kalra S, Czupryniak L, Kilov G, Lamptey R, Kumar A, Unnikrishnan AG, Boudiba A, Abid M, Akanov ZA, Latheef A, Araz M, Audehm R, Bahendeka S, Balde N, Chaudhary S, Deerochanawong C, Fasanmade O, Iraqi H, Latt TS, Mbanya JC, Rodriguez-Saldana J, Hyun KS, Latif ZA, Lushchyk M, Megallaa M, Naseri MW, Bay NQ, Ramaiya K, Randeree H, Raza SA, Shaikh K, Shrestha D, Sobngwi E, Somasundaram N, Sukor N, Tan R. Expert Opinion: Patient Selection for Premixed Insulin Formulations in Diabetes Care. Diabetes Ther 2018; 9:2185-2199. [PMID: 30390228 PMCID: PMC6250631 DOI: 10.1007/s13300-018-0521-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 01/10/2023] Open
Abstract
Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.
Collapse
Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital Karnal, Karnal, India.
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Gary Kilov
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Roberta Lamptey
- Department of Family Medicine, Korle Bu Teaching Hospital, University of Ghana, School of Public Health Ghana, Accra, Ghana
| | - Ajay Kumar
- Department of Diabetology, Diabetes Care and Research Centre, Patna, India
| | - A G Unnikrishnan
- Department of Endocrinology, Chellaram Diabetes Institute, Pune, India
| | - Aissa Boudiba
- Department of Endocrinology and Diabetology, University Hospital Center Mustapha, Algiers, Algeria
| | - Mohamed Abid
- Department of Endocrinology and Diabetology, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Zhanay A Akanov
- Center of Diabetes, Clinic of Internal Diseases, Asfendyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan
| | - Ali Latheef
- Department of Medicine, Indra Gandhi Hospital, Male, Maldives
| | - Mustafa Araz
- Department of Endocrinology and Metabolism, Gaziantep University Hospital, Gaziantep, Turkey
| | - Ralph Audehm
- Department of General Practice, University of Melbourne, Melbourne, Australia
| | - Silver Bahendeka
- Department of Diabetology, St. Francis Hospital, Nsambya, Uganda
| | - Naby Balde
- Department of Endocrinology, Donka Conakry University Hospital, Conakry, Guinea
| | - Sandeep Chaudhary
- Department of Endocrinology, NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Chaicharn Deerochanawong
- Diabetes and Endocrinology Unit, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Olufemi Fasanmade
- Department of Endocrinology, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Hinde Iraqi
- Department of Endocrinology and Diabetology, Faculty of Medicine and Pharmacie, Mohammed V University, Rabat, Morocco
| | | | | | | | - Ko Seung Hyun
- Department of Endocrinology, St Vincent's Hospital, Catholic University, Suwon, South Korea
| | | | - Maxim Lushchyk
- Department of Endocrinology, Belarusian Medical Academy of Postgraduate Education, Minsk, Belarus
| | - Magdy Megallaa
- Department of Diabetes and Metabolism, Alexandria University, Alexandria, Egypt
| | - Mohammed Wali Naseri
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, Kabul University of Medical Sciences, Kabul, Afghanistan
| | | | - Kaushik Ramaiya
- Department of Diabetology, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Hoosen Randeree
- Department of Endocrinology, Parklands Medical Centre, Durban, South Africa
| | - Syed Abbas Raza
- Department of Endocrinology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Khalid Shaikh
- Department of Endocrinology, Royal Oman Police Hospital, Muscat, Oman
| | - Dina Shrestha
- Department of Endocrinology, Norvic International Hospital, Kathmandu, Nepal
| | - Eugene Sobngwi
- Department of Internal Medicine, Central Hospital, Yaoundé, Cameroon
| | - Noel Somasundaram
- Department of Diabetes and Endocrinology, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Norlela Sukor
- Endocrine Unit, Department of Medicine, National University of Malaysia Medical Center, Kuala Lumpur, Malaysia
| | - Rima Tan
- Institute for Studies on Diabetes Foundation Inc, Marikina City, Philippines
| |
Collapse
|
7
|
Li W, Ping F, Xu L, Zhang H, Dong Y, Li H, Sun Q, Li Y. Contribution of BHG and PPHG to Overall Hyperglycemia in T2DM Patients Treated with LM25 and LM50: Post Hoc Analysis of a Randomized Crossover Trial. Diabetes Ther 2018; 9:1605-1614. [PMID: 29951978 PMCID: PMC6064593 DOI: 10.1007/s13300-018-0462-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION To investigate the relative contribution rates of basal hyperglycemia (BHG) and postprandial hyperglycemia (PPHG) to overall hyperglycemia in patients with type 2 diabetes mellitus (T2DM) treated with insulin lispro mix 25 and 50 (LM25 and LM50) as evaluated by continuous glucose monitoring (CGM). METHODS Eighty-one T2DM patients treated with premixed human insulin 70/30 (PHI70/30) were randomly divided into two groups and received a crossover protocol. In the first 16-week stage, one group received LM25 twice daily, the other group received LM50 twice daily. In the second 16-week stage, the two groups exchanged therapeutic regimen. Glycosylated hemoglobin (HbA1c) measurement and CGM were performed at enrollment and at the end of each treatment stage. RESULTS BHG's contribution rate increased with increasing HbA1c (from 34.5% to 60.8%). PPHG's contribution rates in the LM50 regimen were significantly lower than those in LM25 and PHI70/30 regimens at HbA1c levels < 7.5%. Compared with LM50, LM25 shows a significant difference in reducing HbA1c in the subgroup with baseline HbA1c ≥ 8.5% (ΔHbA1c LM25 vs. LM50 - 0.6 ± 0.1% vs. 0.3 ± 0.1%, p < 0.05). CONCLUSIONS For T2DM patients treated with premixed insulin analogues, postprandial hyperglycemia played a major role in the subgroup of patients with HbA1c < 8.5%, while fasting hyperglycemia became the major contributor to overall hyperglycemia in the subgroup of patients with HbA1c ≥ 8.5%. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier ChiCTR-TTRCC-12002516. FUNDING Lilly Suzhou Pharmaceutical Co., Ltd. (Shanghai Branch, China) and National Key Program of Clinical Science of China (WBYZ2011-873).
Collapse
Affiliation(s)
- Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaxiu Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongmei Li
- Department of Endocrinology, China Meitan General Hospital, Beijing, China
| | - Qi Sun
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
8
|
Su Q, Liu J, Li P, Qian L, Yang W. Relative Contribution of Fasting and Postprandial Blood Glucose in Overall Glycemic Control: Post Hoc Analysis of a Phase IV Randomized Trial. Diabetes Ther 2018; 9:987-999. [PMID: 29574635 PMCID: PMC5984909 DOI: 10.1007/s13300-018-0403-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Few prospective clinical trials have investigated the role of fasting blood glucose (FBG) and/or postprandial glucose (PPG) in assessing overall glycemic control by using different insulin regimens. In the present post hoc analysis, we assessed the contribution of FBG and/or PPG in overall glycemic control in Chinese patients under insulin treatment. METHODS CLASSIFY is a phase IV, randomized, open-label, 26-week, parallel-arm, treat-to-target, multinational, controlled study in patients with type 2 diabetes mellitus to compare the efficacy and safety of insulin lispro mix 25 (LM25) and insulin lispro mix 50 (LM50) as starter insulins. Insulin was titrated with an aim to target pre-meal blood glucose (BG) levels at > 3.9 and ≤ 6.1 mmol/L before breakfast and dinner. The primary outcome assessed was the change in HbA1c from baseline. RESULTS Chinese patients contributed 38.7% (N = 156) of the total population. The majority of patients were male (52.6%). The mean (SD) body mass index was 24.54 (3.04) kg/m2 and mean (SD) HbA1c was 8.54 (1.10) % at baseline. At week 26, LM50 showed a significantly greater reduction from baseline in HbA1c (- 2.03% vs - 1.55%, P < 0.001), average daily BG (- 3.21 vs - 2.34 mmol/L, P < 0.001), average post-meal BG (- 3.58 vs - 2.39 mmol/L, P < 0.001), and average prandial BG excursion (- 1.01 vs - 0.22 mmol/L, P = 0.006) than the LM25 group. The reductions in average pre-meal BG (- 2.59 vs - 2.28 mmol/L, P = 0.137) were not significantly different between the groups. The proportion of patients achieving HbA1c targets (< 7% or ≤ 6.5%) without nocturnal hypoglycemia or weight gain was greater (P < 0.05) with LM50 compared with LM25. CONCLUSION LM50 achieved better overall glycemic control than LM25 as a starter insulin in Chinese patients, which may be due to greater improvement in PPG levels. TRIAL REGISTRATION Clinicaltrials.gov identification number: NCT01773473. FUNDING Eli Lilly and Company, Shanghai, China.
Collapse
Affiliation(s)
- Qing Su
- Department of Endocrinology and Metabolism, Xin Hua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Endocrinology and Metabolism, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Pengfei Li
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Lei Qian
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
- Medical Science Department, Shanghai Haihe Pharmaceutical Co. Ltd, Shanghai, China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.
| |
Collapse
|
9
|
Erratum. J Diabetes 2018; 10:423. [PMID: 29630785 DOI: 10.1111/1753-0407.12656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
10
|
Li W, Ping F, Xu L, Zhou M, Li H, Dong Y, Li Y. Effects of Insulin Lispro Mix 25 and Insulin Lispro Mix 50 on Postprandial Glucose Excursion in Patients with Type 2 Diabetes: A Prospective, Open-Label, Randomized Clinical Trial. Diabetes Ther 2018. [PMID: 29520742 PMCID: PMC6104282 DOI: 10.1007/s13300-018-0398-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION We compared the effects of insulin lispro mix 25 (LM25) and insulin lispro mix 50 (LM50) on postprandial glucose excursion in patients with type 2 diabetes mellitus (T2DM). METHODS In this randomized, open-label, investigator-initiated trial, 81 T2DM patients treated with premixed human insulin 70/30 (PHI70/30) for more than 90 days were randomly divided into two groups and received a crossover protocol of either LM25 or LM50 twice daily for 16 weeks. Continuous glucose monitoring (CGM) was performed for 72 h at baseline and at the end of each treatment phase to evaluate glycemic excursions in the subjects. RESULTS The LM50 regimen resulted in significantly smaller postprandial glycemic excursions than the LM25 regimen after breakfast (1.3 ± 2.5 vs. 2.4 ± 2.6 mmol/L, P = 0.046) and dinner (1.5 ± 2.8 vs. 2.8 ± 2.4 mmol/L, P = 0.036). Glycosylated hemoglobin levels were similar for the patients on the three regimens. The percentage of patients who achieved their glycosylated hemoglobin target was significantly higher for the LM25 and LM50 regimens than for the PHI70/30 regimen, regardless of whether the target was set at 7.0% or 6.5%. The proportion of the patients who were hypoglycemic for a high percentage (> 10%) of the time was lower for the LM50 regimen than for the LM25 and PHI70/30 regimens. CONCLUSIONS LM50 may provide better glycemic excursion control after breakfast and dinner than LM25 in T2DM patients. TRIAL REGISTRATION http://www.chictr.org.cn # ChiCTR-TTRCC-12002516. FUNDING Lilly Suzhou Pharmaceutical Co., Ltd. (Shanghai Branch, China) and National Key Program of Clinical Science of China (WBYZ 2011-873).
Collapse
Affiliation(s)
- Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meicen Zhou
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongmei Li
- Department of Endocrinology, China Meitan General Hospital, Beijing, China
| | - Yaxiu Dong
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
11
|
Deed G, Kilov G, Dunning T, Cutfield R, Overland J, Wu T. Use of 50/50 Premixed Insulin Analogs in Type 2 Diabetes: Systematic Review and Clinical Recommendations. Diabetes Ther 2017; 8:1265-1296. [PMID: 29116584 PMCID: PMC5688993 DOI: 10.1007/s13300-017-0328-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Premixed insulin analogs represent an alternative to basal or basal-bolus insulin regimens for the treatment of type 2 diabetes (T2D). "Low-mix" formulations with a low rapid-acting to long-acting analog ratio (e.g., 25/75) are commonly used, but 50/50 formulations (Mix50) may be more appropriate for some patients. We conducted a systematic literature review to assess the efficacy and safety of Mix50, compared with low-mix, basal, or basal-bolus therapy, for insulin initiation and intensification. METHODS MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LillyTrials.com, and NovoNordisk-trials.com were searched (11 or 13 Dec 2016) using terms for T2D, premixed insulin analogs, and/or Mix50. Studies (randomized, nonrandomized, or observational; English only) comparing Mix50 with other insulins (except human) and reporting key efficacy [glycated hemoglobin (HbA1c), fasting and postprandial glucose] and/or safety (hypoglycemia, weight gain) outcomes were eligible for inclusion. Narrative reviews, letters, editorials, and conference abstracts were excluded. Risk of bias in randomized trials was assessed using the Cochrane tool. RESULTS MEDLINE and EMBASE searches identified 716 unique studies, of which 32 met inclusion criteria. An additional three studies were identified in the other databases. All 19 randomized trials except one were open label; risk of other biases was generally low. Although not conclusive, the evidence suggests that Mix50 may provide better glycemic control (HbA1c reduction) and, particularly, postprandial glucose reduction in certain patients, such as those with high carbohydrate diets and Asian patients, than low-mix and basal therapy. Based on this evidence and our experience, we provide clinical guidance on factors to consider when deciding whether Mix50 is appropriate for individual patients. CONCLUSIONS Mix50 may be more suitable than low-mix therapy for certain patients. Clinicians should consider not only efficacy and safety but also patient characteristics and preferences when tailoring insulin treatment to individuals with T2D. FUNDING Eli Lilly.
Collapse
Affiliation(s)
| | - Gary Kilov
- Launceston Diabetes Clinic, Launceston, TAS, Australia
- Department of General Practice (Honorary), University of Melbourne, Melbourne, VIC, Australia
| | - Trisha Dunning
- Centre for Quality and Patient Safety Research, Barwon Health Partnership, Deakin University, Geelong, VIC, Australia
| | | | - Jane Overland
- Faculty of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Ted Wu
- Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| |
Collapse
|
12
|
Watada H, Imori M, Li P, Iwamoto N. Insulin lispro 25/75 and insulin lispro 50/50 as starter insulin in Japanese patients with type 2 diabetes: subanalysis of the CLASSIFY randomized trial. Endocr J 2017; 64:705-717. [PMID: 28539526 DOI: 10.1507/endocrj.ej17-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In Japan, premixed insulins are commonly used as starter insulin for type 2 diabetes. This subpopulation analysis assessed the efficacy and safety of twice-daily LM25 (25% insulin lispro/75% insulin lispro protamine) and LM50 (50% insulin lispro/50% insulin lispro protamine) as starter insulin in Japanese subjects, and compared these results with the whole-trial populations of East Asian subjects. In this subpopulation analysis of an open-label, phase 4, randomized trial (CLASSIFY), Japanese subjects received LM25 (n = 88) or LM50 (n = 84) twice-daily for 26 weeks. The primary outcome was change from baseline at Week 26 in glycated hemoglobin (HbA1c). Results for Japanese subjects were generally similar to those for the whole-trial population. Similar changes from baseline in HbA1c were observed for LM25 and LM50 groups (least squares [LS] mean difference [95% confidence interval] of LM25 - LM50 = 0.13 [-0.16, 0.41]%, 1.42 [-1.75, 4.48] mmol/mol, p = 0.388). More LM50-treated subjects than LM25-treated subjects achieved HbA1c targets of <7.0% (59.5% versus 43.2%; p = 0.034) or ≤6.5% (45.2% versus 28.4%; p = 0.027). The reduction in postprandial blood glucose concentrations after morning and evening meals was statistically significantly greater for LM50 than for LM25. The incidence of both hypoglycemia and treatment-emergent adverse events were similar between treatment groups. Both LM25 and LM50 twice daily appear to be effective and well tolerated as starter insulin, although LM50 might be more effective for Japanese type 2 diabetes patients.
Collapse
Affiliation(s)
- Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Imori
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| | - Pengfei Li
- Medical Department, Lilly Suzhou Pharmaceutical Co. Ltd, Shanghai, China
| | - Noriyuki Iwamoto
- Medicines Development Unit Japan, Eli Lilly Japan K.K., Kobe, Japan
| |
Collapse
|