E Jungmann1. 1. St. Vinzenz-Hospital Rheda-Wiedenbrück. ProfEJungmann@aol.com
Abstract
BACKGROUND AND OBJECTIVE:Intensified insulin therapy using rapid acting insulin analogues is advocated in younger type 2 diabetic patients at risk of developing diabetic complications. Most patients prefer postprandial insulin injections. So far, however, there were no data on glycemic control by postprandial aspart insulin in patients with type 2 diabetes. PATIENTS AND METHODS: To compare blood glucose responsiveness to preprandial vs. postprandial aspart injections, a randomised open intraindividual cross-over trial was carried out. Blood glucose was measured before and one hour after the three main meals and at bedtime. 18 insulin-naive patients with type 2 diabetes (age, 60 +/- 3 years (mean +/- SEM), known duration of the disease, 7 +/- 2 years) participated at this study. RESULTS: Both with preprandial and postprandial injections of aspart insulin, the averages of the 7-point blood glucose profiles (8.27 +/- 0.50 vs. 8.5 +/- 0.61 mmol/l) were similar. With postprandial aspart insulin, however, 84 % of the blood glucose levels measured one hour after breakfast exceeded > 10 mmol/l in comparison to 38 % with preprandial aspart insulin (p < 0.05). Patients injected similar amounts of basal and aspart insulin on both experimental days (insulin glargin, 11 +/- 3 U, aspart insulin, 23 +/- 2 vs. 25 +/- 2 U/day, p = 0.4843). CONCLUSION: Both preprandial and postprandial insulin aspart can be allowed to well-controlled type 2 diabetic patients. However, patients will benefit from the recommendation to inject insulin aspart immediately before meal if food with a high glycemic index such as the continental breakfast is to be consumed.
RCT Entities:
BACKGROUND AND OBJECTIVE: Intensified insulin therapy using rapid acting insulin analogues is advocated in younger type 2 diabeticpatients at risk of developing diabetic complications. Most patients prefer postprandial insulin injections. So far, however, there were no data on glycemic control by postprandial aspartinsulin in patients with type 2 diabetes. PATIENTS AND METHODS: To compare blood glucose responsiveness to preprandial vs. postprandial aspart injections, a randomised open intraindividual cross-over trial was carried out. Blood glucose was measured before and one hour after the three main meals and at bedtime. 18 insulin-naivepatients with type 2 diabetes (age, 60 +/- 3 years (mean +/- SEM), known duration of the disease, 7 +/- 2 years) participated at this study. RESULTS: Both with preprandial and postprandial injections of aspartinsulin, the averages of the 7-point blood glucose profiles (8.27 +/- 0.50 vs. 8.5 +/- 0.61 mmol/l) were similar. With postprandial aspartinsulin, however, 84 % of the blood glucose levels measured one hour after breakfast exceeded > 10 mmol/l in comparison to 38 % with preprandial aspartinsulin (p < 0.05). Patients injected similar amounts of basal and aspartinsulin on both experimental days (insulin glargin, 11 +/- 3 U, aspartinsulin, 23 +/- 2 vs. 25 +/- 2 U/day, p = 0.4843). CONCLUSION: Both preprandial and postprandial insulinaspart can be allowed to well-controlled type 2 diabeticpatients. However, patients will benefit from the recommendation to inject insulinaspart immediately before meal if food with a high glycemic index such as the continental breakfast is to be consumed.