Clinical use and efficacy of biphasic insulin lispro 50/50 in people with insulin treated diabetes - a nationwide evaluation of clinical practice.
OBJECTIVES: This study aims to investigate the metabolic effects of biphasic insulin lispro 50/50 in routine clinical practice. A total of 229 patients who were ≥18 years old with diabetes, newly treated with biphasic insulin lispro 50/50, were sourced from six secondary care services in England. METHODS: Detailed clinical parameters were compared at baseline, and 3 and 6 months post-initiation. Responders was defined as those with HbA1c <7.5% (58 mmol/mol) and/or an HbA1c reduction of >1% (11 mmol/mol) at 6 months. RESULTS: HbA1c showed significant reduction: -0.93% (-10 mmol/mol) and -1.2% (-13 mmol/mol) at 3 and 6 months respectively, while no significant change was noted for all the other parameters. When analyzed according to frequencies of injections/day, the greatest reduction was observed with the three times a day regimen (-1.0% [-11.0 mmol/mol] and -1.3% [-14.6 mmol/mol] at 3 and 6 months respectively). HbA1c reduction was greatest in the group who previously received a basal-bolus insulin regimen: (-0.8% [-9.0 mmol/mol] and -1.5% [-16.2 mmol/mol] at 3 and 6 months respectively). Reduction in weight was observed at 3 months (-1.8 kg ± 4.3) only for those who were previously on a basal-bolus insulin regimen. Insulin doses increased following conversion to biphasic insulin lispro 50/50, irrespective of the types of insulin used prior to biphasic insulin lispro 50/50, but this was not associated with weight gain. The independent predictors of response to biphasic insulin lispro 50/50 were baseline HbA1c, Caucasian, presence of nephropathy, prior use of basal-bolus insulin and prior use of other premixed combination. CONCLUSION: Biphasic insulin lispro 50/50 is therefore an effective therapeutic option for achieving glycemic control in patients with suboptimal HbA1c levels, especially among those who were previously on a basal-bolus insulin regimen and those who received it three times daily, with a neutral effect on weight parameters. LIMITATIONS: This was a retrospective study of routine clinical practice and is therefore limited by allocation bias and some missing data. Information on rates of hypoglycemia and quality of life are not available.
Item Type | Article |
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Keywords | Adult, Aged, *Biphasic Insulins/administration & dosage/adverse effects, Blood Glucose/analysis, Body Weight/drug effects, *Diabetes Mellitus, Type 2/blood/drug therapy/psychology, Drug Monitoring, England, Female, Hemoglobin A, Glycosylated/analysis, Humans, *Hypoglycemia/chemically induced/prevention & control, Hypoglycemic Agents/therapeutic use, Injections, *Insulin Lispro/administration & dosage/adverse effects, Male, Middle Aged, *Quality of Life, Retrospective Studies, Weight Gain, Biphasic insulin lispro 50/50, HbA1c, Insulin, Routine clinical practice, Adult, Aged, Biphasic Insulins, administration & dosage, adverse effects, Blood Glucose, analysis, Body Weight, drug effects, Diabetes Mellitus, Type 2, blood, drug therapy, psychology, Drug Monitoring, England, Female, Hemoglobin A, Glycosylated, analysis, Humans, Hypoglycemia, chemically induced, prevention & control, Hypoglycemic Agents, therapeutic use, Injections, Insulin Lispro, administration & dosage, adverse effects, Male, Middle Aged, Quality of Life, Retrospective Studies, Weight Gain |
ISI | 351230800013 |