Splitting high-dose insulin, injecting in two sites improved blood glucose control

Issue: November 2011

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EASD 47th Annual Meeting

LISBON — Splitting high-dose insulin and injecting it in two sites may lead to significant improvements in glycemic control for severely insulin-resistant patients with type 2 diabetes in geographic regions where a U500 insulin preparation is not available.

Researchers in Poland enrolled 31 patients with type 2 diabetes in a prospective, randomized trial. Inclusion criteria included: treatment with a multiple insulin dose regimen; the need for >60 IU insulin as a single dose at least once daily; and an HbA1c level >8%. Researchers excluded patients with severe insulin resistance secondary to known causes such as infections or steroid use.

Patients were assigned to one of two groups: two-sites (two doses of >60 IU given in equal parts in symmetrical locations; n=16) or one site (usual injection of the entire dose at one site; n=15). A visual analogue scale (VAS) was used to assess HbA1c, plasma lipids, hypoglycemia occurrence and patient satisfaction every 3 months for 12 months.

At baseline, the mean HbA1c was 10.3% in the two-site group and 10% in the one-site group. The average daily insulin dose was 254 IU in the two-dose group and 240 IU in the one-dose group.

After 3 months of treatment, HbA1c decreased to 9.1% in the two-site group (P<.05) and was stable in the one-site group. Similarly, HbA1c decreased to 8.6% in the two-site group and 9.9% in the one-site group after 6 months of treatment. At 12 months, the mean HbA1c was 8.8% in the two-site group (P<.05) and 10.4% in the one-site group after 12 months.

The researchers also observed improvements in fasting plasma triglycerides in the two-site group (from 236 mg/dL at baseline to 192 mg/dL at 12 months; P<.01); this level remained stable in the one-dose group (252 mg/dL at baseline to 241 mg/dL at 12 months).

No serious hypoglycemic events were reported during the study. Patients were generally satisfied with their treatment in the two-site group (mean treatment satisfaction score: 53 at baseline to 72 at 12 months; P<.05), but remained unchanged in the one-site group (mean score: 55 at baseline to 58 at 12 months).

"We believe that this admittedly small sample study shows that if you treat patients who are severely insulin resistant and poorly controlled — and if, as in my country, you find 500 IU is not available — you might try to split [the dose] in two … There may be a significant improvement in metabolic control,” Malgorzata Saryusz-Wolska, MD, PhD, of the internal medicine and diabetology department at Medical University of Lodz, Poland, concluded. – by Stacey L. Fisher

For more information:

Saryusz-Wolska M. Abstract #109. Presented at: The European Association for the Study of Diabetes 47th Annual Meeting; Sept. 12-16, 2011; Lisbon.