Glycemic control similar with once-daily basal bolus regimen of detemir/aspart, NPH/regular insulin

Patients with type 2 diabetes treated with a basal bolus regimen of once-daily detemir/aspart had equivalent glycemic control and no differences in the frequency of hypoglycemia compared with patients assigned to a split-mixed regimen of neutral protamine Hagedorn and regular insulin.

The controlled, multicenter trial included 130 patients with type 2 diabetes who presented with blood glucose levels between 140 mg/dL and 400 mg/dL. The researchers randomly assigned 67 patients to once-daily detemir and aspart before meals and 63 patients to twice-daily NPH and regular insulin. Patients with blood glucose levels of 140 mg/dL to 200 mg/dL were started on a daily insulin dose of 0.4 U/kg and patients with levels of 201 mg/dL to 400 mg/dL were started on 0.5 U/kg. The mean hospital stay was about six days for patients in the detemir/aspart group and about seven days in the NPH/regular insulin group.

After one day of treatment, patients assigned to detemir/aspart experienced a change in glycemic control from 228 mg/dL to 160 mg/dL. Similarly, patients assigned to NPH/regular insulin also experienced an improvement in glycemic control, from 223 mg/dL to 158 mg/dL.

Less than half of the patients in both treatment groups reached a blood glucose target <140 mg/dL before meals (detemir/aspart: 45%; NPH/regular: 48%). Hypoglycemia, defined as blood glucose <60 mg/dL, was reported in 32.8% of the patients assigned to detemir/aspart and 25.4% assigned to NPH/regular insulin during the hospital stay (P=.34).

Umpierrez GE. J Clin Endocrinol Metab. 2009;94:564-569.