American Diabetes Association Scientific Sessions

American Diabetes Association Scientific Sessions

Issue: August 2013
June 27, 2013
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Prandial insulin initiation feasible through two algorithms in type 2 diabetes

Issue: August 2013
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CHICAGO — In a large, multicenter study, Steven Edelman, MD, Endocrine Today Editorial Board member, and colleagues demonstrated that prandial insulin therapy can be initiated in the primary care setting among patients with type 2 diabetes on basal insulin. Additionally, lispro self-titration was feasible without counting carbohydrates or the need to use a correction factor.

Edelman and colleagues conducted AUTONOMY — two studies (A and B) combined into one protocol — to assess two methods of introducing insulin lispro in patients with type 2 diabetes (n=1,106) who were using basal insulin glargine (Lantus, Sanofi-Aventis), neutral protamine Hagedorn, neutral protamine lispro or detemir (≥20 U/day) plus oral antihyperglycemic agents for ≥3 months. Patients were aged 18 to 85 years, had HbA1c >7% to ≤12% and required prandial therapy.

Steve Edelman, MD 

Steven Edelman

Patients were randomly assigned to one of two bolus insulin treatment algorithms (study A or study B) for 24 weeks after a 6-week glargine optimization period (patients on NPH and detemir were transitioned to glargine). Lispro was added by injection (one, two or three injections, as needed) in both groups, and patients used study diaries to self-adjust their prandial insulin every 3 days (Q3D), as per ADA/EASD guidelines or by one unit of insulin each day (Q1D) based on the blood glucose value before the next meal.

After 24 weeks, Edelman and colleagues observed clinically significant reductions in HbA1c and lower rates of hypoglycemia with both algorithms (study A, n=528 and study B, n=578). In study A, the HbA1c percentage change from baseline was –1.00% for Q1D and –0.96% for Q3D; in study B changes were –0.98% in Q1D and  –0.92% in Q3D. Overall incidence of hypoglycemia was 86.2% for Q1D and 83.2% for Q3D in study A and 82.4% for Q1D and 79.1% for Q3D in study B.

“AUTONOMY is the first to demonstrate that prandial insulin therapy in type 2 diabetes on glargine can be effectively and safely initiated in the primary care setting and that self-titration of lispro may be done by either of two simple algorithms without the complexity of carbohydrate counting and correction factor, regardless of patient age,” they wrote. – by Stacey L. Adams

For more information:

Edelman SV. #46-LB. Presented at: ADA Scientific Sessions; June 21-25, 2013; Chicago.

Disclosure: The researchers report no relevant financial disclosures.