When glycaemic targets can no longer be achieved with basal insulin in type 2 diabetes, can simple intensification with a modern premixed insulin help? Results from a subanalysis of the PRESENT study

Abstract

The aim of this analysis was to assess the efficacy and safety of intensifying insulin therapy from a basal-only regimen to biphasic insulin aspart 30 (BIAsp 30) in patients with type 2 diabetes previously failing to reach glycaemic targets. The analysis is based on data from a subpopulation of the Physicians’ Routine Evaluation of Safety and Efficacy of NovoMix® 30 Therapy (PRESENT) study, which was a 6-month observational study in 15 countries. This subanalysis included patients previously receiving long-acting analogue insulin (AB; n = 348), or human basal insulin (long and intermediate acting) (HB; n = 3414), who were transferred to BIAsp 30. Efficacy end-points included change in glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial plasma glucose (PPG), from baseline to the end of the study. Episodes of hypoglycaemia, adverse events, and physician and patient satisfaction were also recorded. End-points were considered separately by previous basal regimen (AB or HB). After 6 months' treatment with BIAsp 30, HbA1c was significantly lowered in both groups (−1.60% and −1.42% in the AB and HB groups; p < 0.0001 compared with baseline). Reductions in FPG and PPG were also statistically significant in both groups. The rate (events/patient/year) of overall hypoglycaemia remained relatively constant in patients switching from AB, but it was statistically lower in patients switching from HB (change from baseline −3.8; p < 0.001). In routine clinical practice, patients with type 2 diabetes who are failing to reach glycaemic targets on basal insulin can achieve better glycaemic control without an increase in overall hypoglycaemia by intensifying with BIAsp 30. Disclosure Hak Chul Jang, Serdar Guler and Marina Shestakova have no conflicts of interest. What's known Basal insulin is a commonly used insulin initiation regimen in patients with type 2 diabetes who fail to achieve optimal glycaemic control on oral anti-diabetic drugs. As type 2 diabetes takes its natural course of progression, treatment regimens need to be monitored and, when necessary, intensified to maintain acceptable glycaemic control. What's new To date, there are little data that demonstrate how effective modern premixes can be in type 2 patients who are failing to achieve glycaemic targets with basal insulin. The PRESENT study is a 6-month, prospective, uncontrolled, clinical experience evaluation study using biphasic insulin aspart 30 (BIAsp 30) for type 2 diabetes patients in daily clinical practice in several countries. In this subanalysis, we show that patients failing to achieve good control (as defined by HbA1c) on basal insulin were able to significantly improve their glycaemic control by simply intensifying with the modern premix insulin, BIAsp 30.