Combination Insulin Therapy with Pre-Mixed Intermediate/Rapid-Acting Insulin (70/30) and Insulin Lispro Mimicking Physiologic Insulin Secretion: Optimal Glycemic Treatment with Systainability of Control in Type 2 Diabetic Patients

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Title Combination Insulin Therapy with Pre-Mixed Intermediate/Rapid-Acting Insulin (70/30) and Insulin Lispro Mimicking Physiologic Insulin Secretion: Optimal Glycemic Treatment with Systainability of Control in Type 2 Diabetic Patients
 
Creator Nestor Eric R Laplano; Resident, Department of Medicine, University of Santo Tomas Hospital, España Manila, Philippines
Deidri Anne M Quiambao; Fellow, Section of Endocrinology and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila
Jean Uy; Fellow, Section of Endocrinology and Metabolism, Department of Medicine, University of Santo Tomas Hospital, Manila
Leilani B Mercado-Asis; 3Associate Professor, Faculty of Medicine and Surgery, University of Santo Tomas, Chief Section of Endocrinology and Metabolism, University of Santo Tomas, España Manila
 
Subject Medicine
combination insulin; insulin 70/30; lispro
 
Description Background: Physiologic pancreatic response to glucose load yields two peaks of insulin secretion: the first peak within 30 minutes, and the second on the 2nd to 3rd hour after the stimulus. Objective: Our aim was to show that a combination therapy designed to mimic this insulin secretion obtains optimal glycemic control with sustainability. Methods: In this descriptive retrospective study, we measured glycemic control and sustainability in terms of reduction in HbA1c and postprandial capillary blood glucose (pCBG) between patients on insulin 70/30 with lispro and insulin 70/30 alone. We reviewed records of 218 patients (153 females; 65 males) in an outpatient endocrinology clinic. Initial and follow-up pCBG (2 to 4 hours after lunch) and HbA1c were measured and compared among study groups. Metformin 1000 to 1500 mg daily was given in combination with insulin. Results: There was a significant reduction (33%) in pCBG from baseline in patients (n=141) placed on premixed insulin alone (p value <0.0005). A greater significant reduction (45%) in pCBG was obtained in patients (n=39) on premixed insulin and lispro (p value <0.009). Serial HbA1c determination (n=78) showed an initial reduction of 17.5% (from 9.07% to 7.48%) within a mean duration of 7 months (3-21 months). On further follow-up with a mean duration of 5.7 months (3-15 months), a sustained reduction of 18% in HbA1c (mean at 7.44%; n=23) was noted. With automatic snacking instructions, hypoglycemic episodes were insignificant. Conclusion: Combination insulin therapy with 70/30 and lispro mimicking physiologic insulin secretion yielded sustainability of glycemic control (18% HbA1c reduction) in type 2 DM patients. Keywords: combination insulin; insulin 70/30; lispro DOI: 10.3860/pjim.v47i3.1650   Phil. J. Internal Medicine, 47: 93-97, May-June, 2009
 
Publisher The Philippine College of Physicians
 
Contributor —
 
Date 2010-07-23
 
Type Peer-Reviewed Article
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Format application/pdf
 
Identifier http://www.philjol.info/index.php/PJIM/article/view/1650
 
Source Philippine Journal of Internal Medicine; Vol 47, No 3 (2009); 94-97
 
Language en
 
Coverage Philippines
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