Biphasic insulin aspart-30 reduces glycemic variability to a greater degree than insulin detemir: A randomized controlled trial of once-daily insulin regimens using continuous glucose monitoring.

IntroductionWe compared the efficacy of insulin detemir and biphasic insulin aspart-30 given in the morning as an add-on to oral hypoglycemic agents in type 2 diabetes patients. Materials and MethodsThe present study enrolled 30 patients with poorly controlled type 2 diabetes (8% glycated hemoglobin < 11%) being treated with oral hypoglycemic agent mono- or combination therapy with biguanides, sulfonylureas or thiazolidinediones. The patients were randomly assigned to insulin detemir (group D) or insulin aspart-30 (group A) given in the morning as add-on to oral hypoglycemic agents. After adjusting their insulin doses, the patients that underwent continuous glucose monitoring during a 3-day hospitalization and with day 2 continuous glucose monitoring data were subjected to analysis. ResultsThere was no significant difference in patient background, baseline glycated hemoglobin levels and insulin doses during continuous glucose monitoring between the two groups. The percent coefficient of variation of 24-h glucose levels was significantly lower in group A (20.4 7.6) than in group D (27.1 +/- 6.5; P = 0.015). Similarly, mean amplitude of glycemic excursions was significantly smaller in group A (80 +/- 32) than in group D (102 +/- 14; P = 0.021). Postprandial glucose excursions were significantly smaller after breakfast in group A (65 +/- 31 mg/dL) than in group D (106 +/- 32 mg/dL; P = 0.002). ConclusionsAs once-daily insulin injection therapy given before breakfast in type 2 diabetes patients, the biphasic insulin analog might represent a better insulin option in significantly lowering the percent coefficient of variation and mean amplitude of glycemic excursions than the long-acting insulin preparation.