Effects on post-prandial glucose and AGE precursors from two initial insulin strategies in patients with Type 2 diabetes uncontrolled by oral agents Journal of Diabetes and its Complications, 05/17/2012

Sakharova OV et al. - In type 2 diabetes patients failing oral anti-hyperglycemic drugs (OADs) therapy, an initial insulin regimen of twice daily premixed insulin results in significantly improved post-prandial glucose levels as well as a reduction in a precursor of AGEs. The effect of these two initial insulin regimens on long-term diabetic complications requires further study.

• This was a 6-month, open-label, single-center study using a cross-over design.
• 14 subjects were randomized to one of two protocols: once daily insulin glargine or twice-daily 75%/25% neutral protamine lispro/lispro mix.
• At 12 weeks, the subjects were crossed-over to the opposite protocol.
• During each period, insulin doses were titrated to target fasting blood glucose of 90–110mg/dL.
• At baseline and after the two 12-week treatment periods, subjects were studied in the Clinical Research Center; they consumed three liquid mixed isocaloric meals at 4-h intervals, and glucose, free fatty acids (FFA), lipids, and α-dicarbonyls (3-deoxyglucosone [3-DG] and methylglyoxal [MG]) were measured before and after each meal.
• Patient data were analyzed in the context of their assigned insulin strategy groups.

• Both insulin regimens led to a significant improvement in glycemic profiles, including fasting glucose and HbA1c, compared to baseline.
• However, mean post-prandial glucose was lower with lispro mix than with glargine (153±36 vs. 199±49 mg/dL, respectively; P=0.001).
• Likewise, there was a reduction in both fasting (48±13 vs. 57±19, P=0.047) and post-prandial (53±19 vs. 63±23; P=0.007) 3DG levels with lispro mix as compared to glargine.
• No differences were noted in MG concentrations.