Title: Evaluation of Effective Insulin Preparations for Glycemic control among type II Diabetes patients in a Tertiary Care Hospital

Authors: Dr Chinnusamy K, Thangamani S, Simi Joju K

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.101

Abstract

Introduction: The intensification of diabetes treatment that is, the transition from oral antidiabetic drugs to injectable treatments such as insulin is often delayed in many patients, which substantially increases the risk of diabetes-related complications. Therefore, in the present study, we evaluated the clinical effectiveness of different types of insulin preparations in patients with type II diabetes for glycemic control.

Methodology: Prospective Observational Study and it was conducted in the outpatient department of General Medicine, Karuna Medical College Hospital Palakkad in the duration of six months (November 2017 to April 2018). Patients with T2DM and treated with either Insulin Glargine or Premixed insulin preparations (70% NPH/ 30% RI, 50% NPH/50% RI or NPH or lispro and apart in a ratio of 70/30 or 75/25) using pen injector or insulin syringe were included and Baseline and after three months (Review) FBS, PPBS, RBS, HbA1c values were recorded.

Results and Discussion: After 3 months (Review I), PHI group reached statistically significant reduction on FBS (P=0.0001***), PPBS (P=0.0001***) and HbA1c (P=0.0004***). PIA group reached statistically significant small reduction on FBS (P=0.0565*), RBS (P=0.0366*), PPBS (P=0.0177*) as compared than PHI group. GLA group reached statistically significant reduction on FBS (P=0.0048**) and PPBS (P=0.0009***) only and there was no significant reduction of HbA1c.

Conclusion: Insulin Glargine and Premixed Insulin Analogues with or without OHAs are less effective insulin preparations when compared with Premixed Human Insulin (significant reduction in FBS (mg/dL), PPBS (mg/dL), and HbA1c (%)) for patients with T2DM who were inadequately controlled with OHAs.

Keywords: Insulin, Type II diabetes, Glycemic Control.

References

  1. Kanatsuka A et al., Evaluation of insulin regimens as an effective option for glycemic control in patients with type 2 diabetes: A propensity score-matched cohort study across Japan (JDDM31). J Diabetes Invest, 2014; 5: 539–547
  2. Ogbera A et al., Insulin use, prescription patterns, regimens and costs-a narrative from a developing country. Diabetology & Metabolic Syndrome. 2012; 4:50
  3. Ranjit Unnikrishnan et al., Diabetes mellitus and its complications in India. ijcpr 2016; 357-70.
  4. Anjana, R. M. et al.Incidence of diabetes and prediabetes and predictors of progression among Asian Indians: 10‑year follow-up of the Chennai Urban Rural Epidemiology Study (CURES). Diabetes Care 2015;38, 1441–1448.
  5. Qiao Q. et al., Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian cohorts. Diabetes Care 2003;26, 1770–1780.
  6. Lassalle James R et al., Insulin therapy in Type 2 diabetes mellitus: A practical approach for primary care physicians and other health care professionals. Journal of American osteopathic association 2103; 113(3):202.
  7. Yamada S. et al., Switching from premixed human insulin to Premixed Insulin Lispro: A Prospective Study comparing the effects on glucose control and quality of lif, Internal medicine.2007; 42(12)1513-1517.
  8. Hammer H et al., Patients with type 2 diabetes inadequately controlled on premixed insulin: effect of initiating insulin Glargine plus Oral anti-diabetic agents on glycemic control in daily practice. Int J Pract 2007; 61: 2009-2018.
  9. Abhishek Singhaiet al., Comparison of Insulin Glargine with Human Premix Insulin in Patients with Type 2 Diabetes Inadequately Controlled on Oral Hypoglycemic Drugs in a 24-week Randomized Study among Central Indian Population. Diabetic care 2015;38(12): 2211-2216.
  10. Cenci DR et al., Analysis of balance in diabetic patients through the F-Scan system and the berg balance scale. FisiotMov2013; 26(1):55-61.

Corresponding Author

Dr Chinnusamy K

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mob: 8838826058