Three-Year Efficacy of Complex Insulin Regimens in Type 2 Diabetes

In this 3-year multicenter trial, patients with suboptimal glycated hemoglobin levels while receiving metformin and sulfonylurea therapy were randomly assigned to add biphasic, prandial, or basal insulin. During the first year, sulfonylurea therapy was replaced by additional insulin for unacceptable hyperglycemia or subsequently for a glycated hemoglobin level of more than 6.5%. Basal- or prandial-based insulin regimens more often achieved glycated hemoglobin targets. Fewer hypoglycemic episodes and less weight gain occurred with regimens initiated with basal insulin. Basal- or prandial-based insulin regimens more often achieved glycated hemoglobin targets. Fewer hypoglycemic episodes and less weight gain occurred with regimens initiated with basal insulin. Most patients with type 2 diabetes require insulin therapy when oral antidiabetic agents provide suboptimal glycemic control, since long-term glycemic improvement reduces the risks of both microvascular 1 and macrovascular 1 , 2 complications. However, different insulin regimens have varying effects on glycemic control, weight gain, and the risk of hypoglycemia. 3 In the first phase of the Treating to Target in Type 2 Diabetes (4-T) study, we evaluated patients with type 2 diabetes who had suboptimal glycemic control despite maximally tolerated doses of metformin and sulfonylurea to see whether the randomized addition of a biphasic, prandial, or basal analogue insulin would lead to . . .