Initiating Insulin Therapy in Type 2 Diabetes: A comparison of biphasic and basal insulin analogs

OBJECTIVE:--Safety and efficacy of biphasic insulin aspart 70/30 (BIAsp 70/30, prebreakfast and presupper) were compared with once-daily insulin glargine in type 2 diabetic subjects inadequately controlled on oral antidiabetic drugs (OADs). RESEARCH DESIGN AND METHODS--This 28-week parallel-group study randomized 233 insulin-naive patients with HbA[subscript 1c] values [>/=]8.0% on >1,000 mg/day metformin alone or in combination with other OADs. Metformin was adjusted up to 2,550 mg/day before insulin therapy was initiated with 5-6 units BIAsp 70/30 twice daily or 10-12 units glargine at bedtime and titrated to target blood glucose (80-110 mg/dl) by algorithm-directed titration. RESULTS:--A total of 209 subjects completed the study. At study end, the mean HbA[subscript 1c] value was lower in the BIAsp 70/30 group than in the glargine group (6.91 ± 1.17 vs. 7.41 ± 1.24%, P < 0.01). The HbA[subscript 1c] reduction was greater in the BIAsp 70/30 group than in the glargine group (-2.79 ± 0.11 vs. -2.36 ± 0.11%, respectively; P < 0.01), especially for subjects with baseline HbA[subscript 1c] >8.5% (-3.13 ± 1.63 vs. -2.60 ± 1.50%, respectively; P < 0.05). More BIAsp 70/30-treated subjects reached target HbA[subscript 1c] values than glargine-treated subjects (HbA[subscript 1c]