Humalog® Mix50™ before carbohydrate-rich meals in type 2 diabetes mellitus

Aim: To compare pre‐meal injection of Humalog® Mix50™ (Mix50) and Humalog® Mix25™ (Humalog® Mix75/25™ in the US; Mix25) with respect to 2 h postprandial (2 h pp) blood glucose (BG) control after a carbohydrate‐rich breakfast in patients with type 2 diabetes. Research Design and Methods: One hundred and sixteen patients were enrolled in a 16‐week crossover trial and received two treatment regimens in a randomized crossover fashion: (i) Mix50 before breakfast and Mix25 before the evening meal (Mix50/Mix25) and (ii) Mix25 before both breakfast and the evening meal (Mix25 twice daily). Insulin doses were adjusted according to stated glycaemic targets. After 6 and 8 weeks of treatment, the patient's usual morning insulin dose was administered, followed immediately by a test breakfast representative of the patient's usual breakfast meal. Fasting and 2 h pp BG concentrations were measured at the time of the test meal. Haemoglobin A1c (A1C) was measured, and information regarding hypoglycaemia (symptoms) was collected at the end of each treatment period. Results: Insulin doses were similar between treatments (morning = 31–33 U, evening = 26–28 U) at endpoint. Following the test breakfast, the 2 h pp BG was lower (10.9 ± 0.3 mmol/l vs. 12.4 ± 0.3 mmol/l, p = 0.0012) and the 2 h pp BG excursion was smaller (1.4 ± 0.28 mmol/l vs. 3.5 ± 0.28 mmol/l, p