Comparative Study Of Insulin Regimens In Hospitalized Patients
Abstract
Diabetes mellitus is a complicated, long-term illness that is impacted by a number of environmental and genetic variables. Type 2 diabetes is associated with insulin resistance that eventually leads to gradual increase in the requirement of insulin either endogenous or exogenous. Diminished β-cell function is an important part of the disease progression in Type 2 diabetes. In the past few years, new research has provided fresh insights into the pathogenesis of this disease, the importance of Glucagon has gained new perspective in type 2 Diabetes.
The hormone insulin, which is produced by the Beta cells of pancreas, is essential for regulating blood sugar levels. Different insulin doses for basal and meals are used in basal-bolus, providing flexibility. Fixed-ratio insulin for meals and basal needs are combined in premix. Basal + OAD combines oral medicine with basal insulin. The efficiency and safety of several insulin regimens for the management of type 2 diabetes are examined and compared in this study.
References
2. Galicia-Garcia U, Benito-Vicente A, Jebari S, Larrea-Sebal A, Siddiqi H, Uribe KB, Ostolaza H, Martín C. Pathophysiology of type 2 diabetes mellitus. International journal of molecular sciences. 2020 Aug 30;21(17):6275.
3. Tokarz VL, MacDonald PE, Klip A. The cell biology of systemic insulin function. Journal of Cell Biology. 2018 Jul 2;217(7):2273-89.
4. Pasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE. Management of diabetes and hyperglycaemia in the hospital. The lancet Diabetes & endocrinology. 2021 Mar 1;9(3):174-88.
5. Chiang HH, Surampudi P, Sood A. Determinants of initial insulin therapy for hospitalized patients with diabetes mellitus. Journal of Diabetes and its Complications. 2022 Oct 1;36(10):108307.
6. Haw JS, Farrokhi F, Smiley D, Peng L, Reyes D, Newton C, Pasquel FJ, Vellanki P, Umpierrez GE. Comparison of basal insulin regimens on glycemic variability in noncritically ill patients with type 2 diabetes. Endocrine Practice. 2015 Dec 1;21(12):1333-43.
7. Kruger DF, Novak LM. Role of ultrafast-acting insulin analogues in the management of diabetes. Journal of the American Association of Nurse Practitioners. 2019 Sep 1;31(9):537-48.
8. Galindo RJ, Pasquel FJ, Vellanki P, Alicic R, Lam DW, Fayfman M, Migdal AL, Davis GM, Cardona S, Urrutia MA, Perez‐Guzman C. Degludec hospital trial: A randomized controlled trial comparing insulin degludec U100 and glargine U100 for the inpatient management of patients with type 2 diabetes. Diabetes, Obesity and Metabolism. 2022 Jan;24(1):42-9.
9. Mehta R, Chen R, Hirose T, John M, Kok A, Lehmann R, Unnikrishnan AG, Yavuz DG, Fulcher G. Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines. Diabetes, Obesity and Metabolism. 2020 Nov;22(11):1961-75.
10. 1Moon SJ, Choe HJ, Kwak SH, Jung HS, Park KS, Cho YM. Comparison of Prevailing Insulin Regimens at Different Time Periods in Hospitalized Patients: A Real-World Experience from a Tertiary Hospital. Diabetes Metab J. 2022 May;46(3):439-450.
11. 1Garber AJ, King AB, Del Prato S, Sreenan S, Balci MK, Muñoz-Torres M, Rosenstock J, Endahl LA, Francisco AM, Hollander P. Insulin degludec, an ultra-longacting basal insulin, versus insulin glargine in basal-bolus treatment with mealtime insulin aspart in type 2 diabetes (BEGIN Basal-Bolus Type 2): a phase 3, randomised, open-label, treat-to-target non-inferiority trial. The Lancet. 2012 Apr 21;379(9825):1498-507.
12. Bellido V, Suarez L, Rodriguez MG, Sanchez C, Dieguez M, Riestra M, Casal F, Delgado E, Menendez E, Umpierrez GE. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes. Diabetes care. 2015 Dec 1;38(12):2211-6.
13. Kalra S, Czupryniak L, Kilov G, Lamptey R, Kumar A, Unnikrishnan AG, Boudiba A, Abid M, Akanov ZA, Latheef A, Araz M. Expert opinion: patient selection for premixed insulin formulations in diabetes care. Diabetes Therapy. 2018 Dec 9:2185-99.
14. Janka HU, Plewe G, Busch K. Combination of oral antidiabetic agents with basal insulin versus premixed insulin alone in randomized elderly patients with type 2 diabetes mellitus. Journal of the American Geriatrics Society. 2007 Feb;55(2):182-8.
15. Broz J, Janickova Zdarska D, Stepanova R, Kvapil M. Addition of basal insulin to oral antidiabetic agents in patients with inadequately controlled type 2 diabetes leads to improved HbA1c levels: metabolic control, frequency of hypoglycemia, and insulin titration analysis as results of a prospective observational study (Bali study). Diabetes Therapy. 2019 Apr 10:663-72.
16. Cheng CN, Wang CY, Lin HW, Chang TY, Lin HJ, Chou C, Lin FJ. Clinical outcomes of basal insulin and oral antidiabetic agents as an add-on to dual therapy in patients with type 2 diabetes mellitus. Scientific Reports. 2020 Apr 1;10(1):5746.
17. Pérez A, Ramos A, Carreras G. Insulin Therapy in Hospitalized Patients. Am J Ther. 2020 Jan/Feb;27(1) e71-e78.17
18. Cernea S, Raz I. Insulin Therapy: Future Perspectives. Am J Ther. 2020 Jan/Feb;27(1) e121-e132.18
19. Dias DL, Gomes EJ. Insulin prescribing pattern in geriatric type 2 diabetic mellitus patients of different nutritional status at a tertiary level of health care: a retrospective study. Int J Basic Clin Pharmacol asashe2019;8:584-8.19
20. Haque WZ, Demidowich AP, Sidhaye A, Golden SH, Zilbermint M. The j alahaFinancial Impact of an Inpatient Diabetes Management Service. Curr Diab Rep. 2021 Jan 15;21(2):5.20
21. Raccah D, Huet D, Dib A, Joseph F, Landers B, Escalada J, Schmitt H. Review of basal-plus insulin regimen options for simpler insulin intensification in people with Type 2 diabetes mellitus. Diabet Med. 2017 Sep;34(9):1193-1204.21
22. Rodbard HW, Rodbard D. Biosynthetic Human Insulin and Insulin Analogs. Am J Ther. 2020 Jan/Feb;27(1):e42-e51.22
23. Silver B, Ramaiya K, Andrew SB, Fredrick O, Bajaj S, Kalra S, Charlotte BM, Claudine K, Makhoba A. EADSG guidelines: insulin therapy in diabetes. Diabetes therapy. 2018 Apr;9:449-92.23
24. Chen M, Zhang P, Zhao Y, Duolikun N, Ji L. Where to Initiate Basal Insulin Therapy: Inpatient or Outpatient Department? Real-World Observation in China. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2022 Jan 1:3375-85.24
25. Ghosal S, Sinha B, Majumder A, Das AK, Singh AK, Ghoshdastidar B, Maji D, Goyal G, Mukherjee JJ, Gangopadhyay KK, John M, Chatterjee S, Jaggi S, Ray S, Majumdar S, Sharma SK. Consensus on "Basal insulin in the management of Type 2 Diabetes: Which, When and How?". J Assoc Physicians India. 2017 Jul;65(7):51-62.25
26. Levien TL, Baker DE, White JR Jr, Campbell RK. Insulin glargine: a new basal insulin. Ann Pharmacother. 2002 Jun;36(6):1019-27. doi: 10.1345/aph.1A301. PMID: 12022906.26
27. Halberg IB, Lyby K, Wassermann K, Heise T, Zijlstra E, Plum-Mörschel L. Efficacy and safety of oral basal insulin versus subcutaneous insulin glargine in type 2 diabetes: a randomised, double-blind, phase 2 trial. The Lancet Diabetes & Endocrinology. 2019 Mar 1;7(3):179-88.27
28. Siddiq A, Bharathi DR, Raj R, Benny J, Saji S, Sree Lakshmi P. A study on insulin use, prescription pattern and its regimens in a tertiary care hospital. Insulin. 2019 May 31;9:05.28
29. Haw JS, Farrokhi F, Smiley D, Peng L, Reyes D, Newton C, Pasquel FJ, Vellanki P, Umpierrez GE. Comparison of basal insulin regimens on glycemic variability in noncritically ill patients with type 2 diabetes. Endocrine Practice. 2015 Dec 1;21(12):1333-43.29
30. Garber AJ, Ligthelm R, Christiansen JS, Liebl A. Premixed insulin treatment for type 2 diabetes: analogue or human?. Diabetes, Obesity and Metabolism. 2007 Sep;9(5):630-9.30
31. Yki-Järvinen H, Kauppila M, Kujansuu E, Lahti J, Marjanen T, Niskanen L, Rajala S, Ryysy L, Salo S, Seppälä P, Tulokas T. Comparison of insulin regimens in patients with non-insulin-dependent diabetes mellitus. New England Journal of Medicine. 1992 Nov 12;327(20):1426-33.31
32. Umpierrez GE, Smiley D, Hermayer K, Khan A, Olson DE, Newton C, Jacobs S, Rizzo M, Peng L, Reyes D, Pinzon I. Randomized study comparing a Basal-bolus with a basal plus correction insulin regimen for the hospital management of medical and surgical patients with type 2 diabetes: basal plus trial. Diabetes care. 2013 Aug 1;36(8):2169-74.32
33. Raskin P, Allen E, Hollander P, Lewin A, Gabbay RA, Hu P, Bode B, Garber A, INITIATE Study Group. Initiating insulin therapy in type 2 diabetes: a comparison of biphasic and basal insulin analogs. Diabetes care. 2005 Feb 1;28(2):260-5.33
34. Pérez A, Reales P, Barahona MJ, Romero MG, Minambres I, HOSMIDIA Study Group. Efficacy and feasibility of basal–bolus insulin regimens and a discharge‐strategy in hospitalised patients with type 2 diabetes–the HOSMIDIA study. International Journal of Clinical Practice. 2014 Oct;68(10):1264-71.34
35. Wysham C, Bhargava A, Chaykin L, de la Rosa R, Handelsman Y, Troelsen LN, Kvist K, Norwood P. Effect of insulin degludec vs insulin glargine U100 on hypoglycemia in patients with type 2 diabetes: the SWITCH 2 randomized clinical trial. Jama. 2017 Jul 4;318(1):45-56.35
36. Zinman B, Philis-Tsimikas A, Cariou B, Handelsman Y, Rodbard HW, Johansen T, Endahl L, Mathieu C, NN1250-3579 (BEGIN Once Long) Trial Investigators. Insulin degludec versus insulin glargine in insulin-naive patients with type 2 diabetes: a 1-year, randomized, treat-to-target trial (BEGIN Once Long). Diabetes care. 2012 Dec 1;35(12):2464-71.36
37. Onishi Y, Iwamoto Y, Yoo SJ, Clauson P, Tamer SC, Park S. Insulin degludec compared with insulin glargine in insulin‐naïve patients with type 2 diabetes: A 26‐week, randomized, controlled, P an‐Asian, treat‐to‐target trial. Journal of diabetes investigation. 2013 Nov;4(6):605-12.37
38. Fulcher GR, Christiansen JS, Bantwal G, Polaszewska-Muszynska M, Mersebach H, Andersen TH, Niskanen LK. Comparison of insulin degludec/insulin aspart and biphasic insulin aspart 30 in uncontrolled, insulin-treated type 2 diabetes: a phase 3a, randomized, treat-to-target trial. Diabetes Care. 2014 Aug 1;37(8):2084-90.38
39. Philis‐Tsimikas A, Del Prato S, Satman I, Bhargava A, Dharmalingam M, Skjøth TV, Rasmussen S, Garber AJ. Effect of insulin degludec versus sitagliptin in patients with type 2 diabetes uncontrolled on oral antidiabetic agents. Diabetes, Obesity and Metabolism. 2013 Aug;15(8):760-6.39
40. Gracia-Ramos AE, Cruz-Domínguez MD, Madrigal-Santillán EO, Morales-González JA, Madrigal-Bujaidar E, Aguilar-Faisal JL. Premixed insulin analogue compared with basal-plus regimen for inpatient glycemic control. Diabetes Technology & Therapeutics. 2016 Nov 1;18(11):705-12.40
41. Broz J, Janickova Zdarska D, Urbanova J, Pithova P, Donicova V, Palova S, Pelechova B, Smrzova A, Kvapil M. Insulin Management of Patients with Inadequately Controlled Type 2 Diabetes Admitted to Hospital: Titration Patterns and Frequency of Hypoglycemia as Results of a Prospective Observational Study (Hospital Study). Diabetes Therapy. 2021 Jul;12(7):1799-808.41
42. Sendekie AK, Netere AK, Belachew EA. Hypoglycemic events and glycemic control effects between NPH and premixed insulin in patients with type 2 diabetes mellitus: A real-world experience at a comprehensive specialized hospital in Ethiopia. PLoS One. 2022 Sep 23;17(9):e0275032.42
43. Kisioglu SV, Demir AS, Tufekci D, Emur Gunay Y, Coskun H, Ucuncu O, Nuhoglu I, Kocak M, Karakullukcu S, Ersoz HO. Clinical research of insulin glargine U300 basal‐bolus therapy and insulin degludec/aspart co‐formulation in type 2 diabetes mellitus: A real world experience. International Journal of Clinical Practice. 2021 Sep;75(9):e14377.43
44. Umpierrez GE, Gianchandani R, Smiley D, Jacobs S, Wesorick DH, Newton C, Farrokhi F, Peng L, Reyes D, Lathkar-Pradhan S, Pasquel F. Safety and efficacy of sitagliptin therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes: a pilot, randomized, controlled study. Diabetes care. 2013 Nov 1;36(11):3430-5.44