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Associate Professor of Clinical Pharmacy College of Pharmacy Western University of Health Sciences 309 East Second Street Pomona, California 91766-1854 fax 909/469-5539 evivian{at}westernu.edu
Published Online, April 5, 2005. www.theannals.com, DOI 10.1345/aph.1D635b
The data regarding the initial use of premixed insulin are conflicting.
Raskin et
al.2 compared
insulin glargine versus premixed 70% NPH/30% aspart in patients with type 2
diabetes who failed to obtain glycemic control with oral agents. Patients were
randomized to receive metformin 1550–2550 mg in addition to glargine at
bedtime or premixed 70% NPH/30% aspart twice a day. Patients in the premix
group had greater reductions in HbA1C compared with those in
the glargine group (–2.8% vs –2.4%; p < 0.01). In addition, 66%
of patients in the premix group reached the HbA1C goal of
7% compared with 40% of patients in the glargine group.
Janka et al.3 compared glargine with premixed 70% NPH/30% regular insulin in patients with type 2 diabetes who failed to reach glycemic goals with antidiabetic agents. Patients receiving glargine once daily in addition to oral antidiabetic agents (glimipiride plus metformin) had greater reductions in HbA1C (–1.6% vs –1.3%; p = 0.0003) and less nocturnal hypoglycemia (46% vs 29%; p = 0.0013) than patients receiving premixed 70% NPH/30% regular insulin. In both studies, hypoglycemia was more common in patients receiving 2 injections of premixed insulin per day.2,3
Patient variables, insulin pharmacokinetics and compatibility, and cost must be considered before selecting an insulin regimen for a patient. In general, patients prefer insulin pen administration or premixed insulin to free-mixed insulin administered with syringes, but insulin pens and premixed insulin are more expensive than free-mixed insulin.4
Ultimately, the goal is to select an insulin regimen that achieves euglycemia without compromising a patient's quality of life. "We need to keep our (and the patient's) eye on the brass ring, ie, near euglycemia. It does not matter how we get there as long as we do."5
References
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