Newly Published Study Results Showed That Two Mealtime Insulin Dosing Algorithms Were Effective for Patients with Type ...(arb Counting) (P.70); respective values ...),Health

Date:7/22/2008

arb Counting) (P=.70); respective values for A1C <6.5 percent were 44.3 percent and 49.5 percent (P=.28). The Simplified Algorithm group had 53 episodes of severe hypoglycemia in 19 patients, and the Carb Counting group had 37 episodes in 19 patients, leading to estimates of 0.89 and 0.67 event/patient-year for the two groups (P=0.58). SMBG < 50 mg/dL with symptoms was slightly but statistically significantly more common in the Carb Counting group than in the Simplified Algorithm group (8.0 vs. 4.9 events/patient-year, P=0.02).

"A combination of basal and bolus insulin may be needed to achieve optimal glucose control in type 2 diabetes patients," explained study author Richard M. Bergenstal, MD, executive director, International Diabetes Center, Park Nicollet Health Services, Minneapolis, MN. "The simplified algorithm investigated in this study allowed patients to start with a fixed dose of Apidra(R) and then effectively adjust to target based on premeal glucose patterns, or to use carbohydrate counting, which involves a mathematical formula that helps patients match the size of their mealtime insulin dose with the amount of carbohydrates they eat. Having two effective options for managing mealtime insulin doses may increase patients' and clinicians' willingness to initiate basal-bolus therapy."

Throughout the study, SMBG levels were recorded before meals and at bedtime each day, as well as a 7-point blood glucose profile at weeks 2, 6, 12, 18, and 24 (endpoint). Blood glucose values at each visit declined in both arms, and the within-group change from baseline was statistically significant over all daily time points and study visits. By the study's conclusion, both arms significantly improved fasting plasma glucose (FPG) levels as well, with averages of 112.0 mg/dl in the Simplified Algorithm group and 101.8 mg/dl in the Carb Counting group (P<0.0001 for both groups).

"Type 2 diabetes is a progressive disease that requires treatment adjustments
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