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Relationship between HbA1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin.

Abstract

BACKGROUND

To examine the relationship between glycaemic control and hypoglycaemia in patients with type 2 diabetes treated with metformin (Met) and either insulin lispro mixtures, given twice or thrice daily (LM + Met), or insulin glargine, given once daily (G + Met).

METHODS

Data from three randomized clinical trials were pooled to compare effects of LM + Met with G + Met.

RESULTS

The LM + Met group achieved lower mean HbA(1c) (mean+/-SE, 7.2+/-0.1 vs. 7.7+/-0.1%, p<0.0001) and all meals combined post-prandial blood glucose (BG) (8.9+/-0.1 vs. 10.2+/-0.1 mmol/L, p<0.0001) compared with the G + Met group, but had higher fasting blood glucose (8.1+/-0.1 vs. 6.8+/-0.1 mmol/L, p<0.0001) and insulin requirement (0.7+/-0.01 vs. 0.6+/-0.01 U/kg, p<0.0001). Over the entire study period, daytime hypoglycaemia was higher for the LM + Met group (10.3 vs. 3.5 episodes/patient/year, p<0.0001) than for the G + Met group; however, nocturnal hypoglycaemia was lower (3.4 vs. 6.6 episodes/patient/year, p=0.003). At endpoint, daytime hypoglycaemia was higher for the LM + Met group (6.2 vs. 1.4 episodes/patient/year, p<0.0001); however, nocturnal hypoglycaemia was similar in both groups (1.9 vs. 3.0 episodes/patient/year). An inverse relationship was observed between all confirmed hypoglycaemia and HbA(1c) at endpoint; for every 1% reduction in HbA(1c), the increase (in slope) was 1.4 episodes/patient/year (p=0.04). Patients with confirmed hypoglycaemia had lower HbA(1c) than patients without hypoglycaemia (7.39 vs. 7.64%, respectively; decrement=0.26%, p=0.026).

CONCLUSIONS

These studies demonstrated an inverse relationship between HbA(1c) and 24-h and daytime hypoglycaemia. Lispro insulin mixtures provided lower HbA(1c) and post-prandial blood glucose values than glargine, but caused more daytime hypoglycaemia. Frequency of nocturnal hypoglycaemia was similar and severe hypoglycaemia was rare with both insulin regimens.

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    Eli Lilly Canada Inc., Toronto, Ontario, Canada. chanj@lilly.com

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    MeSH

    Adult
    Aged
    Aged, 80 and over
    Diabetes Mellitus, Type 2
    Fasting
    Female
    Glycated Hemoglobin A
    Humans
    Hypoglycemia
    Hypoglycemic Agents
    Insulin
    Insulin Glargine
    Insulin Lispro
    Insulin, Long-Acting
    Male
    Metformin
    Middle Aged

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    19156705

    Citation

    Chan, John Y C., et al. "Relationship Between HbA1c and Hypoglycaemia in Patients With Type 2 Diabetes Treated With Different Insulin Regimens in Combination With Metformin." Diabetes/metabolism Research and Reviews, vol. 25, no. 3, 2009, pp. 224-31.
    Chan JY, Leyk M, Frier BM, et al. Relationship between HbA1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin. Diabetes Metab Res Rev. 2009;25(3):224-31.
    Chan, J. Y., Leyk, M., Frier, B. M., & Tan, M. H. (2009). Relationship between HbA1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin. Diabetes/metabolism Research and Reviews, 25(3), pp. 224-31. doi:10.1002/dmrr.929.
    Chan JY, et al. Relationship Between HbA1c and Hypoglycaemia in Patients With Type 2 Diabetes Treated With Different Insulin Regimens in Combination With Metformin. Diabetes Metab Res Rev. 2009;25(3):224-31. PubMed PMID: 19156705.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Relationship between HbA1c and hypoglycaemia in patients with type 2 diabetes treated with different insulin regimens in combination with metformin. AU - Chan,John Y C, AU - Leyk,Malgorzata, AU - Frier,Brian M, AU - Tan,Meng H, PY - 2009/1/22/entrez PY - 2009/1/22/pubmed PY - 2009/5/22/medline SP - 224 EP - 31 JF - Diabetes/metabolism research and reviews JO - Diabetes Metab. Res. Rev. VL - 25 IS - 3 N2 - BACKGROUND: To examine the relationship between glycaemic control and hypoglycaemia in patients with type 2 diabetes treated with metformin (Met) and either insulin lispro mixtures, given twice or thrice daily (LM + Met), or insulin glargine, given once daily (G + Met). METHODS: Data from three randomized clinical trials were pooled to compare effects of LM + Met with G + Met. RESULTS: The LM + Met group achieved lower mean HbA(1c) (mean+/-SE, 7.2+/-0.1 vs. 7.7+/-0.1%, p<0.0001) and all meals combined post-prandial blood glucose (BG) (8.9+/-0.1 vs. 10.2+/-0.1 mmol/L, p<0.0001) compared with the G + Met group, but had higher fasting blood glucose (8.1+/-0.1 vs. 6.8+/-0.1 mmol/L, p<0.0001) and insulin requirement (0.7+/-0.01 vs. 0.6+/-0.01 U/kg, p<0.0001). Over the entire study period, daytime hypoglycaemia was higher for the LM + Met group (10.3 vs. 3.5 episodes/patient/year, p<0.0001) than for the G + Met group; however, nocturnal hypoglycaemia was lower (3.4 vs. 6.6 episodes/patient/year, p=0.003). At endpoint, daytime hypoglycaemia was higher for the LM + Met group (6.2 vs. 1.4 episodes/patient/year, p<0.0001); however, nocturnal hypoglycaemia was similar in both groups (1.9 vs. 3.0 episodes/patient/year). An inverse relationship was observed between all confirmed hypoglycaemia and HbA(1c) at endpoint; for every 1% reduction in HbA(1c), the increase (in slope) was 1.4 episodes/patient/year (p=0.04). Patients with confirmed hypoglycaemia had lower HbA(1c) than patients without hypoglycaemia (7.39 vs. 7.64%, respectively; decrement=0.26%, p=0.026). CONCLUSIONS: These studies demonstrated an inverse relationship between HbA(1c) and 24-h and daytime hypoglycaemia. Lispro insulin mixtures provided lower HbA(1c) and post-prandial blood glucose values than glargine, but caused more daytime hypoglycaemia. Frequency of nocturnal hypoglycaemia was similar and severe hypoglycaemia was rare with both insulin regimens. SN - 1520-7560 UR - https://www.unboundmedicine.com/medline/citation/19156705/Relationship_between_HbA1c_and_hypoglycaemia_in_patients_with_type_2_diabetes_treated_with_different_insulin_regimens_in_combination_with_metformin_ L2 - https://doi.org/10.1002/dmrr.929 DB - PRIME DP - Unbound Medicine ER -