Aim: T2DM patients are shifted to long-acting insulin analogs when premixed insulin therapy becomes insufficient for individuals to achieve glycemic control. The objective of this study was to investigate glucose patterns from continuous glucose monitoring (CGM) for the clinical assignment of Asian T2DM patients with poor glucose control to Gla-300 basal-plus or Gla-300 basal-bolus therapy.
Method: 20 T2DM premixed insulin outpatients requiring therapy change were enrolled in the study. Based on clinical judgment during routine follow-up, patients were switched to Gla-300 basal-plus or Gla-300 basal-bolus therapy by clinicians. Adjustments were not made to patients’ diet or daily routines. Non-real time CGM was prospectively applied at baseline and one month after switching insulin therapy regimens. Mean fasting and postprandial glucose levels, glucose excursion markers, including mean amplitude of glucose excursion (MAGE) and standard deviation of plasma glucose (SDPG), estimated A1C from CGM and frequency of hypoglycemia were recorded for computer-assisted analysis.
Result: Baseline CGM data indicated that pre-meal (dinner) glucose levels (129 ± 33 vs. 204 ± 92 mg/dL, p=0.046), SDPG (52 ± 11 vs. 72 ± 21 mg/dL, p=0.029) and MAGE (119 ± 26 vs. 174 ± 32 mg/dL, p=0.038) were statistically lower in patients shifted to basal-plus therapy than those shifted to basal-bolus therapy. One month after initiating Gla-300-based insulin therapies, glucose excursion manifestations, estimated A1C levels and hypoglycemia occurrences were shown to decrease in both treatment groups; though without statistical significance between groups.
Conclusion: The baseline glucose excursion markers (i.e., SDPG and MAGE) as well as pre-dinner glucose levels are significant glycemic parameters that can be assessed for the clinical shifting of T2DM Asian patients from premixed insulin to Gla-300 based basal-plus or basal-bolus therapies.
C. Lin: None.
