COMPARISON OF THRICE-DAILY PREMIXED HUMAN INSULIN WITH BASAL- BOLUS THERAPY AMONG PATIENTS WITH TYPE 2 DIABETES MELLITUS

Abstract

OBJECTIVES
In Malaysia’s public hospitals, 82.4% of insulin-treated type 2 diabetes mellitus (T2DM) patients were taking human insulin due to budget constraints. Twice-daily premixed human insulin (PHI) regimen was intensified to basal-bolus (BB) regimen when glycemic control was inadequate. We aimed to compare the efficacy and safety of thrice-daily (TDS) PHI with BB regimen.

METHODOLOGY
A cross-over study among T2DM patients was conducted in Penang Hospital between October 2020 and June 2021. Patients in Group A were assigned to TDS and crossedover to BB at week-12, and vice versa for group B. Glycated haemoglobin (HbA1c), total daily dose (TDD) of insulin, weight, hypoglycaemia, and adherence to insulin injection were measured at baseline, week-12 and week-24.

RESULTS
Forty-four patients (75% female; baseline mean HbA1c 9.55%; mean duration of T2DM 16 years) were included. Mean HbA1c reduced significantly from baseline to week-12 for group A (-0.95%, p<0.001) and group B (-1.06%, p<0.001) respectively. No difference in HbA1c in group A (-0.25%, p=0.212) when switching to BB at week-12 to week-24 but HbA1c reduced significantly in group B (-0.49%, p=0.007) when switching to TDS and significant between the groups, p=0.026. In group A, no difference in TDD but weight reduced significantly at week-12 (-0.5 kg, p=0.002). TDD increased significantly in group B (p=0.042) from baseline to week-12 and between the groups (p=0.044). Meanwhile, no difference in hypoglycaemia and adherence were observed within and between the groups.

CONCLUSION
Thrice-daily PHI is an effective and safe alternative to BB regimen when intensifying insulin treatment.