|Discontinuation rates were 53 of the 194 (27%), 44 of the 194 (23%) and 38 of the 194 (20%), for PMâ€‰âˆ’â€‰2, Gâ€‰+â€‰1 and Gâ€‰+â€‰3.
Glycaemic control improved in all groups (A1C 7.2â€‰Â±â€‰1.37, 7.1â€‰Â±â€‰1.68 and 7.0â€‰Â±â€‰1.21% at 60â€‰weeks; 7.5â€‰Â±â€‰1.29, 7.2â€‰Â±â€‰1.62 and 7.2â€‰Â±â€‰1.63% at endpoint).
Gâ€‰+â€‰1 was statistically non-inferior to PMâ€‰âˆ’â€‰2 in reducing A1C.
Gâ€‰+â€‰3 was slightly superior to PMâ€‰âˆ’â€‰2 in attaining <7.0% at 60â€‰weeks, but only when the analysis included Good Clinical Practice non-adherent sites.
Hypoglycaemia with plasma glucose <2.8â€‰mmol/l was more frequent with PMâ€‰âˆ’â€‰2 versus Gâ€‰+â€‰1 and Gâ€‰+â€‰3; [adjusted incidence: 46 (pâ€‰=â€‰0.0087) vs. 33 (pâ€‰=â€‰0.0045) and 31.5%; events per patient-year: 1.9 vs. 0.8 and 0.9, pâ€‰â‰¤â€‰0.0001].
Insulin dosage and weight-gain were similar.
Basal insulin plus a single prandial injection is as effective in improving glycaemic control as premixed insulin.
Full basal-prandial therapy is only slightly more effective than premixed insulin.
Stepwise basal-prandial regimens improve glycaemic control with less hypoglycaemia than twice-daily premixed insulin.
Source: Riddle, M. C., Rosenstock, J., Vlajnic, A. and Gao, L. (2014), Randomized, 1-year comparison of three ways to initiate and advance insulin for type 2 diabetes: twice-daily premixed insulin versus basal insulin with either basal-plus one prandial insulin or basal-bolus up to three prandial injections. Diabetes, Obesity and Metabolism, 16: 396â€“402. doi: 10.1111/dom.12225
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