Glycemic Control Variations With Biphasic Insulin Aspart vs Basal-Bolus Therapy

Adults diagnosed with type 2 diabetes (T2D) treated with biphasic insulin aspart 30 (BIAsp30) may have improvement in glycemic control and may experience fewer hypoglycemic events compared with patients treated with basal-bolus therapy, according to a study published in Diabetes Therapy.

Researchers identified 335 patients with T2D who were at least 18 years of age from 9 different countries and randomly assigned them to receive 35 weeks of either BIAsp30 once per day, with the possibility of treatment increasing to a maximum of 3 times per day, or insulin glargine once per day with the possibility of treatment increasing to 3 times per day dosing with IAsp. 

The primary outcome of the study (ClinicalTrials.gov identifier: NCT02453685) was to compare the efficacy of stepwise insulin intensification in patients treated with BIAsp30 with the efficacy of stepwise insulin intensification in those treated with basal-bolus therapy (insulin glargine and IAsp). 

At the end of 35 weeks of therapy, a statistically significantly higher number of patients treated with BIAsp30 achieved hemoglobin HbA_1c level <7.0% (odds ratio [OR] 0.58; [95% CI, 0.37; 0.89]; P =.01). The BIAsp30 group also had a lower number of overall severe hypoglycemic events (OR estimated rate ratio 0.32; [95% CI, 0.13; 0.79]; P =.0131).

Interestingly, there were no differences found in the mean total daily insulin dose increase between those treated with BIAsp30 and those treated with basal-bolus therapy during the study treatment period (0.157 and 0.127 U/kg at baseline to 0.700 and 0.708 U/kg at week 32, respectively). 

Researchers concluded that although treatment with both BIAsp30 and basal-bolus therapy resulted in reductions in HbA_1c level, treatment with BIAsp30 resulted in a further decrease in HbA_1c level.

In addition, patients treated with BIAsp30 were found to have a lower rate of overall hypoglycemic events. The study authors concluded that clinicians may consider the use of BIAsp30 in insulin-naive patients with T2D in whom glycemic control has not been achieved with basal insulin or oral antidiabetic drugs.

This study was funded by Novo Nordisk A/S, Bagsværd, Denmark.

Reference

Linjawi S, Lee BW, Tabak Ö, Lövdahl S, Werther S, Abusnana S. A 32-week randomized comparison of stepwise insulin intensification of biphasic insulin aspart (BIAsp30) versus basal-bolus therapy in insulin-naïve patients with type 2 diabetes [published online November 11, 2017] Diabetes Ther.  doi: 10.1007/s13300-017-0334-8