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Published in the July 2008 issue of Diabetes Care, those conclusions were based on a study of 273 type 2 patients who were divided into two groups. Both groups used Lantus as their long-acting basal insulin and Apidra as their rapid-acting bolus insulin.
The “Simplified Algorithm” group took pre-set doses of Apidra before their meals. The dosages were based on their self-monitored BG results from the week before.
The “Carbohydrate Counting” group took doses of Apidra based on an insulin-to-carbohydrate ration. They adjusted their doses based on the amount of carbs they planned to consume at a meal.
At the end of the 24-week study, both groups enjoyed similar results: 73 percent of the “Simplified” group and 69 percent of the “Carb Counters” group achieved A1c’s of 7% or less (6.7% for the “Simplifieds” and 6.54% for the “Carb Counters”).
The overall reduction in A1c’s was 1.46% for the “Simplifieds” (down from 8.1%) and 1.59% for the “Carb Counters” (down from 8.3%).
Study participants ranged from 28 to 71 years in age and had had type 2 diabetes for at least six months. Each participant had been taking two or more insulin injections daily for at least three months before the study, and 33 percent of them were also taking metformin.
Thirty-seven percent entered the study using Lantus and at least one daily injection of a rapid-acting insulin analog. Thirty-six percent were using another pre-mixed insulin, and the remainder were on a combination of other diabetes treatment and drug regimens.
Study author Richard M. Bergenstal, MD, executive director of the International Diabetes Center at Park Nicollet Health Services in Minneapolis, Minn., concluded that “a combination of basal and bolus insulin may be needed to achieve optimal glucose control in type 2 diabetes patients.” The study shows that a set approach and an ad-hoc approach to bolus dosages both seem to work equally well in achieving glycemic control.
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