Study Shows Type 2s Can Lower BGs, A1c’s, Whether They Take Set Insulin Doses or Tailor Them to Carb Consumption

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.

Aug 5, 2008

Type 2s who tried out either of two different basal-bolus treatments using Lantus and Apidra enjoyed significant reductions in post-meal BG levels and longer-term A1c’s.

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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Categories: A1c Test, Diabetes, Diabetes, Glycemic Index & Carb Counting, Insulin, Lantus, Low Carb, Research, Type 1 Issues, Type 2 Issues

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Posted by Anonymous on 25 July 2008

I trust absolutely NOTHING that comes out of Park Nicolet's "International Diabetes Center". They are arrogant, condescending and derisive of Type II's. I have had repeated experiences with them, and wouldn't trust a diabetic dog to their care, even though I don't much like dogs.

Posted by wifey on 27 July 2008

My 79-year-old husband has been using this "simplified algorithm" method ever since Lantus has been available, (with the humalog when needed) and he's far more aware of his body reactions to the blood glucose levels. his HgA1c have always been around mid 6.
However, everything goes to hell when he goes into hospital. (He had TCC cancer and kidney problems) They insist on using "sliding scale" system (without Lantus or humalog) which gives him HUGE highs and lows.
Why, why, why, do they use this? It's crazy.

Posted by Anonymous on 8 August 2008

I think this article is covering the same research reported in another recent, but bit older, Diabetes Health article ( The older report gives better guidance on the mechanics of the insulin adjustment methods and should be reviewed by anyone who finds this article interesting.

Posted by volleyball on 15 August 2008

I disagree with the findings unless there is a lot more information not provided.
A 24 week drop from 8.3 to 6.54 vs 8.1 to 6.7 seems significant to me. Plus what very BG during the day. did the carb control group have less highs and lows during the test? How well were the subjects able to calculate insulin requirements? I would think if this study ran a year, the results would have been more dramatic

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