Efficacy of Twice Daily Human Premixed Insulin Versus Bedtime NPH in Insulin Naïve T2 DM Patients

Abstract

Background: Management of T2DM consist of life style modification and pharmacologic treatment (oral antidiabetic agent and injectable agent). From the recent data Most of Thai diabetes patients failed to achieve good glycemic control despite they already received optimum dose of oral antidiabetic agents. As well as the new diabetes patients who had very high plasma glucose at diagnosis tend to had poor glycemic control and lead to diabetic related complications.
Objective: This study aim to compare the efficacy and safety of human premixed insulin twice daily with bedtime NPH in insulin naïve T2DM patients at Surin hospital
Methods: A, retrospective cohort design therapeutic research was conducted in Surin Hospital, Surin province, Thailand.T2DM patients who received premixed insulin and NPH as the 1st insulin regimen between April 2020 to September 2020 were selected. Patient’s characteristic and glycemic data at time of insulin initiation and at 6 months after treatment were reviewed. To compare the change of HbA1c, number of patients with HbA1c<7%, Number of admission or OPD visit with hypoglycemia. Chi-squared test, t-test, exact probability test and multivariable Gaussian regression were used to evaluate the outcome
Results: total 524 patients,209 patients were prescribed premixed insulin and 315 patients were prescribed NPH. After multivariable Gaussian regression analysis, patients in premixed insulin group achieved the significant higher reduction of HbA1c level than NPH group 5.9%, but no significant difference in the percent of patients with HbA1c <7% . On the other hand premixed insulin group had significant higher number of admission or OPD visit with hypoglycemia than NPH group 1.1 times.
Conclusion: Human premixed insulin twice daily regimen attains the higher reduction of HbA1c level than bedtime NPH regimen. However, this regimen occurs the higher hypoglycemic event.