The premixed insulin analogue, biphasic insulin aspart 30/70 (BIAsp 30, 30% insulin aspart, 70% protaminated aspart) has a more physiological absorption profile than conventional premixed insulin, biphasic human insulin 30/70 (BHI 30, 30% soluble human insulin, 70% NPH), but no studies have previously tested how a switch from BHI 30 to BIAsp 30 can be done safely using a simple guideline. We investigated the occurrence of low interstitial glucose (IG) (using the MiniMed Continuous Glucose Monitoring System, CA, USA), and self-reported hypoglycaemia in patients with type 2 diabetes who switched unit-for-unit from BHI 30 BID to BIAsp 30 BID in the double-blind, randomised, controlled REACH study (reported elsewhere, approved by local Ethical Committee).
After an 8-week run-in for pre-treatment optimisation, patients with HbA1c 6.58.5% entered a 32-week, two-period, randomised, crossover trial. Patient groups included in this sub-analysis were: Athose who received BHI 30 during the run-in followed by BIAsp 30 in period 1; Bthose who received BHI 30 in period 1, followed by BIAsp 30 in period 2. IG data were recorded every 10 s for 3 days in the middle and end of each treatment period and grouped into episodes: sets of continuous low IG readings (<2.5 and <3.5 mmol/l), allowing two consecutive readings above threshold (the start of successive episodes ≥1 h apart). Data are shown for groups A, B and A+B.
There was a general reduction in episodes of low IG and self-reported hypoglycaemia when switching from BHI 30 to BIAsp 30, but none were statistically significant (Table).
|Patient group switching from BHI 30 to BIAsp 30|
|Δ Number of episodes after switch (mean ±S.D.)||A (n=39)||B (n=73)||A+B (n=112)|
|IG <3.5 mmol/l||−1.51±5.12||−0.48±4.45||−0.84±4.70|
|IG <2.5 mmol/l||−1.03±3.29||−0.12±2.69||−0.44±2.93|
Switching from BHI 30 to BIAsp 30 can be done safely unit-for-unit.
06 - 07 Nov 2006
Society for Endocrinology