Long-Acting Insulin Works Best for Many Diabetics

Once-a-day dose optimal when treatment with the hormone becomes necessary, study finds

By Steven Reinberg
HealthDay Reporter

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THURSDAY, Oct. 22 (HealthDay News) -- Adding insulin to standard diabetes drugs results in better blood sugar control for many with type 2 diabetes, British researchers report, and the dose and timing of insulin received can make a big difference.

Specifically, a once-a-day, long-acting dose of insulin may be the best approach for patients making the move to insulin therapy, the study found.

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Keeping blood sugar under control reduces the risk of complications in type 2 diabetes. But diabetes is also a progressive disease, which disrupts insulin production. Consequently, for many diabetes patients, the drugs used to control blood sugar need to be increased repeatedly and most patients will eventually need to take insulin, the researchers said.

"Any treatment which keeps blood sugar under control will minimize risk of complications, but in the end insulin may be the only effective way of doing this," explained lead researcher Dr. Rury Holman, a professor of diabetic medicine at the University of Oxford. "The vast majority will need insulin in the longer term."

The report is published in the Oct. 22 online edition of the New England Journal of Medicine, to coincide with its presentation at the 20th World Diabetes Congress in Montreal. The study received funding from drug maker Novo Nordisk and the nonprofit group Diabetes UK.

For the study, Holman's team compared different forms of insulin therapy for patients with type 2 diabetes. Insulin treatment can start with a "basal" dose that is long-acting, a "prandial" or mealtime dose of insulin that is short-acting or a so-called biphasic dose, a mixture of both short and long-acting insulin.

However, which of these regimens works best was not clear, Holman said. To find out, the researchers randomly assigned 708 patients to biphasic insulin injections twice a day (NovoMix30), mealtime insulin injections three times a day (NovoRapid) or basal insulin injected once a day (Levemir). All of the formulations are made by Novo Nordisk.

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