Basal-Bolus and Premixed Insulin Regimens Both Effective in Managing Blood Sugar Without Severe Hypoglycemia: Study

India: A study published in the Indian Journal of Medical Sciences revealed that both Basal-Bolus and Premixed Insulin Regimens significantly enhanced glycemic control without being linked to any severe hypoglycemia episodes. 

Insulin therapy is fundamental in managing type 2 diabetes mellitus for most patients, given the chronic and progressive nature of the condition. Selecting the appropriate insulin depends on the patient's meal content and pattern, expected adherence and compliance to insulin therapy, and potential drug interactions with existing oral hypoglycemic agents. The complexity of the regimen also plays a crucial role in determining patient adherence.

Several studies have compared the basal-bolus (BB) and premixed (PM) insulin regimens with varying results. The study, conducted by Prithwis Mitra, Department of Pharmacology, Institute of Post-Graduate Medical Education and Research, and Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India et. al. aimed to assess glycemic control and the incidence of hypoglycemia in insulin-naïve patients with type 2 diabetes mellitus (T2D) within the Indian subpopulation. 

This study involved a 12-week prospective, observational analysis of 60 adult patients (equally divided 1:1) who had been living with T2D for over 7 years and were not well-controlled on three oral medications. The researchers evaluated changes in glycemic parameters at weeks 4 and 12, and recorded hypoglycemia events.

The key findings of the study are as follows:

• Premixed insulin significantly reduced fasting plasma glucose at week 4 from baseline and at week 12, whereas the Basal-Bolus insulin group showed significant changes only at week 12.
  
• Fasting plasma glucose reductions were greater in the Premixed Insulin group at both week 4 and week 12 compared to the Basal-Bolus group.
• Both groups experienced significant reductions in post-prandial plasma glucose from baseline at weeks 4 and 12.
• There were no differences between the groups in post-prandial plasma glucose reductions at week 4, but the Premixed Insulin group had greater reductions at week 12.
• The Premixed Insulin group showed a slightly greater reduction in glycated hemoglobin compared to the Basal-Bolus group.
• There was no significant difference in the incidence of hypoglycemia between the two groups.

The researchers concluded that Both treatments significantly enhanced glycemic control and did not result in severe hypoglycemia episodes. Thus, the decision should be based on factors related to the insulin regimen (dosage, complexity) and the patient (dietary habits, adherence levels).

Reference

Mitra P, Siddhanta S, Yasmin N, Sengupta G. Glycemic control and adverse effects in patients with type 2 diabetes receiving basal-bolus insulin regimen versus premixed insulin regimen: An observational study. Indian J Med Sci. 2024;76:56-60. doi: 10.25259/IJMS_204_2023