Insulin combination at mealtime shows significant reduction in glucose and A1C levels

BRIDGEWATER, N.J. A combination treatment of the insulins Lantus and Apidra, by Sanofi-aventis, at mealtime showed a significant reduction in post meal blood glucose and A1C levels, when using two different dosing methods, found a recent study on diabetes care.

The 24-week study, titled, “Adjust to Target in Type 2 Diabetes: Comparison of a Single Algorithm to Carbohydrate Counting for Adjustment of Mealtime Insulin Glulisine,” compared two algorithms for adjusting mealtime insulin. Apidra and Lantus were adjusted weekly in two groups based on the previous week’s self-monitored blood glucose results.

One group, the “Simplified Algorithm” group, was provided set doses of Apidra to take before each meal. The second group, the “Carbohydrate Counting” group, was provided an insulin-to-carbohydrate ratio to use for each meal and adjusted their Apidra dose based on the amount of carbohydrates consumed. After 24 weeks, the percentage of patients who achieved A1C levels of less than 7 percent—the American Diabetes Association’s recommended target for blood sugar control—while following these two treatment algorithms were 73 and 69 percent, respectively.

Study author Richard Bergenstal, executive director of the International Diabetes Center, Park Nicollet Health Services explained that, “The simplified algorithm investigated in this study allowed patients to start with a fixed dose of Apidra and then effectively adjust to target based on premeal glucose patterns, or to use carbohydrate counting, which involves a mathematical formula that helps patients match the size of their mealtime insulin dose with the amount of carbohydrates they eat. Having two effective options for managing mealtime insulin doses may increase patients’ and clinicians’ willingness to initiate basal-bolus therapy.”