Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic condition due to insulin resistance or relative insulin deficiency. Although insulin intensification regimens are commonly prescribed for the management of T2DM, there is uncertainty regarding their optimal use. We conducted a 13 Year narrativ...

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Main Authors:	Penwalla, NI, Othman, Noordin, MN, Norilyani, Nik Ahmad, Nik Nur Fatnoon
Format:	Article
Language:	English
Published:	Malaysian Pharmaceutical Society 2014
Subjects:	RC648 Specialties of Internal Medicine-Diseases of The Endocrine Glands. Clinical Endocrinology
Online Access:	http://irep.iium.edu.my/66667/ http://irep.iium.edu.my/66667/ http://irep.iium.edu.my/66667/1/FAPA%202014%20-%20BB%20Vs%20PM%20-%20MJP%20HPP%2004%20Page%20132.pdf

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recordtype	eprints
spelling	iium-666672019-01-25T07:41:07Z http://irep.iium.edu.my/66667/ Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature Penwalla, NI Othman, Noordin MN, Norilyani Nik Ahmad, Nik Nur Fatnoon RC648 Specialties of Internal Medicine-Diseases of The Endocrine Glands. Clinical Endocrinology Background: Type 2 Diabetes Mellitus (T2DM) is a chronic condition due to insulin resistance or relative insulin deficiency. Although insulin intensification regimens are commonly prescribed for the management of T2DM, there is uncertainty regarding their optimal use. We conducted a 13 Year narrative review to compare outcomes of these regimens in the treatment of T2DM. Method: We searched electronic databases (PubMed, Scopus, Proquest and Google Search), and “grey literature” from January 2000 to December 2013 to identify studies comparing insulin intensification regimens. Results: Out of 17 studies identified, we only included 10 studies specifically comparing Basal-Bolus regimens (BB) versus Pre-mixed Insulin Regimens (PM). Seven trials comparing regimens other than the studied regimens; with study duration lesser than 12 weeks; or involving Type 1 diabetes mellitus patients were excluded. The outcomes measured were divided into safety and efficacy parameters. Among the safety outcomes measured were Hypoglycemia, Weight Gain, Quality of Life (QoL), and other Adverse Events (AE). Whereas, efficacy outcomes measured were Glycosylated Haemoglobin (HbA1c), Fasting Plasma Glucose, Daily Plasma Glucose, Post Prandial Plasma Glucose, Carotid Intima Media Thickness (IMT), Adinopectin Level, 1-5-anhydroglucitol(1,5-AG),Total Daily Insulin (TDI) Dose and Cost. Mixed results were discovered among all the parameters measured favoring in between BB and PM regimens. Conclusion: We found that BB regimens showed better glycemic control especially in terms of the primary endpoint of HbAlc but at the expanse of significantly higher TDI dose, weight gain, and further increase in cost of treatment. Whereas, all other parameters measured were comparable between regimens. Locally, conventional human insulin is still the mainstay of insulin therapy in health facilities nationwide. Yet, none of the identified studies compared head-to-head human insulin in both arms. Thus, future researches comparing non-analogue insulin may be conducted to gather new evidence in the field of diabetes locally. Malaysian Pharmaceutical Society 2014-10 Article PeerReviewed application/pdf en http://irep.iium.edu.my/66667/1/FAPA%202014%20-%20BB%20Vs%20PM%20-%20MJP%20HPP%2004%20Page%20132.pdf Penwalla, NI and Othman, Noordin and MN, Norilyani and Nik Ahmad, Nik Nur Fatnoon (2014) Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature. Malaysian Journal of Pharmacy, 1 (11). http://www.mps.org.my/
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English
topic	RC648 Specialties of Internal Medicine-Diseases of The Endocrine Glands. Clinical Endocrinology
spellingShingle	RC648 Specialties of Internal Medicine-Diseases of The Endocrine Glands. Clinical Endocrinology Penwalla, NI Othman, Noordin MN, Norilyani Nik Ahmad, Nik Nur Fatnoon Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature
description	Background: Type 2 Diabetes Mellitus (T2DM) is a chronic condition due to insulin resistance or relative insulin deficiency. Although insulin intensification regimens are commonly prescribed for the management of T2DM, there is uncertainty regarding their optimal use. We conducted a 13 Year narrative review to compare outcomes of these regimens in the treatment of T2DM. Method: We searched electronic databases (PubMed, Scopus, Proquest and Google Search), and “grey literature” from January 2000 to December 2013 to identify studies comparing insulin intensification regimens. Results: Out of 17 studies identified, we only included 10 studies specifically comparing Basal-Bolus regimens (BB) versus Pre-mixed Insulin Regimens (PM). Seven trials comparing regimens other than the studied regimens; with study duration lesser than 12 weeks; or involving Type 1 diabetes mellitus patients were excluded. The outcomes measured were divided into safety and efficacy parameters. Among the safety outcomes measured were Hypoglycemia, Weight Gain, Quality of Life (QoL), and other Adverse Events (AE). Whereas, efficacy outcomes measured were Glycosylated Haemoglobin (HbA1c), Fasting Plasma Glucose, Daily Plasma Glucose, Post Prandial Plasma Glucose, Carotid Intima Media Thickness (IMT), Adinopectin Level, 1-5-anhydroglucitol(1,5-AG),Total Daily Insulin (TDI) Dose and Cost. Mixed results were discovered among all the parameters measured favoring in between BB and PM regimens. Conclusion: We found that BB regimens showed better glycemic control especially in terms of the primary endpoint of HbAlc but at the expanse of significantly higher TDI dose, weight gain, and further increase in cost of treatment. Whereas, all other parameters measured were comparable between regimens. Locally, conventional human insulin is still the mainstay of insulin therapy in health facilities nationwide. Yet, none of the identified studies compared head-to-head human insulin in both arms. Thus, future researches comparing non-analogue insulin may be conducted to gather new evidence in the field of diabetes locally.
format	Article
author	Penwalla, NI Othman, Noordin MN, Norilyani Nik Ahmad, Nik Nur Fatnoon
author_facet	Penwalla, NI Othman, Noordin MN, Norilyani Nik Ahmad, Nik Nur Fatnoon
author_sort	Penwalla, NI
title	Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature
title_short	Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature
title_full	Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature
title_fullStr	Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature
title_full_unstemmed	Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature
title_sort	safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : a 13 year narrative review of literature
publisher	Malaysian Pharmaceutical Society
publishDate	2014
url	http://irep.iium.edu.my/66667/ http://irep.iium.edu.my/66667/ http://irep.iium.edu.my/66667/1/FAPA%202014%20-%20BB%20Vs%20PM%20-%20MJP%20HPP%2004%20Page%20132.pdf
first_indexed	2023-09-18T21:34:40Z
last_indexed	2023-09-18T21:34:40Z
_version_	1777412741165744128

Safety and efficacy of basal bolus and premixed insulin intensification regimes in the management of type 2 diabetes mellitus : A 13 year narrative review of literature

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