Vol 6: Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study.Report as inadecuate



 Vol 6: Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study.


Vol 6: Improvement of both fasting and postprandial glycemic control by the two-step addition of miglitol and mitiglinide to basal insulin therapy: a pilot study. - Download this document for free, or read online. Document in PDF available to download.

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This article is from Diabetology & Metabolic Syndrome, volume 6.AbstractBackground: Combination therapy consisting of basal insulin and oral hypoglycemic agents OHAs is effective for the treatment of type 2 diabetes T2DM that cannot be adequately controlled using OHAs alone. Though basal insulin with metformin or sulfonylurea is an effective therapy, it cannot reduce postprandial glycemia without the risk of hypoglycemia. We examined a two-step regimen consisting of the addition of postprandial hypoglycemic agents an alpha-glucosidase inhibitor and a glinide in patients whose T2DM was poorly controlled using basal insulin therapy. Methods: Inpatients between the ages of 30–79 years who had T2DM and an HbA1c level of more than 7.0% were recruited. The patients were treated with once-daily insulin glargine with or without metformin, depending on the patient’s age and renal function. Insulin glargine was titrated to achieve a target fasting glucose level of 70–130 mg-dL as a first step STEP0. If the 2-hour postprandial glucose PBG level was higher than the target of 180 mg-dL, miglitol treatment 150 mg-day was initiated, with dose adjustments 75–225 mg allowed depending on abdominal symptoms and the PBG STEP1. If the PBG of the patients remained higher than the target after 3 days of treatment, mitiglinide 30 mg-day, titrated up to 60 mg was added STEP2. We then evaluated the proportion of patients who achieved the target PBG before and after the two-step regimen. Continuous Glucose Monitoring CGM was performed throughout the two-step protocol in most of the patients. Results: Of the 16 patients who were recruited median age, 67.0 58.0-71.0 years; body mass index, 25.0 22.0-27.9 kg-m2; HbA1c level at admission, 9.1% 8.35-10.4%, 1 patient 6.25% achieved the target PBG at STEP 0 and 14 patients 87.5% had achieved the target PBG at the end of the treatment protocol P = 0.002. CGM showed a significant decrease in the glucose level at each step of the protocol. The standard deviations in the CGM glucose levels for 24 hours, MAGE, and M-value also improved. Conclusions: The two-step addition of postprandial hypoglycemic agents to basal insulin therapy is potentially effective and safe for decreasing both the fasting and postprandial glucose levels.



Author: Ihana, Noriko; Tsujimoto, Tetsuro; Yamamoto-Honda, Ritsuko; Kishimoto, Miyako; Kajio, Hiroshi; Noto, Hiroshi; Kakei, Masafumi; Noda, Mitsuhiko

Source: https://archive.org/



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