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Comparison of Inpatient Insulin Regimens with Detemir plus Aspart Versus Neutral Protamine Hagedorn plus Regular in Medical Patients with Type 2 Diabetes

Department of Medicine (G.E.U., D.S., A.T., D.U., M.C., C.N.) and Rollins School of Public Health (L.P.), Emory University, Atlanta, Georgia 30303; and Rush University Medical Center (T.H., C.M., D.B.), Chicago, Illinois 60612

Address all correspondence and requests for reprints to: Guillermo E. Umpierrez, M.D., Professor of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Drive, Atlanta, Georgia 30303. E-mail: geumpie{at}emory.edu.

Background: Studies comparing the use of basal bolus with insulin analogs vs. split-mixed regimens with human insulins in hospitalized patients with type 2 diabetes are lacking.

Research Design and Methods: In a controlled multicenter trial, we randomized 130 nonsurgical patients with blood glucose (BG) between 140 and 400 mg/dl to receive detemir once daily and aspart before meals (n = 67) or neutral protamine Hagedorn (NPH) and regular insulin twice daily (n = 63). Insulin dose was started at 0.4 U/kg · d for BG between 140 and 200 mg/dl or 0.5 U/kg · d for BG 201-400 mg/dl. Major study outcomes included differences in mean daily BG levels and frequency of hypoglycemic events between treatment groups.

Results: Glycemic control improved similarly in both groups from a mean daily BG of 228 ± 54 and 223 ± 58 mg/dl (P = 0.61) to a mean daily BG level after the first day of 160 ± 38 and 158 ± 51 mg/dl in the detemir/aspart and NPH/regular insulin groups, respectively (P = 0.80). A BG target below 140 mg/dl before meals was achieved in 45% of patients in the detemir/aspart group and 48% in the NPH/regular group (P = 0.86). During treatment, 22 patients (32.8%) in the detemir/aspart group and 16 patients (25.4%) in the NPH/regular group had at least one episode of hypoglycemia (BG <60 mg/dl) during the hospital stay (P = 0.34).

Conclusions: Treatment with basal/bolus regimen with detemir once daily and aspart before meals results in equivalent glycemic control and no differences in the frequency of hypoglycemia compared to a split-mixed regimen of NPH and regular insulin in patients with type 2 diabetes.

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