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Published in: Diabetology International 2/2014

01-06-2014 | Original Article

Evaluation of thrice-daily injections of insulin Lispro Mix 50/50 versus basal-bolus therapy in perioperative patients with type 2 diabetes

Authors: Kyu Yong Cho, Osamu Nakagaki, Hideaki Miyoshi, Kazumasa Akikawa, Tatsuya Astumi

Published in: Diabetology International | Issue 2/2014

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Abstract

Purpose

The purpose of this study was to compare two perioperative insulin therapies [thrice-daily injections of insulin Lispro Mix 50/50 (3X-Mix50) versus basal-bolus injections (BBT)] in type 2 diabetic patients who were judged by attending endocrinologists to require intensive insulin treatment before surgery.

Materials and methods

A retrospective analysis was performed on data collected from 47 surgical patients hospitalized at Obihiro-Kosei General Hospital and treated with BBT (n = 27) or 3X-Mix50 (n = 20) for 1 year.

Results

Patient baseline characteristics (age, duration of diabetes, BMI, FPG and HbA1c) were similar between therapeutic groups. Both therapies achieved target glycemic control for surgery in 9 days on average. There was no significant difference in average pre-meal or bedtime blood glucose levels. The total daily insulin dose before surgery was similar (28.3 U in BBT vs. 24.8 U in 3X-Mix50, p = 0.1146). No episodes of severe hypoglycemia occurred, and the number of episodes of mild hypoglycemia during the perioperative period was similar. No surgical complications such as infection occurred, and one orthopedic surgery-related issue occurred in each therapeutic group.

Conclusion

We showed 3X-Mix50 and BBT were comparable in terms of glycemic control, total insulin dose, and incidence of hypoglycemia and perioperative complications. While comparable to classical BBT therapy, the 3X-Mix50 provides a convenient alternative method for maintaining glycemic control in patients with type 2 diabetes during the perioperative period.
Literature
1.
go back to reference Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130:1144.PubMedCrossRef Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130:1144.PubMedCrossRef
2.
go back to reference Estrada CA, Young JA, Nifong LW, Chitwood WR Jr. Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg. 2003;75:1392–9.PubMedCrossRef Estrada CA, Young JA, Nifong LW, Chitwood WR Jr. Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg. 2003;75:1392–9.PubMedCrossRef
3.
go back to reference Marhoffer W, Stein M, Maeser E, Federlin K. Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care. 1992;15:256–60.PubMedCrossRef Marhoffer W, Stein M, Maeser E, Federlin K. Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care. 1992;15:256–60.PubMedCrossRef
4.
go back to reference Turina M, Fry DE, Polk HC Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med. 2005;33:1624–33.PubMedCrossRef Turina M, Fry DE, Polk HC Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med. 2005;33:1624–33.PubMedCrossRef
5.
go back to reference Bower WF, Lee PY, Kong AP, Jiang JY, Underwood MJ, Chan JC, et al. Peri-operative hyperglycemia: a consideration for general surgery? Am J Surg. 2010;199:240–8.PubMedCrossRef Bower WF, Lee PY, Kong AP, Jiang JY, Underwood MJ, Chan JC, et al. Peri-operative hyperglycemia: a consideration for general surgery? Am J Surg. 2010;199:240–8.PubMedCrossRef
6.
go back to reference Okabayashi T, Ichikawa K, Namikawa T, Sugimoto T, Kobayashi M, Hanazaki K. Effect of perioperative intensive insulin therapy for liver dysfunction after hepatic resection. World J Surg. 2011;35:2773–8.PubMedCrossRef Okabayashi T, Ichikawa K, Namikawa T, Sugimoto T, Kobayashi M, Hanazaki K. Effect of perioperative intensive insulin therapy for liver dysfunction after hepatic resection. World J Surg. 2011;35:2773–8.PubMedCrossRef
7.
go back to reference Rosenstock J, Ahmann AJ, Colon G, Scism-Bacon J, Jiang H, Martin S. Advancing insulin therapy in type 2 diabetes previously treated with glargine plus oral agents: prandial premixed (insulin lispro protamine suspension/lispro) versus basal/bolus (glargine/lispro) therapy. Diabetes Care. 2008;31:20–5.PubMedCrossRef Rosenstock J, Ahmann AJ, Colon G, Scism-Bacon J, Jiang H, Martin S. Advancing insulin therapy in type 2 diabetes previously treated with glargine plus oral agents: prandial premixed (insulin lispro protamine suspension/lispro) versus basal/bolus (glargine/lispro) therapy. Diabetes Care. 2008;31:20–5.PubMedCrossRef
8.
go back to reference Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754–60.PubMedCrossRef Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754–60.PubMedCrossRef
9.
go back to reference Zinman B, Tildesley H, Chiasson JL, Tsui E, Strack T. Insulin lispro in CSII: results of a double-blind crossover study. Diabetes. 1997;46:440–3.PubMedCrossRef Zinman B, Tildesley H, Chiasson JL, Tsui E, Strack T. Insulin lispro in CSII: results of a double-blind crossover study. Diabetes. 1997;46:440–3.PubMedCrossRef
10.
go back to reference Yokoyama H, Tada J, Kamikawa F, Kanno S, Yokota Y, Kuramitsu M. Efficacy of conversion from bedtime NPH insulin to morning insulin glargine in type 2 diabetic patients on basal-prandial insulin therapy. Diabetes Res Clin Pract. 2006;73:35–40.PubMedCrossRef Yokoyama H, Tada J, Kamikawa F, Kanno S, Yokota Y, Kuramitsu M. Efficacy of conversion from bedtime NPH insulin to morning insulin glargine in type 2 diabetic patients on basal-prandial insulin therapy. Diabetes Res Clin Pract. 2006;73:35–40.PubMedCrossRef
11.
go back to reference Holman RR, Farmer AJ, Davies MJ, Levy JC, Darbyshire JL, Keenan JF, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361:1736–47.PubMedCrossRef Holman RR, Farmer AJ, Davies MJ, Levy JC, Darbyshire JL, Keenan JF, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361:1736–47.PubMedCrossRef
12.
go back to reference Schernthaner G, Kopp HP, Ristic S, Muzyka B, Peter L, Mitteregger G. Metabolic control in patients with type 2 diabetes using Humalog Mix50 injected three times daily: crossover comparison with human insulin 30/70. Horm Metab Res. 2004;36:188–93.PubMedCrossRef Schernthaner G, Kopp HP, Ristic S, Muzyka B, Peter L, Mitteregger G. Metabolic control in patients with type 2 diabetes using Humalog Mix50 injected three times daily: crossover comparison with human insulin 30/70. Horm Metab Res. 2004;36:188–93.PubMedCrossRef
13.
go back to reference Matthews DR, Cull CA, Stratton IM, Holman RR, Turner RC. UKPDS 26: Sulphonylurea failure in non-insulin-dependent diabetic patients over six years. UK Prospective Diabetes Study (UKPDS) Group. Diabet Med. 1998;15:297–303.PubMedCrossRef Matthews DR, Cull CA, Stratton IM, Holman RR, Turner RC. UKPDS 26: Sulphonylurea failure in non-insulin-dependent diabetic patients over six years. UK Prospective Diabetes Study (UKPDS) Group. Diabet Med. 1998;15:297–303.PubMedCrossRef
14.
go back to reference Gastaldelli A, Ferrannini E, Miyazaki Y, Matsuda M, DeFronzo RA. Beta-cell dysfunction and glucose intolerance: results from the San Antonio metabolism (SAM) study. Diabetologia. 2004;47:31–9.PubMedCrossRef Gastaldelli A, Ferrannini E, Miyazaki Y, Matsuda M, DeFronzo RA. Beta-cell dysfunction and glucose intolerance: results from the San Antonio metabolism (SAM) study. Diabetologia. 2004;47:31–9.PubMedCrossRef
Metadata
Title
Evaluation of thrice-daily injections of insulin Lispro Mix 50/50 versus basal-bolus therapy in perioperative patients with type 2 diabetes
Authors
Kyu Yong Cho
Osamu Nakagaki
Hideaki Miyoshi
Kazumasa Akikawa
Tatsuya Astumi
Publication date
01-06-2014
Publisher
Springer Japan
Published in
Diabetology International / Issue 2/2014
Print ISSN: 2190-1678
Electronic ISSN: 2190-1686
DOI
https://doi.org/10.1007/s13340-013-0140-0

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