Clinical evaluation of thrice-daily lispro 50/50 versus twice-daily aspart 70/30 on blood glucose fluctuation and postprandial hyperglycemia in patients with type 2 diabetes mellitus

Our goal was to compare the effects of thrice-daily lispro 50/50 and twice-daily aspart 70/30 on blood glucose fluctuation and postprandial hyperglycemia in type 2 diabetes mellitus patients.

Thirty-nine type 2 diabetes patients hospitalized at our hospital for poorly controlled disease (26 men, 13 women; mean age 62.5 years, mean BMI 24.1) received either thrice-daily lispro 50/50 (50/50 group, n = 19) or twice-daily aspart 70/30 (70/30 group, n = 20) after 1 week of multiple-daily injection insulin regimen. Efficacy measurements included HbA1c, diurnal variation in blood glucose levels and total daily insulin doses. Despite a small number of subjects, we also explored the potent effect in prevention of progression of atherosclerosis. Ultrasound examination of bilateral carotid arteries (n = 22) and the cardio-ankle vascular index (CAVI) (n = 12) were performed before and after 48 weeks of treatment.

Mean HbA1c levels improved significantly in each treatment group, and HbA1c at 48 weeks was significantly lower in the 50/50 group than the 70/30 group (7.0 ± 1.0 vs. 7.3 ± 1.1 %, P = 0.03), whereas mean fasting blood glucose levels did not differ significantly between the two groups at 48 weeks (127.4 ± 30.9 vs. 132.6 ± 20.6 mg/dL, P = 0.47). A significantly greater percentage of subjects in the 50/50 group achieved the target HbA1c value of ≤ 6.9 %compared to the 70/30 group [57.9 % (11/19 patients) vs. 25.0 % (5/20 patients), P = 0.01). The 50/50 group tended to have less daily plasma glucose fluctuation than the 70/30 group. Although there was a significant difference in the degrees of change in CAVI between the subsets of each group, there were no significant differences in the maximum thickness of the intima-media layers of the carotid arteries (IMT) and plaque scores.

Thrice-daily lispro 50/50 injection reduces the postprandial blood glucose level and stabilizes the diurnal fluctuations of blood glucose levels more efficiently than twice-daily aspart 70/30 in type 2 diabetes mellitus patients.