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Folia Medica Indonesiana

ISSN 0303-7932

Vol. 49 / No. 2 / Published : 2013-04

TOC : 13, and page :128 - 133

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Original Article :

Basal insulin as add-on therapy to oral glucose-lowering drugs in insulin naive patients with type 2 diabetes mellitus in primary public health center

Author :

  1. Hermina Novida*1
  2. Agung Pranoto*2
  3. Jongky Hendro Prayitno*3
  4. Askandar Tjokroprawiro*4
  1. Dosen Fakultas Kedokteran
  2. Dosen Fakultas Kedokteran
  3. Dosen Fakultas Kedokteran
  4. Dosen Fakultas Kedokteran

Abstract :

Effective glycemic control is very important to minimize longterm complications of type 2 diabetes mellitus (DM). However, it is welldocumented that many patients spend prolonged periods above optimal glycaemic range, especially in primary public health centers.Most of primary care physicians, who are responsible to manage them, delay to iniate insulin therapy for some reasons. The aim ofthis study was to evaluate efficacy and safety of insulin detemir added to oral therapy in insulin-naive individuals with type 2 DM.This one group pre- and post-test study involved insulin-naive and previously oral-treated DM patients (n=64, HbA1c> 8.0%),drawn from 10 primary public health center centers all over Surabaya, Indonesia, using simple random sampling method. Patientswere treated with insulin detemir for 12 weeks and insulin doses were titrated to target fasting plasma glucose (FPG) < 125 mg/dl.Outcomes evaluated included HbA1c, level of fasting and 2 hours post-prandial glucose, risk of hypoglycemia and body weight. After12 weeks, HbA1c had decreased by 2.53% (from 11.38% to 8.85%) with detemir insulin once a day (p=0.001). FPG improved from201.75 mg/dl to 152.47 mg/dl (p=0.001) and 2 hour post-prandial glucose improved from 287.91 mg/dl to 222.30 mg/dl (p=0.001).Frequency of hypoglycaemia events were 6.4% (4 hypoglycaemic events) and all cases were mild events so that they did not need tobe admitted in the hospital. Hypoglycaemic events can be treated by the patients themselves with sugar and food intake, and then thedose of detemir insulin was adjusted. Besides hypoglyecemic events, no other side effects were recorded. Mean the pre insulintherapy BMI was 23.94 ± 4.22 kg/m2 to become 23.34 ± 5.60 kg/m 2 at the end of the study. There was a decrease in body weightbefore and after insulin detemir therapy, but it was not statistically significant (p 0.37, 95% CI -0.74-1.95). In conclusion, theaddition of basal insulin to oral antidiabetic drugs in poorly controlled type 2 diabetes patients in primary public health centerachieved clinically improvements in glycaemic control with low risks of hypoglycaemia and non-significant body weightincrease.(FMI 2013;49:128-133)

Keyword :

basal insulin, add-on therapy, oral antidiabetics, glycaemia, type 2 DM,


References :

  1. Hermansen K, Lund P, Clemmensen K, Breum L, Moller KM, Rosenfalk AM, (2007). 3-months results from denmark within the globally prospective and observational study to evaluate insulin detemir treatment in type 1 and type 2 diabetes: The PREDICTIVE Study. - : The Review of Diabetes Study
  2. Hirsch IB, Bergenstal RM, Parkin CG, Wright Jr E, Buse JB, (2005). A real world approach to insulin therapy in primary care practice. - : Clin Diabetes


   


Archive Article

Cover Media Content

Volume : 49 / No. : 2 / Pub. : 2013-04
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  13. Basal insulin as add-on therapy to oral glucose-lowering drugs in insulin naive patients with type 2 diabetes mellitus in primary public health center