Initiating Insulin in Type 2 Diabetes – The “4-T” Trial

First-year comparisons among prandial, biphasic, and basal insulins reveal tradeoffs in efficacy and safety.

We now have a variety of options for initiating insulin in type 2 diabetic patients. In this trial — dubbed “Treating to Target in Type 2 Diabetes,” or “4-T” — U.K. researchers compared three options.

The study included 708 adults with type 2 diabetes and hemoglobin A_1c between 7% and 10% (mean, 8.5%) despite treatment with sulfonylurea plus metformin. Patients with recurrent major hypoglycemia were excluded. Patients continued oral agents initially and were randomized to receive twice-daily biphasic insulin aspart 30 (NovoMix 30), thrice-daily prandial insulin aspart (NovoRapid), or once-daily (twice if required) basal insulin detemir (Levemir). A protocol specified dose titration, glucose monitoring, and follow-up visits. Novo Nordisk supp…

Reviewing Author

Allan S. Brett, MD

Disclosures

Nothing to disclose

Allan S. Brett, MD

Disclosures

Nothing to disclose

Initiating Insulin in Type 2 Diabetes – The “4-T” Trial

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Reviewing Author