Basal Insulin Is as Effective as Preprandial Insulin in Type 2 Diabetes

About half of patients with type 2 diabetes eventually require insulin. Recent guidelines suggest starting insulin therapy with once-daily basal insulin, titrated to control fasting blood glucose. However, some studies suggest that postprandial glucose correlates more closely with glycosylated hemoglobin (HbA_1c) and that better control might be achieved with preprandial short-acting insulin.

Researchers, funded by the manufacturer of insulin glargine (Lantus), randomized 415 patients with type 2 diabetes and HbA_1c levels between 7.5% and 10.5% to take either once-daily insulin glargine or thrice-daily preprandial insulin lispro (Humalog). Insulin doses were titrated weekly by algorithm to achieve fasting blood glucose levels <99 mg/dL for in…