Our aim was to compare the effects of an intermediate acting human
insulin (NPH) and a
long-acting insulin analog,
insulin glargine, in
insulin naïve
type 2 diabetes patients, stratified by the type of
hyperglycemia (fasting or postprandial type). Based on different action profiles, we hypothesized that patients having different
hyperglycemia types would react differently when treated with these
insulins. This is a post hoc analysis of the Lanmet study data. The Lanmet study was a randomized, 36-week controlled
insulin initiation study in
type 2 diabetes patients. 109 subjects with baseline HbA1c >8.0% (64 mmol/mol) completed the study. The patients were divided into two groups according to fasting
glucose (mmol/l)/HbA1c (%) ratio. Patients with a ratio ≥1.3 were defined as having fasting type and those with a ratio <1.3 as having postprandial type
hyperglycemia. The main outcome measures were change in HbA1c and
body weight, and final
insulin dose. Independently of
insulin type, compared to patients with postprandial type
hyperglycemia, those with fasting type
hyperglycemia had 2.1 kg/m(2) greater initial BMI (p = 0.044), gained 2.0 kg more weight (p = 0.020, adjusted for baseline BMI p = 0.035), and had 36% greater final
insulin dose/kg (p = 0.001). With respect to
hyperglycemia type, there was no difference between NPH and
glargine in their effects on HbA1c. When starting bedtime
insulin in
type 2 diabetes patients, those with fasting type
hyperglycemia are prone to greater
weight gain.
Hyperglycemia type does not help in identifying patients who would benefit specially from either
NPH insulin or
insulin glargine.