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Adjust To Target In Type 2 Diabetes: Comparison Of A Simple Algorithm To Carbohydrate Counting For Adjustment Of Mealtime Insulin Glulisine

¹International Diabetes Center at Park Nicollet, Minneapolis MN
²Cotton-O'Neil Clinic, Topeka KS
³sanofi-aventis US, Bridgewater NJ
⁴Baylor Endocrine Center, Dallas TX
⁵Creighton Diabetes Center, Omaha NE

richard.bergenstal{at}parknicollet.com

ABSTRACT

Objective: Carbohydrate counting is an effective approach to mealtime insulin adjustment in type 1 diabetes, but has not been rigorously assessed in type 2 diabetes.

Research and Design Methods: This 24-week, multicenter, randomized, controlled study compared two algorithms for adjusting mealtime (glulisine) insulin along with a standard algorithm for adjusting background (glargine) insulin in 273 intent-to-treat patients with type 2 diabetes. Glulisine and glargine were adjusted weekly in both groups based on previous week's self monitored blood glucose (SMBG) results. The Simple Algorithm group was provided set doses of glulisine to take before each meal. The Carbohydrate Counting group was provided an insulin to carbohydrate ratio to use for each meal and adjusted their glulisine dose based on amount of carbohydrate consumed.

Results: A1C levels at week 24 were 6.70% (Simple Algorithm) and 6.54% (Carb Count). The respective mean A1C changes from baseline to 24 weeks were –1.46% and –1.59% (P=.24). A1C <7.0% was achieved by 73.2% (Simple Algorithm) and 69.2% (Carb Count) (P=.70); respective values for A1C <6.5% were 44.3% and 49.5% (P=.28). The total daily dose of insulin was lower and there was a trend toward less weight gain in Carb Count patients. Severe hypoglycemia rates were low and equal in the two groups.

Conclusions: Weekly basal:bolus insulin adjustments based on premeal and bedtime glucose patterns resulted in significant reductions in A1C. Having two effective approaches to delivering and adjusting rapid-acting mealtime insulin may increase physicians' and patients' willingness to advance therapy to a basal:bolus insulin regimen.

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Death to Carbohydrate Counting?

Nichola J. Davis and Judith Wylie-Rosett
Diabetes Care 2008 31: 1467-1468. [Extract] [Full Text] [PDF]

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				N. J. Davis and J. Wylie-Rosett Death to Carbohydrate Counting? Diabetes Care, July 1, 2008; 31(7): 1467 - 1468. [Full Text] [PDF]