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Alternative to Carb Counting

Posted: Thursday, June 15, 2006

Study shows an innovative mealtime insulin dosing algorithm provides alternative to carb counting for Type 2’s.

Type 2 diabetes patients using a new insulin dosing strategy achieved a mean A1c of 6.6% after 24 weeks of combination therapy with rapid-acting Apidra Insulin and 24 hour Lantus.
Results of a study presented at the ADA found that a simple algorithm to adjust mealtime insulin based on pre-meal glucose patterns is just as effective as the more complex carbohydrate counting method – a technique that many find difficult to use.

This new dosing approach relies on a simple algorithm that allows patients to start with a fixed dose of mealtime glulisine and then adjust to target based on premeal glucose patterns. This is an easy way to dose and adjust mealtime insuli that should meet the needs of many patients who are not prepared to undertake the equally effective but more complex carbohydrate counting method study author Richard M. Bergenstal, MD.

Two hundred and seventy-three subjects participated in the open-label multicenter, randomized 24-week study. The study compared the change in glycemic control, as measured by A1c from baseline to study week 24; in subjects receiving glulisine as mealtime insulin following a variable bolus insulin regimen (based on carb counting) vs a fixed bolus insulin regimen; with glargine as basal insulin in both arms of the study.
All participants were switched to basal / bolus therapy with once-daily glargine titrated to fasting blod glucose <95mg/dL and premeal glulisine to targets of <100mg/dL. pre-lunch/dinner and 130 mg/dL. at bedtime + metformin. Premeal glusline was adjusted weekly. One group used a simple algorithm to add 1, 2, or 3U based on premeal glucose patterns. The other grroup, which used carbohydrate counting, adjusted dose based on the I:C ratio.

At ths end of the 24-week period, A1c was significantly reduced in both arms from an initial 8.2% to a final 6.6% with no difference between the algorithm and carbohydrate counting groups, respectively. The algorithm group received significantly higher does of glulisine (110.2 vs. 84.3U) and glargine 103.4 vs 87.0U) and had significantly less symptomatic hypoglycemia <50 mg/dL (4.9 vs 8.0 events/patient year) then the carbohydrate counting group.

No differences were observed for the proportion of paricipants achieving A1c <7% (73& vs 69.2%) or weight gain (3.7 vs 2.4kg) for the algorithm and carbohydrate counting groups, respectivly. Both groups concluded the study with a basal-bolus ration of 50:50 and used 1.8-2 U/kg of insulin per day. Adverse events in each group were similar and included infection, gastrointestinal disorders and nervous system-related events.


Source: Diabetes In Control: These findings were presented at the 66th Annual Scientific Sessions of the American Diabetes Association (ADA) in Washington, D.C.

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