Advances in Therapy

, Volume 24, Issue 6, pp 1348–1356 | Cite as

Biphasic insulin aspart 70/30 three times a day in older patients with type 2 diabetes not achieving optimal glycemic control on a twice-daily regimen: A retrospective case series analysis from clinical practice

  • Joseph T. Tibaldi


This retrospective study was conducted to determine whether the addition of a third injection of biphasic insulin aspart 70/30 (BIAsp 30) just before lunch in older patients with type 2 diabetes who did not achieve goals with a twice-daily (BID) regimen would optimize glycemic control in a clinical practice setting. A retrospective chart analysis was conducted. In 12 patients aged 52 to 80 y with type 2 diabetes that had been diagnosed between 5 and 24 y earlier and who remained on oral antidiabetes agents, a third injection of BIAsp 30 was added because optimal glycemic control (glycosylated hemoglobin [HbA1c] < 7%) was not achieved on a BID regimen. Changes in HbA1c, body weight, total insulin dose, and frequency of hypoglycemia were analyzed after 6 mo of three times daily (TID) treatment. Mean HbA1c decreased from 8.4% to 7.2%. An HbA1c goal of < 7% was attained by 58% of patients. Although the total insulin dose increased by 11% with the TID regimen, pre-breakfast and predinner doses decreased by 15%. No patient experienced major hypoglycemia on BID or TID dosing. With the TID regimen, no minor hypoglycemic events were reported by patients and mean body weight decreased by 2.25 lb. The addition of a third injection of BIAsp 30 substantially improved HbA1c and decreased body weight and the incidence of hypoglycemia in 12 patients with type 2 diabetes who did not achieve optimal glycemic control on a BID regimen.


premixed insulin analog BIAsp 30 HbA1c hypoglycemia dosing 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Nathan DM. Clinical practice: initial management of glycemia in type 2 diabetes mellitus.N Engl J Med. 2002;347:1342–1349.PubMedCrossRefGoogle Scholar
  2. 2.
    American Diabetes Association. Standards of medical care in diabetes—2007.Diabetes Care. 2007;30:S4-S41.CrossRefGoogle Scholar
  3. 3.
    Davidson JA, Blonde L, Jellinger PS, Lebovitz HE, Parkin CG. Road map for the prevention and treatment of type 2 diabetes.Endocr Pract. 2006;12:148.Google Scholar
  4. 4.
    Saaddine JB, Cadwell B, Gregg EW, et al. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002.Ann Intern Med. 2006;144:465–474.PubMedGoogle Scholar
  5. 5.
    Nathan DM, Buse JB, Davidson MB, et al. Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes.Diabetes Care. 2006;29:1963–1972.PubMedCrossRefGoogle Scholar
  6. 6.
    Hirsch IB. Insulin analogues.N Engl J Med. 2005;352:174–183.PubMedCrossRefGoogle Scholar
  7. 7.
    Garber AJ. Premixed insulin analogues for the treatment of diabetes mellitus.Drugs. 2006;66:31–49.PubMedCrossRefGoogle Scholar
  8. 8.
    Rolla AR, Rakel RE. Practical approaches to insulin therapy for type 2 diabetes mellitus with premixed insulin analogues.Clin Ther. 2005;27:1113–1125.PubMedCrossRefGoogle Scholar
  9. 9.
    Bohannon NJ, Ohannesian JP, Burdan AL, Holcombe JH, Zagar A. Patient and physician satisfaction with the Humulin/Humalog Pen, a new 3.0-mL prefilled pen device for insulin delivery.Clin Ther. 2000;22:1049–1067.PubMedCrossRefGoogle Scholar
  10. 10.
    Korytkowski M, Bell D, Jacobsen C, Suwannasari R. A multicenter, randomized, open-label, comparative, two-period crossover trial of preference, efficacy, and safety profiles of a prefilled, disposable pen and conventional vial/syringe for insulin injection in patients with type 1 or 2 diabetes mellitus.Clin Ther. 2003;25:2836–2848.PubMedCrossRefGoogle Scholar
  11. 11.
    Rubin RR, Peyrot M. Quality of life, treatment satisfaction, and treatment preference associated with use of a pen device delivering a premixed 70/30 insulin aspart suspension (aspart protamine suspension/soluble aspart) versus alternative treatment strategies.Diabetes Care. 2004;27: 2495–2497.PubMedCrossRefGoogle Scholar
  12. 12.
    Abrahamson MJ. A 74-year-old woman with diabetes.JAMA. 2007;297:196–204.PubMedCrossRefGoogle Scholar
  13. 13.
    Hainer TA. Managing older adults with diabetes.J Am Acad Nurse Pract. 2006;18:309–317.PubMedCrossRefGoogle Scholar
  14. 14.
    Brown AF, Mangione CM, Saliba D, Sarkisian CA. Guidelines for improving the care of the older person with diabetes mellitus.J Am Geriatr Soc. 2003;51:S265-S280.PubMedCrossRefGoogle Scholar
  15. 15.
    Narayan KM, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent increase in incidence on future diabetes burden: US, 2005–2050.Diabetes Care. 2006;29:2114–2116.PubMedCrossRefGoogle Scholar
  16. 16.
    Korytkowski M, Niskanen L, Asakura T. FlexPen: addressing issues of confidence and convenience in insulin delivery.Clin Ther. 2005;27:S89-S100.PubMedCrossRefGoogle Scholar
  17. 17.
    Garber AJ, Wahlen J, Wahl T, et al. Attainment of glycemic goals in type 2 diabetes with once-, twice-, or thrice-daily dosing with biphasic insulin aspart 70/30 (the 1-2-3 study).Diabetes Obesity Metab. 2005;8:58–66.CrossRefGoogle Scholar
  18. 18.
    American Diabetes Association. Postprandial blood glucose.Diabetes Care. 2001;24:775–778.CrossRefGoogle Scholar
  19. 19.
    Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c).Diabetes Care. 2003;26:881–885.PubMedCrossRefGoogle Scholar
  20. 20.
    Boehm BO, Home PD, Behrend C, Kamp NM, Lindholm A. Premixed insulin aspart 30 vs. premixed human insulin 30/70 twice daily: a randomized trial in Type 1 and Type 2 diabetic patients.Diabet Med. 2002;19:393–399.PubMedCrossRefGoogle Scholar
  21. 21.
    Roach P, Yue L, Arora V. Improved postprandial glycemic control during treatment with Humalog Mix25, a novel protamine-based insulin lispro formulation. Humalog Mix25 Study Group.Diabetes Care. 1999;22:1258–1261.PubMedCrossRefGoogle Scholar
  22. 22.
    Roach P, Trautmann M, Arora V, Sun B, Anderson JH Jr. Improved postprandial blood glucose control and reduced nocturnal hypoglycemia during treatment with two novel insulin lisproprotamine formulations, insulin lispro mix25 and insulin lispro mix50. Mix50 Study Group.Clin Ther. 1999;21:523–534.PubMedCrossRefGoogle Scholar
  23. 23.
    Malone JK, Kerr LF, Campaigne BN, Sachson RA, Holcombe JH. Combined therapy with insulin lispro Mix 75/25 plus metformin or insulin glargine plus metformin: a 16-week, randomized, open-label, crossover study in patients with type 2 diabetes beginning insulin therapy.Clin Ther. 2004;26:2034–2044.PubMedCrossRefGoogle Scholar
  24. 24.
    Malone JK, Bai S, Campaigne BN, Reviriego J, Augendre-Ferrante B. Twice-daily pre-mixed insulin rather than basal insulin therapy alone results in better overall glycaemic control in patients with Type 2 diabetes.Diabet Med. 2005;22:374–381.PubMedCrossRefGoogle Scholar
  25. 25.
    Raskin P, Allen E, Hollander P, et al. Initiating insulin therapy in type 2 diabetes: a comparison of biphasic and basal insulin analogs.Diabetes Care. 2005;28:260–265.PubMedCrossRefGoogle Scholar
  26. 26.
    Jacobsen LV, Sogaard B, Riis A. Pharmacokinetics and pharmacodynamics of a premixed formulation of soluble and protamine-retarded insulin aspart.Eur J Clin Pharmacol. 2000;56:399–403.PubMedCrossRefGoogle Scholar
  27. 27.
    Hermansen K, Colombo M, Storgaard H, Ostergaard A, Kolendorf K, Madsbad S. Improved postprandial glycemic control with biphasic insulin aspart relative to biphasic insulin lispro and biphasic human insulin in patients with type 2 diabetes.Diabetes Care. 2002;25:883–888.PubMedCrossRefGoogle Scholar
  28. 28.
    Cramer JA. A systematic review of adherence with medications for diabetes.Diabetes Care. 2004;27:1218–1224.PubMedCrossRefGoogle Scholar

Copyright information

© Health Communications Inc 2007

Authors and Affiliations

  1. 1.Flushing Hospital Medical CenterFlushing

Personalised recommendations