The effect of type and daily doses of insulin to treatment success in type 2 diabetes patients who are receiving basal bolus insulin therapy

Objectives The present study aims to compare different types of insulin concerning treatment success and insulin dose requirement in type 2 diabetes patients who were receiving basal-bolus insulin therapy and to evaluate the causes of treatment failure despite high doses of insulin. Methods In our retrospective study, 198 type 2 diabetes patients who were receiving basal-bolus insulin therapy included. Patients were divided into three groups according to the insulin types (Group 1: short and long-acting analogue insulin users (n=83), Group 2: short and long-acting human regular insulin users (n=58), Group 3: human regular insulin + long-acting analogue insulin users (57)). Demographic data and daily insulin doses were recorded from the patient follow-up files. These data and the rates of achievement of the target HbA1c levels were also compared between groups. In addition, insulin doses of the patients whose glycemic targets could and could not be achieved were compared. Results In this study, 123 (62.1%) of the 198 patients were female and 65 (47.9 %) were male. The mean age of the three groups was 55.81±8.1, 58.3±8.9, 58.3±8.8, respectively. HbA1C values were 8.72±1.65% in group 1, 9.0±1.98% in group 2 and 9.05±2.24% in group 3. The rates of achievement HbA1c value below 7% were 27.7% in analogue insulin group, 25.9% human regular insulin group and 31.6% in regular + analogue insulin group (p >0.05). There were no significant differences in daily basal and bolus insulin doses, total daily and per kg insulin doses and basal-bolus rates between groups. Higher total daily insulin doses were determined in patients who could not achieve target glycemic values than achieved it in group 1 and 2. Higher basal insulin doses were determined in patients who could not achieve target glycemic values than could achieved it in group 3. Conclusion In our study, in which we did not find any significant difference in the dose analysis between analogue and regular insulin, the findings showed that high insulin doses might not be sufficient for glycemic control. The underlying causes should be investigated and correctible reasons should be eliminated in these patients.