Randomized Crossover Study to Examine the Necessity of an Injection-to-Meal Interval in Patients With Type 2 Diabetes and Human Insulin

July 2013
Diabetes Care;Jul2013, Vol. 36 Issue 7, p1865
Academic Journal
OBJECTIVE--Patients with diabetes and insulin therapy with human insulin were usually instructed to use an interval of 20-30 min between the injection and meal. We examined the necessity of the injection-to-meal interval (IMI) in patients with type 2 diabetes mellitus (T2DM) and flexible insulin therapy with human insulin. RESEARCH DESIGN AND METHODS--In this randomized, open crossover trial, 100 patients with T2DM (47% men, mean age = 66.7 years) were randomized to the IMI first group (phase 1, IMI 20 min; phase 2, no IMI) or IMI last group (phase 1, no IMI; phase 2, IMI 20 min). The main outcome measures were HbA1c, blood glucose profile, incidence of hypoglycemia, quality of life, treatment satisfaction, and patient preference. RESULTS--Forty-nine patients were randomized to the IMI first group and 51 patients to the IMI last group. Omitting the IMI only slightly increases HbA1c (average intraindividual difference = 0.08% [95% CI 0.01-0.151). Since the difference is not clinically relevant, a therapy without IMI is noninferior to its application (P < 0.001). In the secondary outcomes, the incidence of mild hypoglycemia also did not differ between no IMI and IMI significantly (mean of differences = --0.10, P = 0.493). No difference in the blood glucose profile of both groups was found. Treatment satisfaction increased markedly, by 8.08, if IMI was omitted (P < 0.001). The total score of the quality of life measure did not show differences between applying an IMI or not. Insulin therapy without IMI was preferred by 86.5% of patients (P < 0.001). CONCLUSIONS--An IMI for patients with T2DM and preprandial insulin therapy is not necessary.


Related Articles

  • Correlates of Insulin Injection Omission. Peyrot, Mark; Rubin, Richard R.; Kruger, Davida F.; Travis, Luther B. // Diabetes Care;Feb2010, Vol. 33 Issue 2, p240 

    OBJECTIVE -- The purpose of this study was to assess factors associated with patient frequency of intentionally skipping insulin injections. RESEARCH DESIGN AND METHODS -- Data were obtained through an Internet survey of 502 U.S. adults self-identified as taking insulin by injection to treat...

  • Long-Term Outcome of Individuals Treated With Oral Insulin. VEHIK, KENDRA; CUTHBERTSON, DAVID; RUHLIG, HOLLY; SCHATZ, DESMOND A.; PEAKMAN, MARK; KRISCHER, JEFFREY P. // Diabetes Care;Jul2011, Vol. 34 Issue 7, p1585 

    OBJECTIVE--To evaluate the long-term intervention effects of oral insulin on the development of type 1 diabetes and to assess the rate of progression to type 1 diabetes before and after oral insulin treatment was stopped in the Diabetes Prevention Trial-Type 1 (DPT-1). RESEARCH DESIGN AND...

  • Evaluation of an Algorithm to Guide Patients With Type 1 Diabetes Treated With Continuous Subcutaneous Insulin Infusion on How to Respond to Real-Time Continuous Glucose Levels. Jenkins, Alicia J.; Krishnamurthy, Balasubramanium; Best, James D.; Cameron, Fergus J.; Colman, Peter G.; Farish, Steven; Hamblin, Peter S.; O'Connell, Michele A.; Rodda, Christine; Rowley, Kevin; Teede, Helena; O'Neal, David N. // Diabetes Care;Jun2010, Vol. 33 Issue 6, p1242 

    OBJECTIVE-- To evaluate an algorithm guiding responses of continuous subcutaneous insulin infusion (CSII)-treated type 1 diabetic patients using real-time continuous glucose monitoring (RT-CGM). RESEARCH DESIGN AND METHODS-- Sixty CSII-treated type 1 diabetic participants (aged 13-70 years,...

  • Overall satisfaction increased more with inhaled insulin than with subcutaneous insulin in type 1 diabetes. Bilous, Rudy // ACP Journal Club;May/Jun2002, Vol. 136 Issue 3, p101 

    Comments on a study which investigated treatment satisfaction with inhaled insulin in patients with type 1 diabetes. Outcome measures; Comparison of the effects of inhaled insulin and subcutaenous insulin injection on patients with type 1 diabetes mellitus.

  • Unnecessary insulin treatment for diabetics. Kromann, H.; Borch, E.; Gale, E.A.M. // British Medical Journal (Clinical Research Edition);11/21/1981, Vol. 283 Issue 6303, p1386 

    Investigates the unnecessary insulin treatment for diabetes. Indications for starting treatment with insulin; Classification of diabetes; Symptoms of hypogycemia.

  • Insulin therapy.  // Nursing Standard;10/18/2006, Vol. 21 Issue 6, p58 

    A quiz that tests nurses' knowledge on insulin therapy is presented.

  • Flexible Insulin Regimens for People with Type 1 Diabetes.  // American Family Physician;11/15/1999, Vol. 60 Issue 8, special section p1 

    Deals with the proper use of insulin for people with type 1 diabetes. Definition of insulin; Information on the flexible insulin regimen; Importance of counting carbohydrates.

  • Inpatient Management of Hyperglycemia and Diabetes. Seley, Jane Jeffrie // Diabetes Spectrum;Fall2008, Vol. 21 Issue 4, p230 

    The article discusses various reports published within the issue including one by Nancy J. D'Hondt on continuous intravenous insulin (CII) treatment for diabetes and another by Joyce Malaskovitz on the importance of data collection in efforts to enhance the quality of inpatient hyperglycemia and...

  • Learning About New Therapies: Phase 3 Clinical Studies--And Beyond. RIDDLE, MATTHEW C. // Diabetes Care;Sep2013, Vol. 36 Issue 9, p2453 

    An introduction to a study comparing 200 units formulation of insulin degludec with 100 units of insulin glargine for the treatment of diabetes is presented.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics