Davidson JA, Lacaya LB, Jiang H, Heilmann CR, Scism-Bacon JL, Gates JR, Jackson JA.
Department of Medicine, University of Texas Southwestern Medical School, Dallas, TX.
Objective: To explore the impact of race/ethnicity on the efficacy and safety of commonly-used insulin regimens in patients with type 2 diabetes (T2D).Methods: Pooled data from 11 multinational clinical trials involving 1455 patients with T2D were used to compare specific insulin treatments-once daily insulin glargine or NPH [BASAL]; insulin lispro mix75/25 (LMBID) twice daily; insulin lispro mix50/50 (LMTID) thrice daily-in Latino/Hispanic, Asian, and African-descent patient populations relative to Caucasians.Results: Race/ethnicity was associated with significant outcome differences relative to Caucasians for each of the insulin regimens. BASAL therapy was associated with greater improvement in several measures of glycemic control among Latino/Hispanic patients compared with Caucasians (lower endpoint A1C, greater reduction in A1C from baseline, and a larger proportion of patients achieving A1C <7%). In contrast, LMBID therapy was associated with higher endpoint A1C and less of a decrease in A1C from baseline in both Latino/Hispanics and Asians compared with Caucasians. Furthermore, fewer Asians attained A1C <7% compared with Caucasians. For LMTID therapy, A1C outcomes were comparable across patient groups. Fasting blood glucose and glycemic excursions varied among racial/ethnic groups for the 3 insulin regimens. Weight change was comparable among racial/ethnic groups in each of the insulin regimens. During treatment with LMTID, Asians experienced higher incidence and rate of severe hypoglycemia than Caucasians.Conclusion: Latino/Hispanic, Asian, and African-descent patients with T2D showed different metabolic responses to insulin therapy, dependent in part on insulin type and regimen intensity. These findings, if confirmed, may have important implications for clinical practice.
PMID: 20439249
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