The choice of initial insulin treatment plan for type 2 diabetes mellitus patients with failure of oral hypoglycemic agents

Objective To investigate the insulin treatment plan after the failure of oral hypoglycemic agents for type 2 diabetes in China. Methods 180 patients with type 2 diabetes who failed to oral hypoglycemic drugs were randomly divided into three groups on average: A group(insulin glargine+ metformin+ gliclazide sustained-release tablets), B group(insulin aspart 30+ metformin) and C group(insulin glargine+ metformin+ insulin aspart). 24 weeks later, the hypoglycemic effect and security were observed.Three years later, the compliance that patients used original treatment plan were observed. Results 24 weeks later, HbA1c of the three group significantly decreased compared with that before the study[A group: (7.3±0.8)% vs.(10.2±1.7)%; B group: (7.0±0.8)% vs.(9.9±1.5)%; C group: (6.9±0.7)% vs.(10.4±1.8)%, all P<0.05]. The incidence of hypoglycemia in C group(1.66 times·year-1·people-1) was significantly higher than that in A group(1.04 times·year-1·people-1) and B group(1.31 times·year-1·people-1)(χ2=11.777, 4.362, all P<0.05). However, the daily average cost of the drug in the B group[(12.9±3.0)yuan]was significantly lower than that in A group[(25.6±3.8)yuan]and C group[(22.7±4.7)yuan](t=18.943, 13.226, all P<0.05). Three years later, the percentage of patients who used original treatment plan in the C group(40.0%) was significantly less than that in A group(68.0%) and B group(73.0%)(χ2=8.656, 12.398, all P<0.05). Conclusion Type 2 diabetic patients who failed to oral hypoglycemic agents, according to their own economic conditions, might choose aspart 30 or glargine.The hypoglycemic treatment of aspart 30 has better long term effect, lower costs and incidence of hypoglycemia, better compliance. Key words: Diabetes mellitus, type 2; Insulin aspart 30; Medication adherence