Efficacy and safety of basal-first titration order in individuals with type 2 diabetes receiving short-term intensive insulin therapy: An exploratory analysis of BEYOND V

Aims: To present the results of an exploratory analysis of the BEYOND V study in which Chinese individuals with uncontrolled type 2 diabetes (T2D) received short-term intensive insulin therapy (SIIT) during study run-in (prior to randomization) using a basal-first insulin titration method. Materials and methods: This was exclusively an exploratory analysis of the 7- to 10-day run-in period of BEYOND V. Participants were hospitalized and had oral therapies withdrawn (except metformin). They received SIIT with once-daily insulin glargine and three-times-daily premeal insulin glulisine, titrated daily from a total starting dose of 0.4 to 0.5 units/kg/d, first adjusting insulin glargine to achieve fasting blood glucose (FBG) of 4.4 to 6.1 mmol/L (79 to 119 mg/dL), then insulin glulisine to achieve pre-meal blood glucose of 4.4 to 6.1 mmol/L. Key outcomes were the proportions of participants achieving FBG and 2-hour postprandial blood glucose (PBG) targets. Results: Overall, 397 entered the run-in (mean 54.2 years, 235 males [59.2%]). At the end of SIIT, 374/396 participants (94.4%) had both FBG < 7.0 mmol/L (< 126 mg/dL) and 2-hour PBG < 10 mmol/L (< 180 mg/dL) and 282/396 (71.2%) had both FBG < 6.1 mmol/L (< 100 mg/dL) and 2-hour PBG < 10 mmol/L. The mean first time taken to achieve FBG < 7 mmol/L, 2-hour PBG < 10 mmol/L, and both, was 4.35, 3.88, and 5.04 days, respectively. Hypoglycaemia occurred in 99 participants (24.9%). There was no severe hypoglycaemia. Conclusions: Titrating basal insulin first is an effective and safe method of SIIT in individuals with T2D, rapidly achieving target glucose levels with a relatively low rate of hypoglycaemia.

Automated summary

The aim of this study was to explore the results of short-term intensive insulin therapy (SIIT) using a basal-first insulin titration method in Chinese individuals with uncontrolled type 2 diabetes (T2D). The study found that titrating basal insulin first is an effective and safe method of SIIT, achieving target glucose levels rapidly with a relatively low rate of hypoglycemia.