“Patients with type 2 diabetes, who are inadequately controlled on basal insulin plus oral anti-diabetic medications (OADs), obtained comparable reduction in A1c, whether they intensified with bolus insulin treatment step by step, or followed a full basal-bolus treatment with every meal from the start”

…

“Both treatment regimens succeeded in lowering A1c levels to the same extent. The change from baseline A1c was -0.98% after 32 weeks in the step-wise treatment group, compared with -1.12% in the basal-bolus group (not statistically significant).”

This seems very encouraging to me. Taking these patients and putting them on either a basal/bolus or on a bolus only regime did not produce significant differences in the reduction in A1C levels. My interpretation is that a bolus only regimen reduced A1c 0.98% more than a basal only regimen, and that a basal/bolus regimen reduced A1c 1.12% more than a basal only regimen. This indicates to me that a bolus only regimen is better that a basal only regimen. This is what Al has been saying for years; type 2 diabetics first lose the ability to produce the prandial insulin spike. In addition, the combined basal/bolus was not significantly better than the bolus only.

“Findings also showed that step-wise intensification of mealtime insulin therapy—adding doses over a period of several weeks—resulted in a significantly lower rate of hypoglycemia compared with a full basal-bolus intensification.”

The bolus only regimen had lower risk of hypoglycemia than the basal/bolus regimen. I think this is because the patient’s pancreas can stop producing insulin if the bolus insulin has not dissipated when the meal is digested, but if the patient is taking both basal and bolus, there is just too much insulin even if the pancreas stops producing insulin.

This almost seems like the perfect trial to show the benefit of a drug like Afrezza.

Thanks for posting this Brentie.