Automatic snacking prevents hypoglycemia among outpatient type 2 diabetic patients on intensive insulin therapy
- Author:
Zarina G Lorenzo
;
Leilani B Mercado-Asis
- Publication Type:Journal Article
- From:
Philippine Journal of Internal Medicine
2011;49(2):57-60
- CountryPhilippines
- Language:English
-
Abstract:
Background: Intensive insulin therapy is efficacious in achieving glycemic targets. However, it is associated with adverse cardiovascular outcomes due to an increased risk of hypoglycemia. Objective: To demonstrate the value of automatic snacking in preventing hypoglycemia among outpatient type 2 diabetic patients. Methods: Charts of 118 type 2 diabetes mellitus (DM) patients with HbA1c >7.0% despite oral antidiabetic agents, insulin therapy or in combination were reviewed. Insulin regimens were given as follows: glargine or determir prebreakfast with lispro/aspart premeals 3x a day (regimen A), or premixed 70/30 prebreakfast and predinner with lispro or aspart premeals 3x a day (regimen B), or a premixed 70/30 NPH and aspart (Novomix) 3x a day (regimen C). HBA1c was taken at baseline and repeated three to six months later. Twenty-four hour calorie supplementation included three main meals and three snacks taken automatically two hours after each meal, even the patient was not hungry. Hypoglycemia monitoring was done accordingly. Results: Of the 118 patients, 46(39%) were males; 72 (61%) were females with mean age of 57 years. The majority (75%) of patients were obese (BMI >25kg/m2) with family history of DM (76%). Mean baseline HbA1c was 9.2 ± 1.96 % (7.9 to 14%). Repeat HbA1c on follow-up within six months was 7.17 ± 1.10%. A significant mean decrease of 2.03 ± 1.66 % with a p value of <0.0001 (0.3 to 5.95%) was observed. A total of 103 (88%) patients reached target HbA1c of 7% or below. Of the 88%, 46% reached target HbA1c after three months while the remaining 54% after six months. Of note, no one had significant hypoglycemia. Conclusion: Automatic snacking prevented significant hypoglycemia among outpatient type 2 DM on intensive insulin therapy while achieving target HbA1c level.
