Endocrine Abstracts

We describe 10 obese patients with longstanding type 2 diabetes mellitus treated with a combination of basal insulin coupled with insulin Aspart and oral metformin. Average age was 59.5 years. Average BMI was 31.82 and Hemoglobin A1c 8.71%. Average Total Daily insulin dose (TDD) was 157.1 IU. EGFR was >60 in all patients. No patient underwent weight reduction surgery.Patients were randomized into 2 groups of 5 patients each. One group(1) received only Humulin U-500 Regular insulin by (CSII) via Animas pump. The other group(2) was randomized to receive 2/3 of the basal insulin dose coupled with CSII insulin Aspart via Animas pump and continuation of metformin. The patients in group1 also received the CGMS Dexcom sensor. Duration of the study was 15 months. At the end of the study, the average BMI was 33.47, average A1c hemoglobin 7.14% and TDD was 145 IU in group 1 vs. 35.28 BMI, 7.26% A1c hemoglobin and 149.2 TDD in group 2. (table 1). Average incidence of hypoglycemia was 8% in group1 vs. 4% in group 2.

Conclusion: Treatment of significantly obese type 2 diabetes mellitus patients with Humulin U-500 Regular insulin via insulin pump can lead to signicant improvement in glycemic control and at a statisticallly significant weight advantage over a combination of continous insulin Aspart coupled with adjuvant basal insulin and metformin. The additional hypoglycemia could be prevented by adding a CGMS to the treatment algorithm.

TDD is expressed in 100 unt/ml (for U-500 units divide by 5) A+L+M=Aspart CSII +Lantus or Levemir+Metformin WCM=White Caucasian Male AAM=African American Male Lantus, Levemir, Humulin U-500, Animas, Dexcom are all Registered Trademarks.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.