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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EMost patients are likely to need more than one type of insulin to achieve target glucose levels in the longer term, according to the one-year results of the Treating to Target in Type 2 Diabetes [4-T] Study.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes \u0026amp; endocrinology clinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ediabetes mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einsulin\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EMost patients are likely to need more than one type of insulin to achieve target glucose levels in the longer term, according to the one-year results of the 4-T Study (Treating to Target in Type 2 Diabetes).\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIn discussing the study, Michael Roden, MD, Medical University of Vienna, Austria, noted that the rationale for the 4-T trial was that there is still uncertainty about which strategy of insulin treatment is most favorable for type 2 diabetics who still produce insulin and exhibit fasting hyperinsulinemia. \u201cThe 4-T Study is important,\u201d Prof. Roden said, \u201cbecause it directly compares the efficacy and safety of three analog insulin regimens for one year under matched conditions of oral antidiabetic therapy.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EJonathan Levy, MD, Oxford Centre for Diabetes, UK, described the 4-T protocol. In 4-T, 708 men and women aged \u226518 years with type 2 diabetes were randomly assigned to one of three open-label Novo Nordisk regimens: BID biphasic insulin (NovoMix 30), TID prandial insulin (NovoRapid) or once-daily basal insulin (Levemir) before bed, with a morning injection added if necessary. The primary outcome was the HbA1c levels achieved by each regimen.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EPatients were required to have had type 2 diabetes for at least one year, HbA1c levels between 7.0\u201310.0%, body mass index \u226440 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, and be currently taking sulfonylureas or metformin. Insulin titration was according to an online Trial Management System giving a single algorithm for all groups. Doses were increased if one-third or more glucose values were above target and reduced in the presence of hypoglycemia. Patients were educated as to how to adjust dosing between visits (7 from randomization to 1 year with 8 interim telephone contacts).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAt baseline, mean age was \u223c62 years; mean diabetes duration was 9 years; HbA1c was 8.5%; and mean fasting plasma glucose was 9.6 mmol\/L. The median insulin starting dose was 15 U\/day (range 10\u201324), 77% of patients received \u0026gt;10 U\/day, 37% \u0026gt;20 U\/day, and 5% \u0026gt;40 U\/day. No grade 3 hypoglycemic events occurred within 2 weeks of starting insulin. Adherence to dose adjustment recommendations (\u00b110%) was 89.7%, 80.4%, and 90.2% for the biphasic, prandial and basal insulin groups, respectively. Significantly more patients in the basal group (17.9%; p\u0026lt;0.001) required a second insulin formulation versus those in the biphasic (8.9%) or prandial groups (4.2%).\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EPrimary outcome results were presented by Rury Holman, FRCP, Oxford Centre for Diabetes, Endocrinology and Metabolism, UK (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11288\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11288\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11288\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003E4-T One-year HbA1c Levels.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ESignificantly more patients had HbA1c \u0026lt;6.5% while taking prandial (23.9%) or biphasic (17.0%) insulin versus basal insulin (8.1%; p=0.001). Weight gain was highest in the prandial group (5.7 kg; p\u0026lt;0.005 vs biphasic) and lowest in the basal insulin group (1.9 kg; p\u0026lt;0.001 vs the prandial and biphasic groups). Median insulin doses (U\/kg\/day) were 0.53 for biphasic, 0.61 for prandial and 0.49 for basal insulin. Mean hypoglycemic events (\u2265 grade 2) were significantly greater with prandial insulin (12.0 per patient per year) than with biphasic (5.7) or basal (2.3).\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EProf. Holman concluded that regimens using biphasic or prandial insulin reduced HbA1c to a greater extent than basal, but were associated with greater risks of hypoglycemia and increased weight gain.\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EClosing his analysis of 4T, Prof. Roden recommended that for patients with HbA1c above target despite maximal doses of metformin plus sulfonylureas, \u201cAdd basal insulin because it is as effective as biphasic and prandial insulin to decrease HbA1c, at least when HbA1c is \u22648.5%.\u201d\u003C\/p\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EProf. Roden concluded, \u201cLong-term randomized controlled trials comparing different insulins and oral antidiabetes drugs regarding macrovascular endpoints are still lacking to allow supporting one specific therapeutic regimen in type 2 diabetes.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/6\/7.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm7op\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzm7op\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}