Basal Hyperglycemia Dominates at High A1C Levels

Contribution reduced to about one-third after basal insulin, two-thirds after alternate regimen

THURSDAY, Dec. 1 (HealthDay News) -- For patients with type 2 diabetes with hemoglobin A1c (A1C) levels of >7.0 percent, the contribution of basal hyperglycemia (BHG) to total hyperglycemic exposure is high, and is reduced following intensification of treatment and concomitant reduction of A1C levels, according to a study published in the December issue of Diabetes Care.

Matthew Riddle, M.D., from the Oregon Health and Science University in Portland, and colleagues investigated the relative contributions of BHG versus postprandial hyperglycemia (PPHG) to hyperglycemic exposure (>100 mg/dL), before and after intensifying treatment, among patients with an A1C of >7.0 percent on oral therapy. Data from six trials for 1,699 participants, comparing titrated insulin glargine against an alternative regimen (basal, premixed, or postprandial insulin or oral agents), provided plasma-referenced glucose profiles and A1C values.

The investigators found that participants on prior oral therapy had a mean fasting plasma glucose (FPG) of 194 mg/dL and mean A1C of 8.7 percent. The average BHG contribution to hyperglycemia was 76 to 80 percent at baseline. Adding basal insulin for 24 or 28 weeks, or an alternative regimen, reduced the mean FPG to 117 and 146 mg/dL, respectively; A1C to 7.0 and 7.1 percent, respectively; and the BHG contribution to 32 to 41 percent and 64 to 71 percent, respectively. Among patients with an average A1C of 7.6 to 7.7 percent, BHG contributed 76 percent at baseline, 34 percent after basal insulin, and 68 percent after other therapies.

"When A1C is higher than 7.0 percent despite diet and oral therapy, BHG dominates hyperglycemic exposure over a wide range of A1C values," the authors write.

Several authors disclosed financial relationships with pharmaceutical companies, including Sanofi-Aventis, which funded the study.

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