Glycaemic control without weight gain in insulin requiring type 2 diabetes: 1-year results of the GAME regimen

Authors: de Boer,; Keizers¹; Jansen²; Verschoor¹; Ruineman-Koerts³

Source: Diabetes, Obesity and Metabolism, Volume 8, Number 5, September 2006 , pp. 517-523(7)

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Abstract:

Introduction:

Weight gain appears to be unavoidable in patients with type 2 diabetes who are switched from oral agents to insulin therapy. Peripheral hyperinsulinism induced by the use of long-acting insulin may be the key to explain this adverse effect. Aim:

The aim of this study was to investigate whether a regimen free of long-acting insulin can provide long-term glycaemic control without causing weight gain. Patients and methods:

This is an uncontrolled, 1-year study comprising 58 patients with type 2 diabetes and secondary failure, age 30-75 years, BMI 25-35 kg/m², HbA1c > 7.5% and fasting C-peptide level > 0.3 mmol/l. All patients were treated with the GAME regimen, a combination of glimepiride administered at 20:00 hours for nocturnal glycaemic control, insulin aspart three times daily for meal-related glucose control and metformin. Results:

Seventy-one per cent of the patients were considered evaluable. HbA1c decreased from 10.0 ± 0.3 to 7.4 ± 0.1% (p < 0.001). Fifty-nine per cent reached HbA1c levels ≤ 7.5%. Symptomatic nocturnal hypoglycaemia was not reported. Body weight tended to decrease during the first 3 months (−1.0 ± 0.5 kg, p = 0.06), but then gradually rose to a value 0.8 ± 0.5 kg higher than at baseline (p = 0.12). This is 4.4 ± 0.6 kg less than predicted for conventional regimens employing long-acting insulin (p < 0.001). Conclusion:

The GAME regimen provides long-term glycaemic control as well as stabilization of body weight in about 60% of type 2 patients presenting with secondary failure.

Keywords: diabetes mellitus type 2; insulin aspart; glimepiride; weight gain

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1463-1326.2005.00537.x

Affiliations: 1: Department of Internal Medicine, Ziekenhuis Rijnstate, Arnhem, the Netherlands 2: Department of Pharmacology, Ziekenhuis Rijnstate, Arnhem, the Netherlands 3: Department of Clinical Chemistry, Ziekenhuis Rijnstate, Arnhem, the Netherlands

Publication date: 2006-09-01

Glycaemic control without weight gain in insulin requiring type 2 diabetes: 1-year results of the GAME regimen

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