COMPARING GLYCAEMIC CONTROL AFTER INITIATION OF BASAL WITH INITIATION OF BIPHASIC INSULIN IN TYPE-2 DIABETES MELLITUS: A SYSTEMATIC LITERATURE REVIEW

Introduction and Objective; Type 2 Diabetes Mellitus is a progressive condition that often eventually requires insulin therapy. With a global prevalence of 8% in all adults, and rising, insulin management will fast become a staple of the family doctor. UK national guidance (2008) recommends initiating once or twice daily basal insulin but admits to a lack of literature comparing basal with biphasic insulin. We performed an in-depth literature review critically appraising all new studies from 2008 – 2014, to establish which form was superior. Method; All papers (2008 – 2014) comparing basal and biphasic insulin initiation in insulin naïve Type 2 diabetic patients were found using numerous strategic searches: PICO method, inclusion, exclusion, hand searching and reference list searching. Databases used were: Medline, Pubmed, Cochrane collaboration, DARE and Embase. Each paper was then critically appraised using the CASP questionnaire tool and thematic synthesis. Results and Conclusions; Eight papers were found to be suitable: seven randomized control trials and one observational. Both modalities showed significant reduction in HbA1c from between 64-69mmol/mol (8.0-8.5%) to approximately 53mmol/mol (7.0%) within at least 24 weeks. Within a thematic analysis, it was found that biphasic insulin had an initial greater effect on lowering HbA1c. After one year of treatment both modalities needed intensification to more complex regimes in order to maintain glycaemia control. We conclude, in contrast to current guidance, basal insulin is not superior to biphasic insulin when initiating therapy targeted at lowering HbA1c.