Comparison of thrice-daily premixed insulin with a basal-bolus regimen in Iraqi patients with insulin-dependent diabetes

Abstract

The use of basal-bolus therapy is common in Iraq, yielding positive results in terms of glycemic control but often leading to poor patient satisfaction and compliance due to the increased number of required injections. There is a need for an alternative insulin regimen that maintains efficacy and safety comparable to the basal-bolus protocol while offering greater convenience. Unlike in Western communities, premixed insulin is more widely utilized and accepted among Iraqi patients. The study compares the effectiveness of thrice-daily premixed insulin therapy with the basal-bolus regimen in patients with insulin-dependent diabetes. In a prospective, non-randomized, controlled interventional trial, 25 patients previously using a basal-bolus regimen were transitioned to thrice-daily premixed human insulin. The primary outcomes assessed were changes in HbA1c levels, and secondary outcomes included differences in daily self-monitored blood glucose (SMBG) readings, the number of hypoglycemic events, weight changes, and overall patient satisfaction. The mean HbA1c level in patients when on the basal-bolus protocol was 8.828, which decreased to 8.7 after three months of switching to thrice-daily premixed insulin (a mean difference of -0.179±0.09, with a p-value<0.0001). The mean number of weekly hypoglycemic events remained similar between the basal-bolus regimen (1.44 events) and the premixed insulin regimen (1.48 events). Furthermore, 65% of the patients expressed satisfaction with the results of the new treatment protocol, and 75% found it to be easier and more convenient. Thrice-daily premixed insulin therapy is deemed non-inferior to the basal-bolus regimen when patients require intensification of their insulin therapy, as it maintains glycemic control and hypoglycemic event frequency while offering the advantages of improved patient convenience and compliance.