Away with the pre-meal insulin injection interval in people with thy 2 diabetes

TITLE: Randomized Crossover Study to Examine the Necessity of an Injection-to-Meal Interval in Patients With Type 2 Diabetes Mellitus and Human Insulin

CITATION: Published online before print January 22, 2013, doi:10.2337/dc12-1694

URL: http://care.diabetesjournals.org/content/early/2013/01/15/dc12-1694.abstract.html?papetoc

CORRESPONDING AUTHOR: Nicolle Müller, nicolle.mueller@med.uni-jena.de.

SUMMARY: This elegant study examined whether a pre-meal insulin interval was necessary in persons with type 2 diabetes on pre-prandial insulin.  They randomized patients into a 20-minute pre-meal insulin injection interval and a zero-minute pre-meal insulin interval.  They did this in crossover design.  They found that omitting the pre-meal interval only slightly increases HbA_1c (average intra-individual difference = 0.08% [CI 0.01–0.15]). They concluded that the difference was not clinically relevant and that insulin therapy without a pre-meal interval is non-inferior to a 20-minute pre-meal interval (P < 0.001). In the secondary outcomes, the incidence of mild hypoglycemia also did not differ between the two groups. No difference in the blood glucose profile of both groups was found.  Treatment satisfaction increased markedly in the no interval group.  Overall they concluded that for patients with type 2 diabetes on pre-prandial insulin therapy a pre-meal insulin interval is not necessary.

COMMENT:  I love studies that address an aspect of diabetes care that is taken for granted and show that it is not necessary.These investigators looked at one of the more annoying aspects of insulin treatment, the pre-meal insulin injection interval.  They found that it was not necessary thereby eliminating this annoying process and freeing up physicians’ and diabetes educators’ time for more important things.