Wann mit der intensivierten Insulintherapie beginnen? – Der BeAM-Wert zur besseren Abschätzung einer prandialen Insulintherapie bei Typ-2-Diabetes mellitus

Stephan Kress; Anja Borck; Ariel Zisman; Peter Bramlage; Thorsten Siegmund

doi:10.1055/a-0958-2034

Diabetologie und Stoffwechsel, Table of Contents

Diabetologie und Stoffwechsel 2019; 14(04): 302-309
DOI: 10.1055/a-0958-2034

Übersicht

Wann mit der intensivierten Insulintherapie beginnen? – Der BeAM-Wert zur besseren Abschätzung einer prandialen Insulintherapie bei Typ-2-Diabetes mellitus

When to Start an Intensified Insulin Treatment? – The BeAM value for Adequate Assessment for a Need for Prandial Insulin Treatment in Patients with Type 2 Diabetes

Stephan Kress

¹Diabetologie, Vinzentius-Krankenhaus, Landau, Germany

,

Anja Borck

²Medical Affairs, Sanofi Aventis Deutschland, Berlin, Germany

,

Ariel Zisman

³The Endocrine Center of Aventura, Aventura, FL, USA

,

Peter Bramlage

⁴Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany

,

Thorsten Siegmund

⁵Klinikum Bogenhausen, Städt. Klinikum München GmbH, Bogenhausen, Germany

› Author Affiliations

Abstract

Zusammenfassung

Der BeAM-Wert ist ein kumulatives Maß der postprandialen Hyperglykämie. Er lässt sich aus der Blutglukosekonzentration vor dem Zubettgehen (Be) und der darauf folgenden Nüchternglukose am Morgen (AM) errechnen. In zwei retrospektiven Auswertungen von Daten aus Phase-III- und -IV-Studien wurde der Nutzen des BeAM-Wertes als Entscheidungshilfe für den Beginn der intensivierten Insulintherapie bei Typ-2-Diabetes mellitus (T2DM) Patienten unter basalinsulinunterstützter oraler Therapie (BOT) dargelegt.

Bei Patienten, deren Therapie von einer oralen antidiabetischen Therapie (OAD) auf eine basalinsulinunterstützte orale Therapie umgestellt wird, steigen Ausmaß der postprandialen Hyperglykämie und der BeAM-Wert an bei gleichzeitig sinkendem HbA_1c-Wert und Nüchternglukose. Nach Umstellung auf eine intensivierte Insulintherapie fällt der BeAM-Wert und das Ausmaß der postprandialen Hyperglykämie geht zurück.

Insbesondere Patienten mit einem BeAM-Wert > 50 mg/dl profitieren von der Umstellung auf eine intensivierte Insulintherapie. Ein negativer BeAM-Wert spricht gegen den Einstieg in die prandiale Insulintherapie.

Abstract

The extent of postprandial hyperglycaemia may be adequately assessed using the BeAM value. This parameter is calculated from bedtime (Be) and morning (AM) glucose concentrations. Two retrospective analyses of Phase III and IV data revealed that the BeAM value is a valuable tool to support the decision when to initiate prandial insulin therapy in patients with type 2 diabetes mellitus (T2DM) receiving basal insulin and oral antidiabetic drug therapy (BOT).

When antidiabetic therapy is switched from oral antidiabetic drugs to BOT, fasting blood glucose and HbA1c improve but the extent of postprandial hyperglycaemia and the BeAM value increase. Further intensification of insulin therapy by addition of prandial insulin results in normalisation of postprandial glucose and decrease of the BeAM value.

Patients on BOT with BeAM values > 50 mg/dl most likely benefit from prandial insulin therapy, whereas those with a negative BeAM value do not.

Schlüsselwörter

Glargin - Glulisin - Typ-2-Diabetes - Prandiales Insulin - Basal-Plus

Key words

glargine - glulisine - Type 2 diabetes - prandial insulin - basal-plus

Full Text

References

Literatur
1 Turner RC, Cull CA, Frighi V. et al. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. Jama 1999; 281: 2005-2012
2 Davies MJ, D’Alessio DA, Fradkin J. et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 41 (12) 2669-2701 . doi: 10.2337/dci18-0033. Epub 2018 Oct 4
3 Landgraf R, Kellerer M, Fach E. et al. Praxisempfehlungen DDG/DGIM – Therapie des Typ-2-Diabetes. Diabetologie und Stoffwechsel 2015; 10: S140-S151
4 Riddle MC, Rosenstock J, Gerich J. et al. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes care 2003; 26: 3080-3086
5 Rosenstock J, Davies M, Home PD. et al. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 2008; 51: 408-416 , DOI:10.1007/s00125-007-0911-x
6 Strange P. Treat-to-target insulin titration algorithms when initiating long or intermediate acting insulin in type 2 diabetes. J Diabetes Sci Technol 2007; 1: 540-548
7 Shaefer C, Traylor L, Gao L. et al. Exploratory study of a dose-response curve for basal insulin. Diabetes 2015; 64: A253
8 Ong WM, Chua SS, Ng CJ. Barriers and facilitators to self-monitoring of blood glucose in people with type 2 diabetes using insulin: a qualitative study. Patient Prefer Adherence 2014; 8: 237-246 , DOI:10.2147/PPA.S57567
9 Choi JH, Park CY, Cha BS. et al. Perception of clinicians and diabetic patients on the importance of postprandial glucose control and diabetes education status: a cross sectional survey. Diabetes Metab J 2012; 36: 120-127 , DOI:10.4093/dmj.2012.36.2.120
10 Zisman A, Morales F, Stewart J. et al. BeAM value: an indicator of the need to initiate and intensify prandial therapy in patients with type 2 diabetes mellitus receiving basal insulin. BMJ open diabetes research & care 2016; 4: e000171 , DOI:10.1136/bmjdrc-2015-000171
11 Kress S, Borck A, Zisman A. et al. A large difference between bedtime and pre-breakfast blood glucose (BeAM) indicates the need for initiation and intensification of prandial therapy. Diabetes/metabolism research and reviews 2019
12 Siegmund T, Borck A, Zisman A. et al. A higher blood glucose level pre-breakfast in comparison to bedtime is a contraindication for intensification of prandial insulin therapy in patients with type 2 diabetes – The impact of a negative BeAM value. J Clin Transl Endocrinol 2018; 14: 34-38
13 Bretzel RG, Nuber U, Landgraf W. et al. Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycaemic agents (APOLLO): an open randomised controlled trial. Lancet 2008; 371: 1073-1084 , DOI:10.1016/S0140-6736(08)60485-7
14 Gerstein HC, Yale JF, Harris SB. et al. A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study. Diabetic medicine: a journal of the British Diabetic Association 2006; 23: 736-742 , DOI:10.1111/j.1464-5491.2006.01881.x
15 Janka HU, Plewe G, Riddle MC. et al. Comparison of basal insulin added to oral agents versus twice-daily premixed insulin as initial insulin therapy for type 2 diabetes. Diabetes care 2005; 28: 254-259
16 Standl E, Maxeiner S, Raptis S. et al. Good glycemic control with flexibility in timing of basal insulin supply: a 24-week comparison of insulin glargine given once daily in the morning or at bedtime in combination with morning glimepiride. Diabetes care 2005; 28: 419-420
17 Yki-Jarvinen H, Kauppinen-Makelin R, Tiikkainen M. et al. Insulin glargine or NPH combined with metformin in type 2 diabetes: the LANMET study. Diabetologia 2006; 49: 442-451 , DOI:10.1007/s00125-005-0132-0
18 Lankisch MR, Ferlinz KC, Leahy JL. et al. Introducing a simplified approach to insulin therapy in type 2 diabetes: a comparison of two single-dose regimens of insulin glulisine plus insulin glargine and oral antidiabetic drugs. Diabetes, obesity & metabolism 2008; 10: 1178-1185
19 Davidson MB, Raskin P, Tanenberg RJ. et al. A stepwise approach to insulin therapy in patients with type 2 diabetes mellitus and basal insulin treatment failure. Endocr Pract 2011; 17: 395-403 , DOI:10.4158/EP10323.OR
20 Del Prato S, Nicolucci A, Lovagnini-Scher AC. et al. Telecare Provides comparable efficacy to conventional self-monitored blood glucose in patients with type 2 diabetes titrating one injection of insulin glulisine-the ELEONOR study. Diabetes technology & therapeutics 2012; 14: 175-182 , DOI:10.1089/dia.2011.0163
21 Owens DR, Luzio SD, Sert-Langeron C. et al. Effects of initiation and titration of a single pre-prandial dose of insulin glulisine while continuing titrated insulin glargine in type 2 diabetes: a 6-month “proof-of-concept” study. Diabetes, obesity & metabolism 2011; 13: 1020-1027 , DOI:10.1111/j.1463-1326.2011.01459.x
22 Owens DR. Stepwise intensification of insulin therapy in type 2 diabetes management--exploring the concept of the basal-plus approach in clinical practice. Diabetic medicine: a journal of the British Diabetic Association 2013; 30: 276-288 , DOI:10.1111/dme.12019
23 Kalra S, Gupta Y. Insulin initiation: bringing objectivity to choice. J Diabetes Metab Disord 2015; 14: 17 , DOI:10.1186/s40200-015-0146-1
24 Bonora E, Corrao G, Bagnardi V. et al. Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus. Diabetologia 2006; 49: 846-854 , DOI:10.1007/s00125-006-0203-x
25 Brindisi MC, Rabasa-Lhoret R, Chiasson JL. Postprandial hyperglycaemia: to treat or not to treat?. Diabetes & metabolism 2006; 32: 105-111
26 Ceriello A, Davidson J, Hanefeld M. et al. Postprandial hyperglycaemia and cardiovascular complications of diabetes: an update. Nutrition, metabolism, and cardiovascular diseases 2006; 16: 453-456 , DOI:10.1016/j.numecd.2006.05.006
27 Yu PC, Bosnyak Z, Ceriello A. The importance of glycated haemoglobin (HbA(1c)) and postprandial glucose (PPG) control on cardiovascular outcomes in patients with type 2 diabetes. Diabetes Res Clin Pract 2010; 89: 1-9 , DOI:10.1016/j.diabres.2009.12.009
28 Riddle M, Umpierrez G, DiGenio A. et al. Contributions of basal and postprandial hyperglycemia over a wide range of A1C levels before and after treatment intensification in type 2 diabetes. Diabetes care 2011; 34: 2508-2514 , DOI:10.2337/dc11-0632
29 Monnier L, Colette C, Owens D. Postprandial and basal glucose in type 2 diabetes: assessment and respective impacts. Diabetes technology & therapeutics 2011; 13 (Suppl. 01) S25-S32 , DOI:10.1089/dia.2010.0239
30 Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA(1c). Diabetes care 2003; 26: 881-885
31 Pearson J, Powers MA. Systematically initiating insulin: the staged diabetes management approach. The Diabetes educator 2006; 32: 19S-28S , DOI:10.1177/0145721705285640
32 Giugliano D, Ceriello A, Esposito K. Glucose metabolism and hyperglycemia. Am J Clin Nutr 2008; 87: 217S-222S
33 Bretzel RG, Eckhard M, Landgraf W. et al. Initiating insulin therapy in type 2 diabetic patients failing on oral hypoglycemic agents: basal or prandial insulin? The APOLLO trial and beyond. Diabetes care 2009; 32 (Suppl. 02) S260-S265 , DOI:10.2337/dc09-S319
34 Odawara M, Kadowaki T, Naito Y. Incidence and predictors of hypoglycemia in Japanese patients with type 2 diabetes treated by insulin glargine and oral antidiabetic drugs in real-life: ALOHA post-marketing surveillance study sub-analysis. Diabetology & metabolic syndrome 2014; 6: 20 , DOI:10.1186/1758-5996-6-20
35 van Dijk JW, Manders RJ, Hartgens F. et al. Postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients. Diabetes Res Clin Pract 2011; 93: 31-37 , DOI:10.1016/j.diabres.2011.03.021
36 King AB. Misled by the Morning “Fasting” Plasma Glucose. J Diabetes Sci Technol 2015; 9: 1342-1345 , DOI:10.1177/1932296815586425
37 Gluck ME, Venti CA, Salbe AD. et al. Nighttime eating: commonly observed and related to weight gain in an inpatient food intake study. Am J Clin Nutr 2008; 88: 900-905
38 Ercan A, Kiziltan G. Obesity-related abnormal eating behaviors in Type 2 diabetic patients. Pak J Med Sci 2013; 29: 1323-1328
39 Ahern JA, Gatcomb PM, Held NA. et al. Exaggerated hyperglycemia after a pizza meal in well-controlled diabetes. Diabetes care 1993; 16: 578-580
40 Pories WJ, Dohm GL. Diabetes: have we got it all wrong? Hyperinsulinism as the culprit: surgery provides the evidence. Diabetes care 2012; 35: 2438-2442 , DOI:10.2337/dc12-0684
41 Shanik MH, Xu Y, Skrha J. et al. Insulin resistance and hyperinsulinemia: is hyperinsulinemia the cart or the horse?. Diabetes care 2008; 31 (Suppl. 02) S262-S268 , DOI:10.2337/dc08-s264
42 Dankner R, Chetrit A, Shanik MH. et al. Basal-state hyperinsulinemia in healthy normoglycemic adults is predictive of type 2 diabetes over a 24-year follow-up: a preliminary report. Diabetes care 2009; 32: 1464-1466 , DOI:10.2337/dc09-0153