Initiating insulin therapy in type 2 diabetic patients failing on oral hypoglycemic agents: basal or prandial insulin? The APOLLO trial and beyond.

Insulin glargine resulted in a highly significant ( P < 0.0001) absolute reduction of mean daytime glucose level from baseline to end point: 9.9 ± 2.0 to 6.9 ± 1.5 mmol/l, which corresponds to −3.0 ± 2.1 mmol/l.

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This effect may be explained by the lower magnitude of A1C reduction in the 4-T study group compared with baseline (Δ baseline versus end point −1.75 in the APOLLO trial and −0.80 in the 4-T study).Weight gain after 1 year was significantly lower in the basal insulin detemir group compared with the prandial insulin aspart group in the 4-T study, whereas weight gain after 44 weeks was only slightly less in the basal insulin glargine group, but the difference with prandial insulin lispro did not reach statistical significance in the APOLLO trial.

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