Comparison of morning basal + 1 bolus insulin therapy (insulin glulisine + insulin glargine 300 U/mL vs insulin lispro + insulin glargine biosimilar) using continuous glucose monitoring: A randomized crossover study

INTRODUCTION: We compared the effects of morning administration of insulin glulisine + insulin glargine 300 U/mL (G + G300) with that of insulin lispro + insulin glargine biosimilar (L + GB). MATERIALS AND METHODS: A total of 30 patients with type 2 diabetes who wore a continuous glucose monitoring device on admission after glucose levels were stabilized by morning long‐acting and ultra‐rapid‐acting insulins were randomly allocated to groups who received G + G300 on days 1 and 2, and the same dose L + GB on days 3 and 4, or vice versa. Data collected on days 2 and 4 (mean amplitude of glycemic excursion, mean of daily differences: all days) were analyzed. Insulin was injected at 08.00 h. A day was defined as the period from 08.00 h one day, to 08.00 h the next day. Test meals were given. RESULTS: Increased post‐breakfast glucose level, post‐breakfast glucose gradient, mean glucose level, standard deviation and M‐value (24 h, 00.00–06.00 h), mean amplitude of glycemic excursion, and mean of daily differences were significantly lower in patients taking G + G300 than those taking L + GB (P ≤ 0.0001–0.04). The area over the glucose curve (<70 mg/dL) was not significantly different between groups. Pre‐lunch − pre‐breakfast glucose levels were significantly lower in patients taking L + GB than those taking G + G300 (P < 0.0001). The difference in the highest post‐breakfast glucose level between groups (Δ = G + G300 − L + GB) was significantly correlated to 24‐h mean glucose level (r = 0.40, P = 0.03). CONCLUSIONS: Compared with L + GB, G + G300 decreases post‐breakfast glucose level reducing rate of rise of that, nocturnal and 24‐h glucose variability and level without causing hypoglycemia, and daily variance.