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Response: Efficacy and Safety of Biphasic Insulin Aspart 30/70 in Type 2 Diabetes Suboptimally Controlled on Oral Antidiabetic Therapy in Korea: A Multicenter, Open-Label, Single-Arm Study (Diabetes Metab J 2013;37:117-24)
Kee-Ho Song1, Jung Min Kim2, Jung-Hyun Noh3, Yongsoo Park4, Hyun-Shik Son5, Kyong Wan Min6, Kyung Soo Ko2
Diabetes & Metabolism Journal 2013;37(3):214-215.
DOI: https://doi.org/10.4093/dmj.2013.37.3.214
Published online: June 14, 2013
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1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.

2Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.

3Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.

4Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea.

5Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.

6Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea.

corresp_icon Corresponding author: Kyung Soo Ko. Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 139-707, Korea. kskomd@paik.ac.kr

Copyright © 2013 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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We thank Byung-Wan Lee for his thoughtful and insightful comments on our study regarding "Efficacy and safety of biphasic insulin aspart 30/70 in type 2 diabetes suboptimally controlled on oral antidiabetic therapy" [1].
To the first point, there have been many guidelines regarding insulin initiation in type 2 diabetic patients. Therefore, various options are available, including the types of insulin to be chosen, the starting dose, and the ratio of prebreakfast to predinner insulin. At the time of the study design and initiation, dividing the premixed insulin dose with the ratio of 2:1 was usual clinical practice in Korea, which was adopted in our study. Regarding the time of single insulin injection in the morning, we wanted to avoid nocturnal hypoglycemia to enhance the adherence to insulin therapy.
Second, as we mentioned in our article, oral antidiabetic drug (OAD) treatment should be combined with insulin, even after conversion to insulin treatment, as OAD(s) plays an important role in blood glucose control. Metformin can be used at full dose in concert with insulin, but it is uncertain whether sulfonylurea should be maintained with insulin therapy or decreased. Recent American Diabetes Association/European Association for the Study of Diabetes guideline showed some tips on combination use of insulin and OAD(s). It is recommended that insulin secretagogues be avoided once prandial insulin regimens are employed, and thiazolidinedions be reduced in dose (or stopped) to avoid edema and excessive weight gain [2,3].
Third, the major side effect of insulin therapy is weight gain. The disparity in weight gain between our study and Jang's study may be arise from study population (mean age of 57 years vs. over 65), study design (prospective vs. retrospective) and discontinuation of metformin in our study [1,4].
Finally, insulin therapy in Korean may not be different from other ethnic groups. When we use premixed insulin once or twice and cannot achieve target goals, further actions should be taken to control postlunch blood sugar, such as combining OAD(s) and/or adding prelunch insulin injection.

No potential conflict of interest relevant to this article was reported.

  • 1. Song KH, Kim JM, Noh JH, Park Y, Son HS, Min KW, Ko KS. Efficacy and safety of biphasic insulin aspart 30/70 in type 2 diabetes suboptimally controlled on oral antidiabetic therapy in Korea: a multicenter, open-label, single-arm study. Diabetes Metab J 2013;37:117-124. ArticlePubMedPMC
  • 2. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, Peters AL, Tsapas A, Wender R, Matthews DR. American Diabetes Association (ADA). European Association for the Study of Diabetes (EASD). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364-1379. ArticlePubMedPMCPDF
  • 3. Lund SS, Tarnow L, Frandsen M, Nielsen BB, Hansen BV, Pedersen O, Parving HH, Vaag AA. Combining insulin with metformin or an insulin secretagogue in non-obese patients with type 2 diabetes: 12 month, randomised, double blind trial. BMJ 2009;339:b4324ArticlePubMedPMC
  • 4. Jang HC, Lee SR, Vaz JA. Biphasic insulin aspart 30 in the treatment of elderly patients with type 2 diabetes: a subgroup analysis of the PRESENT Korea NovoMixstudy. Diabetes Obes Metab 2009;11:20-26. ArticlePubMed

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        Response: Efficacy and Safety of Biphasic Insulin Aspart 30/70 in Type 2 Diabetes Suboptimally Controlled on Oral Antidiabetic Therapy in Korea: A Multicenter, Open-Label, Single-Arm Study (Diabetes Metab J 2013;37:117-24)
        Diabetes Metab J. 2013;37(3):214-215.   Published online June 14, 2013
        DOI: https://doi.org/10.4093/dmj.2013.37.3.214
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      Response: Efficacy and Safety of Biphasic Insulin Aspart 30/70 in Type 2 Diabetes Suboptimally Controlled on Oral Antidiabetic Therapy in Korea: A Multicenter, Open-Label, Single-Arm Study (Diabetes Metab J 2013;37:117-24)
      Response: Efficacy and Safety of Biphasic Insulin Aspart 30/70 in Type 2 Diabetes Suboptimally Controlled on Oral Antidiabetic Therapy in Korea: A Multicenter, Open-Label, Single-Arm Study (Diabetes Metab J 2013;37:117-24)
      Song KH, Kim JM, Noh JH, Park Y, Son HS, Min KW, Ko KS. Response: Efficacy and Safety of Biphasic Insulin Aspart 30/70 in Type 2 Diabetes Suboptimally Controlled on Oral Antidiabetic Therapy in Korea: A Multicenter, Open-Label, Single-Arm Study (Diabetes Metab J 2013;37:117-24). Diabetes Metab J. 2013;37(3):214-215.
      DOI: https://doi.org/10.4093/dmj.2013.37.3.214.
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