The driving learn more factor of this finding is likely the reported reduction in hypoglycaemia rate in the BIAsp QD + Sit group versus the BIAsp BID group. Also noteworthy, the change in bodyweight was significantly less in the BIAsp QD + Sit group versus the BID groups. Furthermore,

according to TRIM-D questionnaire results, the impact on the patient is broadly similar regardless of treatment, suggesting that changing to a BIAsp 30-based regimen in these patients is not burdensome, and compliance and convenience are not compromised. Our findings support different intensification regimens with BIAsp 30 that could be used in the treatment continuum of T2D. It should be noted, however, that although other regimens can be considered when starting insulin therapy e.g. basal insulin [1] and [2], our findings are relevant for those patients where premix insulin has been selected as the starting insulin of choice. Given the limited guidance from the ADA/EASD consensus algorithm regarding withdrawing DPP-4 inhibitors or adding on insulin therapy when intensification is required, we consider the presented data to be an important source of evidence to help guide clinicians and support individualized decisions

based on endpoints that are pertinent to a patient’s wellbeing and management of their diabetes. Adding BIAsp 30 BID to sitagliptin plus metformin would be the most effective Y-27632 concentration choice (versus the other groups studied here) if targeting glycaemic control was the main concern; however, relative risk of hypoglycaemia and weight gain are also greater with this regimen and should be taken into consideration, along with patients’ circumstances, when devising a treatment plan.

Conversely, our data suggest that patients concerned about weight gain and/or those more prone to hypoglycaemia may benefit more from adding BIAsp QD to sitagliptin, although the extent of improvement in HbA1c is not as considerable versus a BID BIAsp regimen with or without sitagliptin. Discontinuing sitagliptin followed by initiation of BIAsp BID (while continuing metformin) had similar efficacy, but a significantly greater change in bodyweight, versus adding BIAsp QD to sitagliptin and metformin. The treatment costs associated with discontinuing sitagliptin Farnesyltransferase and starting BIAsp BD were 1.8- and 2.1-fold lower versus the BIAsp QD + Sit and BIAsp BID + Sit groups, respectively, thus the impact of costs also needs to be weighed against the clinical benefits and risks when comparing regimens. To our knowledge, this is the first randomized, global study evaluating the combination of BIAsp 30 and sitagliptin, and the substitution of sitagliptin with BIAsp 30, thus providing valuable evidence for clinicians who would consider this approach for poorly controlled, insulin-naïve patients with T2D.