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This study evaluated the proportions of prandial (PHG) vs fasting hyperglycaemia (FHG) over 24h in a group of patients with type 2 diabetes (overall and for Caucasian vs Asian patients), and tested the hypothesis that an insulin regimen with a prandial component allows a greater response than basal insulin at low glycated haemoglobin (HbA1c) levels with a higher proportion of PHG than FHG.Relative contributions of PHG and FHG to overall hyperglycaemia were analyzed by baseline HbA1c quartiles and by ethnicity at baseline and after 24-week treatment with either insulin glargine or insulin lispro mix 25 in the DURABLE study.With increasing baseline HbA1c, the mean relative contribution of PHG to the total area under the curve decreased (from 41% to 27%) while FHG was increased (from 59% to 73%). Both insulins decreased FHG, but only insulin lispro mix 25 decreased PHG. More patients with baseline HbA1c9%, where PHG was more relevant, achieved the target HbA1c of7% at endpoint with insulin lispro mix 25 compared with glargine. On average, Asians had a 10% larger contribution of PHG at all HbA1c quartiles, and a lower proportion of Asians reached the HbA1c target of7% with either insulin treatment compared with Caucasians.At baseline, the contribution of FHG to overall hyperglycaemia predominated at all HbA1c quartiles, whereas PHG was more clinically relevant at lower HbA1c levels and with a greater response to insulin lispro mix 25. Asians had a greater proportion of PHG and a lesser response to either insulins compared with Caucasians. Thus, responses to diabetes drugs by baseline HbA1c and ethnicity are worth investigating to better target and individualize treatment.

Introduction Dans le DT2, Monnier a montre une plus grande contribution de l’hyperglycemie post-prandiale (HPP) versus a jeun (HAJ) pour des taux d’HbA1c bas. Nous avons reevalue ces resultats avec un profil glycemique de 7 points en 24 h et en comparant les insulines glargine (G) et Lispro Mix25 (LM25). Patients et methodes Dans l’etude DURABLE, 2 091 patients DT2 ont ete randomises sous G (1x/j) ou LM25 (2x/j) pendant 24 semaines. Les contributions de HAJ et HPP sont calculees avec l’aire sous la courbe entre 100 mg/dL et la glycemie a jeun (GAJ) et au-dessus de la ligne de GAJ, respectivement. Resultats Du quartile inferieur au quartile superieur d’HbA1c, la contribution de HAJ augmente de 59 a 73 % (HPP diminue de 41 a 27 %). LM25 et G diminuent HAJ, mais seul LM25 diminue HPP. Sous 9 % d’HbA1c le pourcentage de patients atteignant la cible HbA1c Discussion La contribution de HPP versus HAJ diminue aux HbA1c plus elevees, confirmant les resultats de Monnier. Un role significatif de HPP, avec un pourcentage plus eleve de patients atteignant une HbA1c