Page 569 - fbkCardioDiabetes_2017

Cardio Diabetes Medicine 2017 545

4T Study : Three Way Randomisation

Glycemic target: A1C ≤6.5%

Add once (or twice) daily Add prandial insulin
basal insulin* if glycaemic target not met †

700 T2DM
on OAD R Add twice daily biphasic Add midday prandial insulin if
insulin* glycaemic target not met †

Add thrice daily prandial Add basal insulin
insulin* if glycaemic target not met †

Randomisation One Two Three
visit year years years

* progress to more intensive insulin regimen only if clinically necessary
† stop sulphonylurea if taken

4T Study : Mean One-year Changes

p= 0.04
20 25
20
10 p<0.001 p<0.001 p<0.001 p<0.001 15
10
percentage change -10 Hypoglycemia 0
0
5

grade 2 or 3
(events/pts/yr)
-20

Mean -30 Biphasic

-40 Prandial
HbA1C FPG PPG Weight Basal
8.5 9.6 mmol/l 12.6 mmol/l 85.8 kg
(%) (173 mg/dl) (227 mg/dl) (188 lbs)

N Engl J Med 2007;357:1716-30.

Cardio Diabetes Medicine