Prandial Inhaled Insulin Plus Basal Insulin Glargine Versus Twice Daily Biaspart Insulin for Type 2 Diabetes: A Multicentre Randomised Trial: Article Review

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Introduction

The article under consideration dwells upon effectiveness of prandial inhaled insulin and basal insulin glargine compared to biaspart insulin used for treatment of patients with type 2 diabetes. The researchers aimed at comparing efficacy of the two types of treatment. They also note that contemporary insulin therapy often has a late onset and extended duration of action which can lead to late postprandial hypoglycaemia (Rosenstock et al., 2010, p. 2244). Rosenstock et al. (2010) argue that prandial inhaled insulin plus insulin glargine has proved to be more effective during clinical research though extensive study has to be carried out.

Hence, the researchers conducted a large-scale randomized study which involved 677 participants. The samples were divided into two groups and they received different treatment. Rosenstock et al. (2010) observed the change in n glycosylated haemoglobin, weight and occurrence of severe and mild-to-moderate hypoglycaemic events during 52 weeks.

It was found that the use of prandial inhaled insulin and basal insulin glargine was more effective than the use of biaspart insulin as in the former case participants had lower weight and fewer hypoglycaemic events though the level of glycosylated haemoglobin was similar in both treatment strategies. It is noted that safety and tolerability was equal in both types of therapy. Rosenstock et al. (2010) conclude that prandial inhaled insulin and basal insulin glargine is preferable as it is associated with positive outcomes for patients with type 2 diabetes.

Research Methods Evaluation

Literature Review Evaluation

In the first place, it is necessary to point out that the present research article does not contain a literature review section. Nonetheless, the article is still relevant since it has numerous references to previous studies. These references are predominantly in introduction and discussion sections. It is noteworthy that the article reports on a specific study implemented by researchers and, hence, it does not require extensive literature review. The authors refer to other studies when they discuss and analyze their results. This makes the article in question relevant and comprehensive.

Relevant Health Issues

Relevance of the study is also obvious as the findings of the present research add valuable insights into the ongoing debate on treatment of type 2 diabetes. This disease is a common chronic disorder and over 346 million people are diagnosed with it worldwide (Shrivastava, Shrivastava & Ramasamy, 2013). Insulin replacement therapy has been the primary treatment for almost 90 years (Akhter & Nijhu, 2012). Notably, a variety of ways to deliver insulin have been developed throughout these years.

At present, people prefer insulin pens and inhaled insulin to injections which are still common though (Technosphere insulin, 2011). Yaturu (2013) notes that there are numerous advances in the sphere of insulin delivery technology and people tend to increasingly use transdermal insulin. Researchers also report on development of new drugs, substances and delivery technologies. Clearly, significant number of opportunities requires substantial research aimed at identifying the most effective therapies and technologies. It is also important to remember that different groups of patients (for example, people of different age or ethnicity) often need specific treatment. Therefore, these are major issues researchers are still working on.

Research Type

It is necessary to note that Rosenstock et al. (2010) utilized experimental research type, which contributes to the overall study as particular effects of certain therapies are observed and analyzed. The research in question is based on trials of two different therapies. Two groups of participants are given two types of treatment. Notably, participants in each group have similar characteristics (there are equal numbers of males, females, people of different races). Hence, the results of the research are relevant.

Sample Evaluation

When it comes to participants of the research, it is necessary to go into detail and evaluate the sample. As has been mentioned above, 677 participants were involved in the study. At this point, it is important to note that 2064 patients were screened to choose participants for the research. Eligible samples were non-smokers (during six preceding months) with body-mass index of 40 kg/m2, required no more than 1·4 IU insulin per kg of body weight and had 70% (or higher) diffusing lung capacity (Rosenstock et al., 2010, p. 2245). Admittedly, the size of the sample is significant and can ensure relevance of the results.

More so, the sample can be regarded as diverse as people of different age, sex and race took part in the research. Notably, both groups (which got different treatment) had similar composition. There was a similar number of people of both sexes, similar age groups. It is noteworthy that people of several races (such as White, Black, Hispanic, Asian) participated in the study. Obviously, this also contributes to relevance of the data obtained. It is possible to conclude that the research was not biased.

Practical Research

As far as I am concerned, the research seems practical to me. Rosenstock et al. (2010) claim that the results of the research can be applied in healthcare as healthcare professionals as well as patients can make their choice on the basis of this particular study. Benefits of the therapy analyzed have been proved. More importantly, the study is a part of a broader clinical research on the use of Technosphere inhaled insulin. The researchers emphasize that the therapy is efficient.

I believe the therapy could (and even should) be applied on a larger scale. More people can benefit from the use of prandial inhaled insulin and basal insulin glargine and improve quality of their lives. Apart from direct use in hospital, results of the study can be used by other researchers working on development of effective therapies for patients with type 2 diabetes.

Possible Improvements

I believe the study is quite comprehensive and could hardly have been improved. It involves substantial number of participants and it is efficient enough as it is only a part of a larger clinical research. Hence, the present study does not need any improvements.

Clarity

It is necessary to add that the article is clear and straightforward. Since it focuses on the use of certain therapy, the article contains numerous clinical terms. However, the use of these terms is justified as it is impossible to discuss effects of a specific therapy without going into detail concerning physiological and clinical issues. Numerous data are provided in tables, which makes them easier to understand. At the same time, the researchers manage to provide a clear account of the issue. It is noteworthy that the audience of the article can be quite wide due to clarity and coherency of the article.

Further Research

As has been mentioned above, the research is a part of a broader clinical study. However, further research may include a number of spheres. In the first place, clinical trials have to be carried out nationwide. It is essential to analyze effects of the therapy on representative samples.

It can be also beneficial to identify differences (if any) in the use of the therapy for men and women as well as different races. Research shows that genetics plays a significant role in development of the disease or insulin tolerance (Swaroop, Rajarajeswari & Naidu, 2012). It is possible to implement a deeper analysis of the therapy outcomes.

Furthermore, it is possible to carry out certain research on cost-effectiveness of the therapy. This may include analysis of clinical outcomes, patients satisfaction, production costs, healthcare professionals and patients awareness of the therapy and its outcomes and so on. This will help understand whether this therapy can be seen as a primary treatment strategy which can be applicable nationwide.

Conclusion

To sum up, the article in question is a relevant source which provides valuable insights into the use of a therapy used in patients diagnosed with type 2 diabetes. The researchers carried out a profound study which included the significant and representative sample. The article dwells upon particular clinical outcomes and contains numerous terms.

Nonetheless, it is clear and straightforward. It is easy to follow and lots of people including healthcare professionals, students, patients and officials can benefit from reading the article. Apart from this, the present research is another stride and further studies can be implemented. These studies can focus on correlation of race / gender and the use of the therapy. The article expands the scope of knowledge on the use of insulin replacement therapies and their use in patients with type 2 diabetes.

Reference List

Akhter, D.T., & Nijhu, R.S. (2012). Diabetes mellitus: A journey of insulin. International Current Pharmaceutical Journal, 1(2), 32-42.

Rosenstock, J., Lorber, D.L., Gnudi, L., Howard, C.P., Bilheimer, D.W., Chang, P.C.,& Richardson, P.C. (2010). Prandial inhaled insulin plus basal insulin glargine versus twice daily biaspart insulin for type 2 diabetes: A multicentre randomised trial. Lancet, 375(1), 2244-53.

Shrivastava, S.R., Shrivastava, P.S., & Ramasamy, J. (2013). Role of self-care in management of diabetes. Journal of Diabetes & Metabolic Disorders, 12(14), 1-5.

Swaroop, J.J., Rajarajeswari, D., & Naidu, J.N. (2012). Association of TNF-± with insulin resistance in type 2 diabetes mellitus. Indian Journal of Medical Research, 135(1), 127-130.

Technosphere insulin: A new inhaled insulin. (2011). Practical Diabetes, 28(9), 397-398a.

Yaturu, S. (2013). Insulin therapies: Current and future trends at dawn. World Journal of Diabetes, 4(1), 1-7.

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