inovation insulin

1. LockSTEP
SLIDE DECK
1
Innovation in insulin therapy:
Co-formulation insulin
dr. M. Irfan, SpPD
RS Permata Keluarga
21 Juni 2022

2. The Journey of Insulin Innovation

3. Novo Nordisk®
The quest for Ideal Basal insulin
Animal
insulin
preparations
First-generation
basal insulin
analogues
Isolation of insulin
(Banting & Best)
Ultra-long-acting
basal insulin
analogues
NPH insulin
High
Half-life (hours):
Variability: Medium Low
λ 5–10 12–19 25
Glargine
U300
Detemir
Degludec
Glargine U100
Detemir, insulin detemir; glargine U100, insulin glargine 100 units/mL; glargine U300, insulin glargine 300 units/mL; NPH, neutral protamine Hagedorn;
SmPC, summary of product characteristics; NPH insulin SmPC. https://www.ema.europa.eu/documents/product-information/insulatard-epar-product-
information_en.pdf; Detemir SmPC. https://www.ema.europa.eu/documents/product-information/levemir-epar-product-information_en.pdf; Glargine U100 SmPC.
https://www.ema.europa.eu/documents/product-information/lantus-epar-product-information_en.pdf; Glargine U300 SmPC.
https://www.ema.europa.eu/documents/product-information/toujeo-epar-product-information_en.pdf; Degludec SmPC.
https://www.ema.europa.eu/documents/product-information/tresiba-epar-product-information_en.pdf All accessed September 2019

4. Novo Nordisk®
Limitation of first-generation basal insulin
4
Do not last up to
24 hours for some
patients1.2
Relatively high
glycaemic
variability3
Glycaemic
Variability related to
hypoglycaemia4
Fix administration
time5.6
1. Singh AK et al, Indian J Endocrinol Metab. 2014; Nov-Dec; 18(6): 784-793. 2. Adapted from Evans et al. Diab Obesity Metab 2011;13:677–684; 3. Heise et al. Diabetes 2004;53:1614–20 4.
Adapted from Kovatchev et al. Diabetes Care 2006;29:2433–8 5. Peyrot et al. Diabet Med 2012;29:682–9; 6. Peyrot et al. Diabetes Care 2010;33:240–5

5. Novo Nordisk®
The quest for ideal insulin
Animal
insulin
preparations
First-generation
basal insulin
analogues
Isolation of insulin
(Banting & Best)
Ultra-long-acting
basal insulin
analogues
NPH insulin
High
Half-life (hours):
Variability: Medium Low
λ 5–10 12–19 25
Glargine
U300
Detemir
Degludec
Glargine U100
Detemir, insulin detemir; glargine U100, insulin glargine 100 units/mL; glargine U300, insulin glargine 300 units/mL; NPH, neutral protamine Hagedorn;
SmPC, summary of product characteristics; NPH insulin SmPC. https://www.ema.europa.eu/documents/product-information/insulatard-epar-product-
information_en.pdf; Detemir SmPC. https://www.ema.europa.eu/documents/product-information/levemir-epar-product-information_en.pdf; Glargine U100 SmPC.
https://www.ema.europa.eu/documents/product-information/lantus-epar-product-information_en.pdf; Glargine U300 SmPC.
https://www.ema.europa.eu/documents/product-information/toujeo-epar-product-information_en.pdf; Degludec SmPC.
https://www.ema.europa.eu/documents/product-information/tresiba-epar-product-information_en.pdf All accessed September 2019

6. Novo Nordisk®
From a molecule perspective
Insulin Degludec
New Molecule of Insulin Degludec
Forms soluble multi-hexamers
25 hours
> 42 hours
Glargine U100
First generation basal insulin
analogue
Precipitates as microcrystals
13.5 hours
22-24 hours
Glargine U300
Up-concentrated formulation of
first generation basal insulin
analogue
Precipitates as microcrystals
19 hours
>32 hours
Type of
insulin
molecule
Mode of
protraction
Half-life
(T 1/2)
Duration of
action
Diameter 64.10 μm
Diameter 67.45 μm
Diameter 49.52 μm
500 μm
Heise T, Mathieu C. Diabetes Obes Metab 2017;19(1):3-12

7. Novo Nordisk®
Insulin Degludec has a FLAT glucose lowering profile & 2x longer half
life
IDeg IGlar U100
0.4
U/kg
0.6
U/kg
0.8
U/kg
0.4
U/kg
0.6
U/kg
0.8
U/kg
Half-life
(hours)
25.9 27.0 23.6 11.5 12.9 11.9
Mean half-
life 25.4 12.1
2x longer half-life of Ideg vs with IGlar U100
Flat time-action profile in T1D at steady state
FLAT
Heise et al. Diabetes 2011;60(Suppl. 1):LB11; Heise et al. Expert Opin Drug Metab Toxicol 2015;11:1193–201; Heise et al.
Diabetes 2012;61(Suppl. 1):A259;
Heise et al. Diabetes Obes Metab 2012;14:859-64; Heise et al. Poster presentation at DTM 2016

8. Novo Nordisk®
4x Lower day to day variability in glucose lowering effect for IDeg
vs IGlarU100/U300
0
25
50
75
100
125
150
175
200
225
250
275
Day-to-day
variability
in
AUC
GIR
(CV%)
Time interval (hour) Time interval (hour)
IDeg vs. IGlar U300* IDeg vs. IGlar U100**
IDeg
IGlar U300
IGlar U100
AUC, area under the curve; CV, coefficient of variation; GIR, glucose infusion rate; IDeg, insulin degludec; IGlar U100, insulin glargine U100; IGlar
U300, insulin glargine U300
*NN1250-4227: Heise et al. Presented at Diabetes Technology Meeting, 16th Annual Scientific Sessions, 10–12 November 2016, Bethesda, MD, USA
**NN1250-1991: Heise et al. Diabetes Obes Metab 2012;14:859-64

9. Novo Nordisk®
BEGIN
SWITCH
DEVOTE
EU-TREAT
CONFIRM
REFLECT
Trial/study
HbA1c
versus comparator
CONCLUDE
Increase
Reduction
FPG
versus comparator
Increase
Reduction
Dose
versus comparator
Increase
Reduction
Hypoglycaemia
versus comparator
Increase
Reduction
Comparator
Glargine U100
Glargine U100
Glargine U100
Glargine U300
Glargine U100,
detemir, NPH insulin
Glargine U300
Basal insulins prior to
switch
RWE
* * *
*
* *
* *
*
*‡ *†
* *
*
* *
* * *
RCTs
*Significant difference. †Insulin-naïve: significantly reduced dose, basal–bolus: no difference. ‡Insulin-naïve: significant reduction,
basal–bolus: not significant. FPG, fasting plasma glucose; glargine U100/U300, insulin glargine 100/300 units/mL;
NPH, neutral protamine Hagedorn; RCTs, randomised controlled trials; RWE, real-world evidence; T2D, type 2 diabetes
Real-world & RCT data of Insulin Degludec in patients with T2D vs
Insulin Glargine U100/U300

10. Novo Nordisk®
T1D, type 1 diabetes; T2D, type 2 diabetes
Meneghini et al. Diabetes Care 2013;36:858–64; Mathieu et al. J Clin Endocrinol Metab 2013;98:1154–62
Flexible administration of degludec was tested in both T1D and
T2D
Two phase 3a clinical trials (6 and 12 months)
MON TUE WED THUR FRI SAT SUN
12 am
2 am
12 pm
4 am
6 am
8 am
10 am
2 pm
4 pm
6 pm
8 pm
10 pm
Morning Morning Morning
Evening Evening Evening Evening
40 h 8 h 40 h 40 h
8 h 24 h

11. Novo Nordisk®
Glargine U100, insulin glargine 100 units/mL; NS, not significant; OD, once daily
1. Aye & Atkin. Drug Healthc Patient Saf 2014;6:55–67; 2. Meneghini et al. Expert Rev Endocrinol Metab 2012;7:9–14; 3. Meneghini et al. Diabetes Care 2013;36:858–64
Flexibility can benefit patients who find it challenging to inject at
the same time each day1,2
“…In particular, this could include individuals who
travel regularly ... Shift workers may also greatly
benefit from the freedom to change their dosing
schedule…”1
“Flexibility in the timing of insulin
administration can benefit patients who find
it challenging to always inject insulin at the
same time each day.”2
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
0 2 4 6 8 10 12 14 16 18 20 22 24 26
Confirmed
hypoglycaemia
(cumulative
events
per
patient)
0
45
60
50
75
70
55
40
HbA
1c
(mmol/mol)
65
35
5.0
5.5
6.0
6.5
7.0
7.5
8.0
8.5
9.0
0 2 4 6 8 10 12 14 16 18 20 22 24 26
HbA
1c
(%)
HbA1c
3
0.0
Degludec Flexible vs. glargine U100
Treatment difference:
non-inferior
NS
Time (weeks)
Degludec Flexible vs. degludec Fixed
Treatment difference:
NS
Confirmed hypoglycaemia3
Time (weeks)
Degludec Flexible OD
Degludec Fixed OD
Glargine U100 OD

12. But why the problems are still existed?

13. Once basal insulin initiated: poor glycaemic control persists
More than ≥70% patients on basal insulin
FAILED to achieved HbA1C target1
Greater contribution to HbA1c from PPG
31.5 30.8
35.4 34.3
41.1
68.5 69.2
64.6 65.7
58.9
0
10
20
30
40
50
60
70
80
<6.5 6.5 - <7.0 7.0 - <7.5 7.5 - <8.0 ≥8.0
Total
hyperglycaemia
(%)
Week 24 HbA1c category (%)
After 24/28 weeks of basal insulin treatment
Basal hyperglycaemia Postprandial hyperglycaemia
1. Mauricio D, et al. Diabetes Obes Metab. 2017 Aug;19(8):1155-1164 |
2. Riddle M, et al. Diabetes Care 34:2508–2514, 2011

14. Glucose Triad
HbA1c
PPG FPG
Glycaemic control requires attention to both FPG and
PPG1
PPG is the predominant contributor in patients with satisfactory to
good control of diabetes, contribution of FPG increases with
worsening diabetes2
PPG has a stronger correlation with HbA1c than
FPG4
1. Riddle M, et al. Diabetes Care 34:2508–2514, 2011 | 2. Monnier et al. Endocr Pract. 2006;12:S1:42–63. Monnier et al. Diabetes Care.
2007;30:263–9 | 4. Ketema et al. Arch Public Health. 2015;73:43.

15. Insulin therapy from basal to basal-bolus is complex1
BID, twice daily; OAD, oral antidiabetic drug; OD, once daily; IAsp, insulin aspart; TID, thrice daily
1. Adapted from American Diabetes Association. Diabetes Care 2017;40(Suppl.1):S64–S74 | 2. Peyrot et al. Diabet Med. 2012;29: 682–9
3. Jarab et al. Int J Clin Pharm. 2014;36(4):725-33
57% of insulin
patients reported
intentional insulin
omission
20% reported
skipping injections
“sometimes” or
“often”
Additional bolus insulin (2-4) pens/injections/day:
• Need more education, monitoring
• Lead to complexity & lower adherence2,3

16. Fear of hypoglycaemia conflicts with treatment
success for both patients and clinicians
*, Total patient sample, n=335 (T1D, n=202; T2D, n=133); #, GAPP™ (A global internet survey of patient and physician beliefs regarding insulin
therapy): total patient sample, n=1250 physicians. T1D, type 1 diabetes; T2D, type 2 diabetes
1. Leiter et al. Can J Diabetes 2005;29:186–92. 2. Peyrot et al. Diabet Med 2012;29:682–9
74%
79%
43%
58%
0%
20%
40%
60%
80%
100%
Non-severe episodes Severe episodes
Patients
modifying
insulin
dose
T1D
T2D
72%
79%
0 20 40 60 80 100
Percentage
I would treat my patients more aggressively if
there was no concern about hypoglycaemia#,2
Percentage of patients decreasing their insulin
dose following a hypoglycaemic event*,1
Primary care physicians
Diabetes specialists

17. Inadequate
GLYCAEMIC
Control
Treatment
COMPLEXITY HYPOGLYCAEMIA
Summary Key Challenges for type 2 diabetes patient needing
insulin treatment
More than 70%
of type 2 diabetes
patients on basal insulin
are not at HbA1c goal1
57%
of patients with diabetes
report skipping their
insulin injections2
58% Patients reduce
insulin doses
in response to experiencing
hypoglycaemia3
1. Mauricio D, et al. Diabetes Obes Metab. 2017 Aug;19(8):1155-1164 2. Adapted from Peyrot M, et al. Diabetes Care
2010:33(2)240-245 3. Leiter et al. Can J Diabetes 2005;29:186–92.

18. IDegAsp Co-formulation

19. Novo Nordisk®
Target profile for Innovation: to tackle the problem
Breakfast Lunch Dinner
Action profile of today’s
modern insulins
Targeted action profiles
of future insulins
For illustrative purposes only

20. Novo Nordisk®
The insulin co-formulation concept
Atkin S. Ther Adv Chronic Dis 2015; 6: 375–388;
Kruszynska YT et al. Diabetologia 1987; 30: 16–21
Physiological insulin profile
Bolus insulin
Basal insulin
Co-formulation of a basal insulin with a bolus insulin
in a single injection can:
Mimic physiological
insulin secretion closely
Simplify the insulin regimen
and lower the injection burden
Avoid the “shoulder
effect” and variability of
protaminated mix insulin
No need resuspension

21. Novo Nordisk®
IDegAsp: First in class Co-formulation Insulin
[basal insulin with an ultra-long duration of action and a mealtime insulin in one pen1,2]
3
Insulin degludec
First basal insulin analogue that
can be combined in a soluble
solution with a mealtime insulin.3
1. Heisse et al. DIABETES CARE, VOLUME 34, MARCH 2011. 2. Haarh et al. Clin Pharmacokinet (2017) 56:339–354. 3 Jonassen, et al. Pharm Res
(2012) 29:2104–2114 4 5. Heller S, et al. Diabetes Metab Res Rev 2012; 28: 50–61

22. Novo Nordisk®
OD IDegAsp Co-formulation gives basal coverage for 24 hr and
prandial coverage at largest meal
• References: 1. Haahr H et al. Clin Pharmacokinet 2017;56(4):339–354 2. Heise et al. Diabetes Obes Metab 2012;14:859-64 3. Sajay Karla. Diabetes Ther
(2014) 5:65-72
Glycaemic Control
Providing basal and prandial
coverage in one injection1
Simplifying Insulin Therapy
Associated with simple regimen
and fewer injection3
Risk of Hypoglycaemia
Co-formulation Insulin contain
Insulin Degludec with flat and low
variability profile2

23. Novo Nordisk®
IDegAsp OD gives patient basal & prandial coverage at the largest
meal
Glucose-lowering effect of IDegAsp given once daily
1. Haahr H et al. Clin Pharmacokinet 2017;56(4):339–354

24. Novo Nordisk®
Flat and low variability profile of Insulin Degludec: potential for low
risk of Hypoglycaemia with IDegAsp
0
40
80
120
160
200
Area under the GIR curve (time interval, hours)
Day-to-day
variability
(coefficient
of
variation
%)
Variability in glucose-lowering effect over 24 hours at steady state
Insulin degludec variability is four-fold
lower than IGlar U100
Insulin degludec
IGlar U100
Heise et al. Expert Opin Drug Metab Toxicol 2015;11:1193–201; Heise et al. Diabetes 2012;61(Suppl. 1):A259; Heise et al. Diabetes Obes Metab 2012;14:859-64

25. Novo Nordisk®
Co-formulation of basal and bolus insulin could allow for SIMPLE
regimen with fewer injection1
IDegAsp Basal Basal Plus
VS
IDegAsp
VS
Basal Bolus
Basal
Bolus
Co-Formulation
Sajay Karla. Diabetes Ther (2014) 5:65-72

26. Novo Nordisk®
Can Co-Formulation Insulin IDegAsp tackle this problem in clinical
practice?
• References: 1. Haahr H et al. Clin Pharmacokinet 2017;56(4):339–354 2. Heise et al. Diabetes Obes Metab 2012;14:859-64 3. Sajay Karla. Diabetes Ther
(2014) 5:65-72
Glycaemic Control
Providing basal and prandial
coverage in one injection1
Simplifying Insulin Therapy
Associated with simple regimen
and fewer injection3
Risk of Hypoglycaemia
Co-formulation Insulin contain
Insulin Degludec with flat and low
variability profile2

27. Novo Nordisk®
IDegAsp vs Basal Insulin regimen

28. • Open-label
• Prior to randomisation, SUs, DPP-4 inhibitors and glinides were discontinued
• IDegAsp was administered with the largest meal of the day; the dosing time was
chosen at the discretion of the patient*
• IGlar U100 was administered according to label (either before breakfast or at
bedtime) at the discretion of the patient*
*Starting dose was 10U
BMI, body mass index; DPP-4, dipeptidyl peptidase 4, IDegAsp, insulin degludec/insulin aspart; IGlar U100, insulin glargine U100; OAD, oral antidiabetic drug; OD, once daily; SU,
sulphonylurea; T2D, type 2 diabetes; U, units
Onishi et al. Diabetes Obes Metab 2013;15:826–32
IDegAsp OD  OADs (n=147)
IGlar U100 OD  OADs (n=149)
0 26
weeks
Inclusion criteria
• Type 2 diabetes ≥6 months
• Previously treated with ≥1 OAD
for at least 12 weeks with at least
recommended maintenance dose
per local labelling
• HbA1c 7.0–10.0%
• BMI ≤35 kg/m2
• Age ≥20 years
Insulin-naïve patients
with type 2 diabetes
(N=296)
Insulin-naïve T2D OD: study design
Onishi et al

29. aCalculated, not measured. CI, confidence interval; ERR, estimated rate ratio; ETD, estimated treatment difference; FPG, fasting plasma glucose; IDegAsp, insulin degludec/insulin aspart;
IGlar U100, insulin glargine U100; NS, not significant; OD, once daily; RR, rate ratio; T2D, type 2 diabetes
Onishi et al. Diabetes Obes Metab 2013;15:826–32
6.0
6.5
7.0
7.5
8.0
8.5
9.0
0 2 4 6 8 10 12 14 16 18 20 22 24 26
HbA
1c
(%)
HbA
1c
(mmol/mol)
a
63
0
51
60
75
69
57
45
72
66
54
48
0.0
Time (weeks)
ETD: -0.28% 95% CI [-0.46; -0.10], p<0.01
superior
Insulin-naïve T2D OD: results
Onishi et al
HbA1c Total insulin dose over time
IDegAsp OD IGlar U100
Nocturnal confirmed hypoglycaemia
RR
(IDegAsp/IGlar):
0.75 (0.34; 1.64),
p=NS
Time (weeks)
Mean
number
of
episodes
(per
subject)
0.4
0.3
0.2
0.1
0.0
0 4 8 12 16 20 24
Time (weeks)
Confirmed
hypoglycaemia
(cumulative
events
per
patient)
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
0 2 4 6 8 10 12 14 16 18 20 22 24 26
27% lower rate with IDegAsp
ERR: 0.73 [0.50; 1.08]
NS
Confirmed hypoglycaemia

30. 59
43
40
25
0
10
20
30
40
50
60
70
Subjects achieving treatment targets
IDegAsp, insulin degludec/insulin aspart; IGlar U100, insulin glargine U100; OD, once daily; OR, odds ratio
Onishi et al. Diabetes Obes Metab 2013;15:826–32
HbA1c <7.0% HbA1c <7.0%
without hypoglycaemia
Proportion
of
subjects
achieving
targets
(%)
OR (IDegAsp/IGlar)
2.10 [1.26; 3.52],
p<0.01
OR (IDegAsp/IGlar)
2.21 [1.25; 3.92],
p<0.01
A significantly higher proportion of patients achieved a glycaemic target of HbA1c < 7% which is
two times higher with IDegAsp than with IGlar U100
IDegAsp OD IGlar U100 OD

31. Conclusions
Onishi et al
*p<0.01
IDegAsp, insulin degludec/insulin aspart; IGlar U100, insulin glargine U100; NS, not significant
Onishi et al. Diabetes Obes Metab 2013;15:826–32
Week 26
IDegAsp
IGlar
U100
vs
Similar
(NS)
25% lower with IDegAsp
(NS)
27% lower with IDegAsp
(NS)
Superiority confirmed*
Total daily insulin dose
Nocturnal-confirmed
hypoglycaemia
Confirmed hypoglycaemia
HbA1c

32. Clinical guidance on initiation
• References: 1. Onishi et al. Diabetes Obes Metab 2013;15:826–32 2. Sarah Galtras et al. J Clin Med 2020. 3. Roopa M et al. Diabetes Obes Metab. 2020;1-15
…IDegAsp OD to be considered as2,3
…Clinical evidence support the study of IDegAsp
initiation of people with T2DM [Onishi]1:
INITIATION (OAD FAILURE)
PREFERRABLE TO BASAL INSULIN ALONE
Numerical lower risk of Nocturnal
Hypoglycemia 25%
Superior reduction of HbA1C
More patient achieve target
without hypoglycemia 2X
• Max OAD therapy but HbA1C >7 and PPG 180 mg/dL
• Extreme and symptomatic Hyperglycaemia
• Postprandial Hyperglycaemia is a concern
• People with low BMI

33. Recommended starting dose for initiations
10Unit/OD
With largest meals
Followed by subsequent INDIVIDUAL dosage
weekly adjustment until the desired FPG
reached
Starting dose
>10Unit/OD
With largest meals
Severe Hyperglycemia
HbA1c >10% (86 mmol/mol)*
*This posology is based on expert recommendations from
Sarah G et al.
References: 1. Sarah Galtras et al. J Clin Med 2020. 2. Roopa M et al. Diabetes Obes Metab. 2020;1-15 3. Ryzodeg®.
Indonesia Prescribing Information. 2021

34. • Dose adjustments based on
lowest of the 3 preceding FPG
measurements
FPG, fasting plasma glucose; IDegAsp, insulin degludec/insulin aspart; T2D, type 2 diabetes
1. Fulcher et al. Diabetes Care 2014;37:2084–90; 2. Gerety et al. Endocr Pract 2016;22:546–54; 3. Endocrinologic and Metabolic Drug Advisory Committee.
Insulin degludec and insulin degludec/insulin aspart treatment to improve glycemic control in patients with diabetes mellitus: NDAs 203314 and 203313
briefing document. Published November 8, 2012
At
individualised
target
Below target
Above target
Below target
At
individualised target
Above target +2
units
Maintain
dose
-2
units
Suggested once-weekly titration schedule for IDegAsp OD in T2D
FPG target should be individualised
Do not increase dose if
hypoglycaemia or symptoms
suggestive of hypoglycaemia are
present

35. If Adequate glycaemic control is not
achieved with
IDegAsp OD
Treatment can be intensified to….
If HbA1C is not met with IDegAsp OD, glucose monitoring is
needed to determine where hyperglycaemia is occurring.
Treatment can be intensified to
IDegAsp (Split dose)
IDegAsp OD + Iasp at one or
more meals
IDegAsp (split dose) + Iasp at
the third meals
A
B
C +
TREATMENT
INTENSIFICATION
Intensification from IDegAsp OD
References: 1. Sarah Galtras et al. J Clin Med 2020. 2. Roopa M et al. Diabetes Obes Metab. 2020;1-15
3
Alternative
Strategy to
achieve adequate
glycaemic control

36. ‘if there are post prandial glucose
excursion after 2 meals’
Recommend a max OD dose 30-
40 unit before splitting.
The dose ratio not necessarily
(1:1) with a minimum dosing
interval of 4 hours
*: this may be vary with individualise target and monitoring frequency
When &
How do
you
intensify:
IDegAsp Split
‘if there are persistent
excessive post prandial
glucose excursion’
(i.e 3 reading of >180 mg/dL
over 1 week on
SMBG/capillary blood
glucose)*
IDegAsp split + Iasp IDegAsp OD + Iasp
or
‘if post prandial occurs when
FPG is normal’
(i.e in country where meals
are typically rich in
carbohydrate)
References: 1. Sarah Galtras et al. J Clin Med 2020. 2. Roopa M et al. Diabetes Obes Metab. 2020;1-15

37. Novo Nordisk®
Case: Initiating IDegAsp after OAD Fail
42
Initial
Age
Weight
BMI
Blood Press
HbA1c
FPG
PPG
Cholesterol
HDL
LDL
TG
Albumin
Current
Treatment

38. Novo Nordisk®
Case: Initiating IDegAsp after OAD Fail
43
Summary Problem
• Xxx
• Xxxx
Summary Plan
• Xxx
• Xxxx

39. Novo Nordisk®
Case: Initiating IDegAsp after OAD Fail
Result
44
Visit 1
HbA1c
FPG
PPG
BB
Tx
Visit 2
HbA1c
FPG
PPG
BB
Tx
Visit 3
HbA1c
FPG
PPG
BB
Tx
Visit 4
HbA1c
FPG
PPG
BB
Tx