Contribution of postprandial versus interprandial blood glucose to HbA1c in type 1 diabetes on physiologic intensive therapy with lispro insulin at mealtime.

Abstract

The substitution of Hum-R with lispro (group 2) resulted in lower postprandial blood glucose, but greater postabsorptive blood glucose (P < 0.05 vs. group 1). The postprandial blood glucose AUC was lower (161 +/- 19 vs. 167 +/- 20 mg.100 ml-1.h-1), but the postabsorptive blood glucose AUC was greater (155 +/- 22 vs. 142 +/- 19 mg.100 ml-1.h-1) (P < 0.05). Therefore, the 24-h blood glucose AUC was no different (NS). Consequently, HbA1c was no different (NS). This occurred because in group 2, mealtime lispro resulted in normal prandial plasma insulin, but also resulted in lower interprandial concentration (P < 0.05 vs. group 1). When NPH was added to lispro (30% at breakfast, 40% at lunch, 10% at dinner) in group 3, postabsorptive plasma insulin was similar to group 1 (NS), in group 3, the postprandial blood glucose AUC (153 +/- 17 mg.100 ml-1.h-1) was lower and the postabsorptive blood glucose AUC was no different, as compared with group 1 (NS). Therefore, the 24-h blood glucose AUC was lower (147 +/- 17 vs. 155 +/- 21 and 158 +/- 20 mg.100 ml-1.h-1), and HbA1c was lower (6.41 +/- 0.12 vs. 6.84 +/- 0.2 and 6.96 +/- 0.2% (groups 3, 1, and 2 respectively, P < 0.05). Frequency of hypoglycemia was greater in group 2 (P < 0.05), but not in group 3 (NS) vs. group 1.

Prevalence and correlates of post-prandial hyperglycaemia in a large sample of patients with type 2 diabetes mellitus

“…Related to this observation we found that patients treated with sulfonylureas had greater post-prandial blood glucose excursions than subjects not taking these medications, suggesting that sulfonylureas are not able to prevent postprandial glucose peaks. Patients taking sulfonylureas who have poor glycaemic control thus might benefit from therapy with glinides and short-acting insulin analogues to control post-prandial hyperglycaemia [40][41][42][43][44][45][46].…”

Insulin analogues and their potential in the management of diabetes mellitus

“…Studies have used multiple injection therapy [11,51, 54±57] or continuous subcutaneous insulin infusion (CSII) [41,42,58]. There has been a consistent improvement in HbA 1 c of 0.3±0.5 % points compared with the use of regular human insulin even when the latter was appropriately injected 30 min before meals (Table 1).…”

“…In one [57] out of six studies [11,51, 54±57] using similar treatment strategies of Type I diabetes mellitus, the hypoglycaemia rate has been lower during treatment with insulin lispro than with regular human insulin [39,61]. In a large study with over 1000 Type I diabetic patients and a statistical power high enough to detect changes in hypoglycaemia, the rate of hypoglycaemia was 12 % less during treatment with insulin lispro.…”

“…In fact, addition of NPH (30 % of the mealtime dose of lispro insulin) to insulin lispro (henceforth referred to as lispro), but not to regular human insulin, maintains the lower early postprandial blood glucose until late afternoon hours [49]. If NPH is not added to mealtime lispro, particularly at lunch, the increase in pre-prandial blood glucose can deteriorate longterm control [11,51].…”

“…The theoretical combination of a prandial insulin peak with a flat, square-wave interprandial plasma insulin profile, would closely mimic the 24-h plasma insulin pattern of normal, non-diabetic people who exhibit very tiny blood glucose variations regardless whether in the fed or fasting state ( Fig. 1) [11].…”