Improved glycaemic control with insulin glargine plus insulin lispro: a multicentre, randomized, cross‐over trial in people with Type 1 diabetes

Ashwell, Susan; Amiel, Stephanie A.; Bilous, Rudolf W.; Dashora, Umesh; Heller, Simon; Hepburn, David; Shutler, S.D.; Stephens, James W; Home, Philip

doi:10.1111/j.1464-5491.2005.01781.x

Cited by 105 publications

(52 citation statements)

References 29 publications

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“…In a smaller but longer study of 56 type 1 subjects, a regimen of glargine plus lispro was associated with a mean HbA1c of 7.5% after 32 weeks compared to 8.0% with a regimen of NPH plus unmodified human insulin. 56 In the third study, a crossover design study of 28 adolescent subjects, there was no significant difference in HbA1c between subjects treated with glargine/lispro and those treated with NPH/regular insulin, each for 16 weeks (8.7% vs. 9.1%; P=0.13). 55 A number of studies have assessed HbA1c levels in patients treated with premixed human insulins versus those treated with premixed insulin analogs, including premixed insulin lispro formulations [57][58][59] and insulin aspart formulations.…”

Section: Clinical Effects Of Insulin Analogs Hba1cmentioning

confidence: 99%

“…53 In one of the longest trials (32 weeks) comparing an all-analog basal-bolus regimen (lispro/glargine) with an all-human insulin regimen (NPH/human insulin), the all-analog regimen was associated with a 15% lower PPG AUC (75 vs. 88 mmol/L/h; P=0.002). 56 …”

Section: Ppgmentioning

confidence: 99%

“…53 Three clinical trials compared all-analog insulin regimens to all-human insulin regimens. [54][55][56] In the largest, a basal-bolus regimen of insulin aspart/insulin detemir was compared with NPH insulin/regular insulin in 595 patients with type 1 diabetes for 18 weeks. 54 At study end, mean HbA1c was lower in the aspart/detemir group compared with the NPH/regular insulin group (7.88% vs. 8.11%; P<0.001).…”

Section: Clinical Effects Of Insulin Analogs Hba1cmentioning

confidence: 99%

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Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Hartman

2008

Clinical Medicine & Research

115

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Despi te 85 years of research since Banting and Best's isolation of insulin-containing extracts, 1 diabetes still remains one of the most significant causes of morbidity and mortality in the world, and its global impact is likely to accelerate over the coming decades. 2,3 Much of the medical and economic consequences of diabetes are attributable to its associated microvascular and macrovascular complications. [4][5][6] Two classic large-scale clinical studies, the Diabetes Control and Complications Trial (DCCT) 6 and the UK Prospective Diabetes Study (UKPDS), 7 demonstrated that intensive blood-glucose control policies can decrease the frequency of complications, arguing that physicians and patients should strive to mimic, as closely as possible, the serum levels of insulin produced by a healthy person. Secretion of insulin by the pancreas, however, is under complex regulation that depends on the intake of nutrients, other gastrointestinal peptides (e.g., incretins), and overall metabolic levels (i.e., exercise versus rest). 8 These physiological variables, which pose real challenges to the accurate metabolic replacement of insulin, are further complicated by the fact that diabetes requires self-management and therefore depends on the psychology, motivation, and understanding of the patient. A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns.The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile.The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure.To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment.The long-act...

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Section: Clinical Effects Of Insulin Analogs Hba1cmentioning

confidence: 99%

Section: Ppgmentioning

confidence: 99%

Section: Clinical Effects Of Insulin Analogs Hba1cmentioning

confidence: 99%

See 1 more Smart Citation

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Hartman

2008

Clinical Medicine & Research

115

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“…Another possibility is that important benefits may have been overlooked in certain subgroups, or may only emerge when insulins are used to full advantage. Finally, combined use of short-and long-acting analogues is likely to maximise their benefits; two open-label studies comparing combinations of short and long-acting analogues with regular and NPH insulins have reported reductions in HbA 1c levels of 0.22 (95% CI −0.34 to −0.10)% and 0.5 (95% CI −0.7 to −0.3)% with less nocturnal hypoglycaemia (55% and 44% respectively) [35,36].…”

Section: Putting the Evidence Togethermentioning

confidence: 99%

Nice insulins, pity about the evidence

Holleman

Gale

2007

Diabetologia

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“…Studies with these insulins prove that they are superior comparing with human basal insulin in MDI in the term of efficacy (blood glucose regulation) and safety (less hypoglycemia and weight gain) [8,9]. Therefore, in the last decade, research is focused on comparison of CSII and MDI with insulin analogues and these two therapeutic regimens are mostly equal in the terms of efficacy and safety [10,11].…”

Section: Introductionmentioning

confidence: 99%