Intensive Replacement of Basal Insulin in Patients With Type 1 Diabetes Given Rapid-Acting Insulin Analog at Mealtime A 3-month comparison between administration of NPH insulin four times daily and glargine insulin at dinner or bedtime

Department of Internal Medicine, Università degli Studi di Perugia, Perugia, Umbria, Italy
Diabetes Care (Impact Factor: 8.42). 05/2003; 26(5):1490-6. DOI: 10.2337/diacare.26.5.1490
Source: PubMed


To establish differences in blood glucose between different regimens of optimized basal insulin substitution in type 1 diabetic patients given lispro insulin at meals, i.e., NPH injected four times a day versus glargine insulin once daily at dinner or at bedtime.
A total of 51 patients with type 1 diabetes on intensive therapy (NPH four times/day and lispro insulin at each meal) were randomized to three different regimens of basal insulin substitution while continuing lispro insulin at meals: continuation of NPH four times/day (n = 17), once daily glargine at dinnertime (n = 17), and once daily glargine at bedtime (n = 17) for 3 months. Blood glucose targets were fasting, preprandial, and bedtime concentrations at 6.4-7.2 mmol/l and 2 h after meals at 8.0-9.2 mmol/l. The primary end point was HbA(1c).
Mean daily blood glucose was lower with dinnertime glargine (7.5 +/- 0.2 mmol/l) or bedtime glargine (7.4 +/- 0.2 mmol/l) versus NPH (8.3 +/- 0.2 mmol/l) (P < 0.05). A greater percentage of blood glucose values were at the target value with glargine at dinner and bedtime versus those with NPH (P < 0.05). HbA(1c) at 3 months did not change with NPH but decreased with glargine at dinnertime (from 6.8 +/- 0.2 to 6.4 +/- 0.1%) and glargine at bedtime (from 7.0 +/- 0.2 to 6.6 +/- 0.1%) (P < 0.04 vs. NPH). Total daily insulin doses were similar with the three treatments, but with glargine there was an increase in basal and a decrease in mealtime insulin requirements (P < 0.05). Frequency of mild hypoglycemia (self-assisted episodes, blood glucose < or =4.0 mmol/l) was lower with glargine (dinnertime 8.1 +/- 0.8 mmol/l, bedtime 7.7 +/- 0.9 mmol/l) than with NPH (12.2 +/- 1.3 mmol/l) (episodes/patient-month, P < 0.04). In-hospital profiles confirmed outpatient blood glucose data and indicated more steady plasma insulin concentrations at night and before meals with glargine versus NPH (P < 0.05). There were no differences between glargine given at dinnertime and at bedtime.
Regimens of basal insulin with either NPH four times/day or glargine once/day in type 1 diabetic patients both result in good glycemic control. However, the simpler glargine regimen decreases the HbA(1c) level and frequency of hypoglycemia versus NPH. In contrast to NPH, which should be given at bedtime, insulin glargine can be administered at dinnertime without deteriorating blood glucose control.

Download full-text


Available from: Elisabetta Torlone, Nov 22, 2015
  • Source
    • "NPH insulin) be administered at meal times to achieve optimal glycemic control than either insulin preparation alone. (Murphy et al. 2003; Rossetti et al. 2003). However, insulin glargine is currently not used in dogs. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Intermediate insulin injections are commonly used for glycemic control in insulin dependent diabetic dogs acting as a replacement for natural insulin. Neutral Protamin Hagedorn (NPH) insulin and insulin glargine are two types of injectable insulin preparations commonly used in humans. In our study, we investigated the time-action profiles of both aforementioned insulin preparations in normal dogs in order to determine whether co-administration of NPH and glargine would be of benefit to insulin dependent diabetic dogs as it is for humans suffering from insulin dependent diabetes. Time-action profiles of NPH insulin and insulin glargine in normal dogs demonstrated a clear difference between both insulin preparations confirming that NPH insulin is an intermediate-acting preparation whereas insulin glargine is a long-lasting preparation. In addition, co-administration of NPH insulin and insulin glargine resulted in tight glycemic control as compared to NPH insulin alone in insulin dependent diabetic dogs. However, co-administration result in hypoglycemia at the dosages tested.
    Full-text · Article · Jul 2008 · Veterinary Research Communications
  • Source
    • ". Incidence of symptomatic (A), nocturnal (B) and severe (C) hypoglycaemia after treatment with glargine (grey), NPH (black), ultralente (green), and CSII (white) in type 1 diabetic patients. 1. Rosenstock et al. (2000), 2. Raskin et al. (2000), 3. Ratner et al. (2000), 4. Hershon et al. (2004), 5. Pieber et al. (2000), 6. Fulcher et al. (2005), 7. Porcellati et al. (2004), 8. Rossetti et al. (2003), 9. Kudva et al. (2005), and 10. Hirsch et al. (2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: For both type 1 and type 2 diabetes, tight glycaemic control is vital to reduce the risk of long-term complications. However, this must be achieved with minimal risk of hypoglycaemia. Glargine is a new long-acting insulin analogue with an action profile designed to overcome this and has now been in clinical use for a number of years. In many countries glargine is widely used. Here we present an update on the clinical information available on glargine with respect to glycaemic control, the risk of hypoglycaemia and quality of life in both type 1 and type 2 diabetes.
    Full-text · Article · Aug 2006 · Basic & Clinical Pharmacology & Toxicology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The main goal of treatment of diabetes mellitus (DM) is to maintain long term near normoglycemia. Insulin therapy plays a pivotal role in the management of DM. Most insulin preparations and insulin delivery systems, do not mimic the physiological insulin secretion in the body, leading to impaired metabolic ocntrol and increased hypoglycemic attacks. Insulin glargine is newer, long acting insulin analog with duration of action of 24 hr. It better efficacy than the currently used insulin replacement therapies with no increased side effects. In the surrent scenario, thought it is difficult to achieve an ideal insulin replacement therapy, insulin glargine is definitely a positive step in theat direction.
    Preview · Article ·
Show more