INSULIN LISPRO - ITS ROLE IN THE TREATMENT OF DIABETES-MELLITUS

OBJECTIVE: To introduce a rapid-acting human insulin analog, insulin l ispro; to review its pharamacology, therapeutics, pharmacokinetics, do sing guidelines, adverse effects, and drug interactions; and to summar ize the clinical trials of its efficacy and safety alone in comparison with regular human insulin in the treatment of diabetes mellitus. DAT A SOURCES: A MEDLINE database search was completed to identify all rel evant articles, including reviews; Eli Lilly and Co.; published articl es and abstracts; and review chapters from medical textbooks. STUDY SE LECTION: Due to the relatively few citations listed in MEDLINE (12 as of December 1995), most of the studies reported were found from abstra cts summarizing the clinical action, adverse effects, or pharacokineti cs of insulin lispro in healthy volunteers or patients with diabetes m ellitus. A few of the studies used patients with diabetes mellitus in multicenter, randomized, crossover trials of insulin lispro. DATA EXTR ACTION: All clinical trials that were available prior to submission of this manuscript for publication, including unpublished reports, were reviewed. DATA SYNTHESIS; The human insulin analog, insulin lispro, wh ich is biosynthetically made by inverting the amino acid sequence of h uman insulin at B-28 and B-29, is more effective than regular human in sulin in improving postprandial glucose control. Subcutaneous injectio ns of insulin lispro result in decreased blood glucose peaks following meals and a potential decreased risk of hypoglycemic episodes, includ ing nighttime hypoglycemia in patients with type 1 diabetes. Insulin l ispro in comparison with regular human insulin provides equal or sligh tly better blood glucose control. When compared with subcutaneous inje ctions of regular human insulin, the peak serum insulin concentration of insulin lispro is three times higher, time to peak is 4.2 times fas ter, the absorption rate constant is double, and the duration of actio n is half as long. Insulin lispro is similar to regular human insulin with reference to dose, toxicity, adverse effects, drug interactions, and immunogenicity. When insulin lispro is mixed with human NPH (isoph ane) or Lente insulins, insulin lispro should be drawn into the syring e first, mixed with the long-acting insulin, and injected immediately after mixing. Patients using insulin lispro perceive an improvement in their well-being and quality of life due to flexible injection times and less frequent hypoglycemic reactions. Insulin lispro is believed t o be suitable for patients using insulin infusion pumps. CONCLUSIONS: Insulin lispro is equipotent to human insulin and has a much more rapi d onset and shorter duration of action than human insulin does, which may reduce the risk of hypoglycemia In addition, insulin lispro improv es the dosing convenience for patients with diabetes and provides a mo re natural control of blood glucose concentrations. Insulin lispro is a useful new agent in the treatment of diabetes mellitus.