EFFECTS OF A SHORT-ACTING INSULIN ANALOG (INSULIN LISPRO) VERSUS REGULAR INSULIN ON LIPID-METABOLISM IN INSULIN-DEPENDENT DIABETES-MELLITUS

Insulin Lispro (IL) is a short-acting insulin analog that better repro duces the physiological postprandial insulin profile. The aim of this study was to compare the effects of intensive insulin therapy on lipid metabolism using preprandial IL and regular insulin (RI) in 10 insuli n-dependent diabetes mellitus (IDDM) subjects. The mean hemoglobin A(1 c) (HbA(1c)) at baseline was 7.13% +/- 1.2% and did not change after b oth treatments. In IDDM patients, total cholesterol and triglyceride l evels appeared lower after RI than after IL. The low-density lipoprote in (LDL) to high-density lipoprotein (HDL) ratio significantly decreas ed only after RI (baseline, 2.01 +/- 0.6; IL, 1.88 +/- 0.6; RI, 1.71 /- 0.5, P<.05), Although no very-low-density lipoprotein (VLDL) compos ition abnormalities were observed at baseline, the protein content was lower (P <.05) after IL (8.13% +/- 2.93%) than after RI (11.93% +/- 3 .41%). Intermediate-density lipoprotein (IDL) protein depletion at bas eline (6.14% +/- 6.84%) was normalized after both treatments (IL, 11.0 9% +/- 12.14%; RI, 10.38% +/- 16.68%, P <.05). LDL, HDL, HDL2, and HDL 3 composition abnormalities were similar after both treatments and did not normalize. IDDM and control subjects showed similar LDL subfracti on distribution at baseline and after both treatments. Two-hour postpr andial VLDL composition alterations, although improved after RI, compl etely normalized after IL (P <.05). Lipoprotein lipase (LPL) and chole steryl ester transfer protein (CETP) activities were similar to the co ntrol group and did not change after both treatments. Hepatic lipase ( HL) activity was lower in diabetic patients (39.6 +/- 35.2 v 87.0 +/- 27.1 U/L, P <.01) and remained lower after both treatments. In conclus ion, in IDDM patients, IL (injected immediately before the meal) may o ffer small different effects on lipoprotein metabolism versus RI (inje cted 30 minutes before the meal) that, taken together, do not seem rel evant. Copyright (C) 1998 by W.B. Saunders Company.