Optimized basal-bolus therapy using a fixed mixture of 75% lispro and 25% NPL insulin in type 1 diabetes patients - No favorable effects on glycemic control, physiological responses to hypoglycemia, well-being, or treatment satisfaction

Citation
Mmj. Janssen et al., Optimized basal-bolus therapy using a fixed mixture of 75% lispro and 25% NPL insulin in type 1 diabetes patients - No favorable effects on glycemic control, physiological responses to hypoglycemia, well-being, or treatment satisfaction, DIABET CARE, 23(5), 2000, pp. 629-633
Citations number
20
Categorie Soggetti
Endocrynology, Metabolism & Nutrition","Endocrinology, Nutrition & Metabolism
Journal title
DIABETES CARE
ISSN journal
01495992 → ACNP
Volume
23
Issue
5
Year of publication
2000
Pages
629 - 633
Database
ISI
SICI code
0149-5992(200005)23:5<629:OBTUAF>2.0.ZU;2-S
Abstract
OBJECTIVE - To investigate the effects of a multiple injection regimen with a mixture of 75% lispro and 25% intermediate-acting insulin (lispro high m ixture [HMI]) before meals on glycemic control, physiological responses to hypoglycemia, well-being, and treatment satisfaction. RESEARCH DESIGN AND METHODS- We studied 35 type 1 diabetes patients. After an 8 to 10-week lead-in period, patients were randomized to HM or human reg ular insulin therapy for 12-14 weeks. During the lead-in and treatment peri ods, HbA(1c) levels and hypoglycemic frequencies were measured, and patient s completed the Well-Being Questionnaire and the Diabetes Treatment Satisfa ction Questionnaire. In 19 patients, responses to hypoglycemia were tested during stepped euglycemic-hypoglycemic clamps. RESULTS - HM treatment improved postprandial glycemia but had no effect on HbA(1c), frequency of hypoglycemia, well-being, or treatment satisfaction. During experimental hypoglycemia, HM therapy was associated with a slightly lower total adrenaline response and a higher autonomic symptom threshold ( i.e., the autonomic symptom response occurred at a lower blood glucose leve l) than human regular insulin therapy We speculate that this effect resulte d from an accumulation of insulin during the night. CONCLUSIONS - Multiple injection therapy with HM rather than human regular insulin before meals does not offer advantages regarding glycemic control, frequency of hypoglycemia, well-being, or treatment satisfaction. In additi on, this regimen causes an attenuation of the adrenaline and autonomic symp tom responses to hypoglycemia.