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
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
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.