News about Humalog and Humalog Mix for the treatment of type 2 diabetes mellitus.

Fast-acting insulin analog (lispro insulin), as well as slow/fast-acting an alog mixtures (NPL-lispro insulin) allow a better control df postprandial g lycemia in type 1 and type 2 diabetic patients (35% mean reduction in area under curve for postprandial glycemia, 2 mmol/l reduction in postprandial g lucose peak), as compared with regular insullin or conventional mixtures of NPH and regular insulin. Analog pharmacokinetics allow to precede to insul in injection immediately before meal, which is convenient for the patients. When used alone, lispro insulin has no impact on basal glycemia, whereas t wice daily injections of NPL-lispro mixtures allow a 1.8 mmol/l mean reduct ion of basal glycemia, as compared with conventional mixtures, meaning a mo re specific effect of NPL intermediate insulin. Other premeal blood glucose levels (lunch and dinner) are not improved by lispro insulin. Most studies did not establish a clear reduction in HbA1c with insulin analogs. When th is is the case, this reduction averages 1.5% and could be more frequently o bserved in studies dealing with type 2 diabetic patients. Finally, the redu ced incidence of delayed hypoglycemic episodes, which is one of the most at tractive effects of insulin analogs, was only reported in a minority of stu dies. Surprisingly, the reduction of hypoglycemia incidence with analogs wa s more frequently reported in type 2 diabetics than in type 1 patients. Thu s fast-acting insulin analogs feature interesting characteristics, notewort hy immediate premeal injection and a better postprandial glucose control. H owever, it is established that the determination of diabetes complications (particularly microangiopathy) mostly relies on average glucose control and not solely on postprandial glycemia. Indeed, most studies suggest that ins ulin analogs are at least as efficient as conventional insulins on HbA1c, b ut possibly not more.