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Glargine plus Lispro provided better control then NPH insulin with less nocturnal hypoglycemia. The goal was to compare blood glucose control using insulin glargine + insulin lispro with that on NPH insulin + unmodified human insulin in adults with Type 1 diabetes managed with a multiple injection regimen.
In this 32-week, five-centre, two-way cross-over study, people with Type 1 diabetes (n = 56, baseline HbA(1c) 8.0 +/- 0.8%) were randomized to evening insulin glargine + mealtime insulin lispro or to NPH insulin (once- or twice-daily) + mealtime unmodified human insulin. Each 16-week period concluded with a 24-h inpatient plasma glucose profile. Results HbA(1c) was lower with glargine + lispro than with NPH + human insulin [7.5 vs. 8.0%, difference -0.5) This was confirmed by an 8% lower 24-h plasma glucose area under the curve (AUC) (187 vs. 203 mmol, a 24% reduction in plasma glucose AUC > 7.0 mmol/l(1) (47 vs. 62 mmol) and a 15% lower post-prandial plasma glucose AUC (75 vs. 88 mmol). There was no reduction in night-time plasma glucose AUC or increase in plasma glucose area < 3.5 mmol/l. Monthly rate of nocturnal hypoglycemia was reduced by 44% with glargine + lispro (0.66 vs. 1.18 episodes/month).
From the results it was concluded that compared with NPH insulin + unmodified human insulin, the combination of insulin glargine with a rapid-acting insulin analogue as multiple-injection therapy for Type 1 diabetes improves overall glycemic control as assessed by HbA(1c) and 24-h plasma glucose monitoring to a clinically significant degree, together with a reduction in nocturnal hypoglycemia. Diabet. Med. 23, 285 -292 (2006).
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