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Glucose‐lowering effect and glycaemic variability of insulin glargine, insulin detemir and insulin lispro protamine in people with type 1 diabetes
Author(s) -
Derosa G.,
Franzetti I.,
Querci F.,
Romano D.,
D'Angelo A.,
Maffioli P.
Publication year - 2015
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12454
Subject(s) - insulin detemir , insulin lispro , medicine , protamine , endocrinology , insulin glargine , insulin , diabetes mellitus , type 2 diabetes , area under the curve , type 1 diabetes , heparin
Aim To compare, using a continuous glucose monitoring ( CGM ) system, the effect on glycaemic variability of insulin glargine, detemir and lispro protamine. Methods A total of 49 white people with type 1 diabetes, not well controlled by three times daily insulin lispro, taken for at least 2 months before study and on a stable dose, were enrolled. The study participants were randomized to add insulin glargine, detemir or lispro protamine, once daily, in the evening. We used a CGM system, the i P ro D igital R ecorder ( M edtronic MiniMed , N orthridge, CA , USA ) for 1 week. Glycaemic control was assessed according to mean blood glucose values, the area under the glucose curve above 3.9 mmol/l ( AUC >3.9 ) or above 10.0 mmol/l ( AUC >10.0 ), and the percentage of time spent with glucose values >3.9 or >10.0 mmol/l. Intraday glycaemic variability was assessed using standard deviation (s.d.) values, the mean amplitude of glycaemic excursions and continuous overlapping of net glycaemic action. Day‐to‐day glycaemic variability was assessed using the mean of daily differences. Results The s.d. was found to be significantly lower with insulin lispro protamine and glargine compared with insulin detemir. AUC >3.9 was higher and AUC >10.0 was lower with insulin lispro protamine and glargine compared with detemir. The mean amplitude of glycaemic excursions and continuous overlapping net glycaemic action values were lower with insulin lispro protamine and glargine compared with detemir. In addition, the mean of daily differences was significantly lower with insulin lispro protamine and glargine compared with detemir. Fewer hypoglycaemic events were recorded during the night‐time with insulin lispro protamine compared with glargine and detemir. Conclusions The results suggest that insulin lispro protamine and glargine are more effective than detemir in reducing glycaemic variability and improving glycaemic control in people with type 1 diabetes. Insulin lispro protamine seems to lead to fewer hypoglycaemic events than other insulin regimens.