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Safety and Effectiveness of U‐500 Insulin Therapy in Patients with Insulin‐Resistant Type 2 Diabetes Mellitus
Author(s) -
Quinn Suzanne L.,
Lansang M. Cecilia,
Mina Deanna
Publication year - 2011
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.31.7.695
Subject(s) - medicine , insulin , diabetes mellitus , insulin resistance , hypoglycemia , type 2 diabetes mellitus , type 2 diabetes , endocrinology
Study Objective. To assess the safety and effectiveness of highly concentrated U‐500 regular insulin in patients with insulin‐resistant type 2 diabetes mellitus who were switched from U‐100 insulin. Design. Retrospective cohort study. Setting. Outpatient diabetes management clinic. Patients. Twenty‐one adults with poorly controlled type 2 diabetes and insulin resistance who were referred to the clinic between July 1, 2007, and June 30, 2008, and whose therapy was changed from large doses of U‐100 insulin to U‐500 insulin. Measurements and Main Results. Demographic and clinical data were collected through a computerized medical record system. Insulin resistance was defined as a requirement of more than 200 units/day of insulin and more than 100 units/injection. The primary outcome was the change in hemoglobin A 1c (A1C) after switching from any type of U‐100 insulin to stabilization with U‐500 highly concentrated regular insulin. Secondary outcomes were the changes in number of daily insulin injections, daily insulin dose, and body weight. With use of U‐500 insulin, patients were able to achieve an average reduction in A1C of 1.7% (p<0.001). The mean number of daily injections decreased from 4.3 with U‐100 insulin to 2.7 after using U‐500 insulin (p<0.001), but changes in body weight after the change in insulin were not statistically significant (279.8 vs 279.2 lbs, p=0.429). No patient discontinued U‐500 insulin during the study, and none experienced hypoglycemia severe enough to require the assistance of another individual. Conclusion. In patients with insulin‐resistant diabetes who have requirements of more than 200 units/day or 100 units/injection, use of U‐500 regular insulin provided the same or better glucose control compared with U‐100 insulin, with fewer daily injections and reduced injection volume. Although this drug represents an excellent treatment option, its safe use requires an experienced physician, a motivated and cooperative patient, and a dynamic diabetes management team.