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Physiological insulin replacement in type 1 diabetes mellitus
1Department of Internal Medicine, University of Perugia, Italy. gbolli@dimisem.med.unipg.it
Summary
Intensive insulin therapy using short-acting insulin analogues for meals and basal insulin replacement (continuous infusion or glargine) is key for managing diabetes. This approach protects against microangiopathic complications by maintaining near-normal blood glucose levels.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Background:
- Type 1 and type 2 diabetes mellitus management requires strategies to prevent microangiopathic complications.
- Long-term near-normoglycaemia is established as a protective factor against these complications.
- Physiological insulin replacement therapy is crucial for achieving near-normoglycaemia.
Purpose of the Study:
- To outline optimal insulin strategies for intensive diabetes management.
- To compare the efficacy and safety of different insulin formulations for mealtime and basal insulin replacement.
- To emphasize the importance of mimicking natural insulin secretion patterns.
Main Methods:
- Review of findings from the DCCT and UKPDS studies.
- Analysis of pharmacokinetic and pharmacodynamic profiles of insulin analogues and traditional insulin preparations.
- Comparison of continuous subcutaneous insulin infusion (CSII) with multiple daily injections (MDI) and specific insulin analogues.
Main Results:
- Short-acting insulin analogues (lispro, aspart) are superior to regular human insulin for mealtime coverage due to convenience, better post-meal glucose control, and reduced risk of late hypoglycemia.
- Continuous subcutaneous insulin infusion (CSII) using short-acting analogues provides superior basal insulin replacement compared to retarded insulin preparations.
- Insulin glargine, a long-acting analogue, offers a flat, peakless, and long-lasting action profile, closely mimicking CSII and outperforming NPH insulin.
Conclusions:
- Modern intensive insulin therapy should incorporate short-acting analogues for mealtime injections.
- Optimized basal insulin replacement is essential for maximizing the benefits of mealtime analogue therapy.
- Insulin glargine is the preferred basal insulin option over NPH insulin for both type 1 and type 2 diabetes, offering improved physiological coverage.