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Human isophane or lente insulin? A double blind crossover trial in insulin dependent diabetes mellitus
Insights
Human isophane insulin demonstrated superior glycemic control in children with insulin dependent diabetes mellitus compared to lente insulin. Patients and parents preferred isophane insulin, citing improved metabolic control.
Area of Science:
- Pediatrics
- Endocrinology
- Metabolic Disorders
Background:
- Insulin therapy is crucial for managing insulin dependent diabetes mellitus (IDDM) in children.
- Choosing the appropriate insulin preparation impacts glycemic control and patient quality of life.
Purpose of the Study:
- To compare the efficacy and patient preference of human isophane insulin versus lente insulin in children with IDDM.
- To assess the impact of different insulin types on glycemic control, hypoglycemia, and insulin profiles.
Main Methods:
- A double-blind, randomized crossover trial involving 52 children with IDDM.
- Patients received human isophane or lente insulin combined with soluble insulin, with treatment periods of four months.
- Glycemic control was assessed using glycated hemoglobin, fasting blood glucose, and fructosamine; insulin profiles and hypoglycemia episodes were also monitored.
Main Results:
- Human isophane insulin significantly lowered glycated hemoglobin compared to lente insulin.
- Fasting blood glucose, fructosamine levels, and hypoglycemia episode frequency were similar between the two insulin regimens.
- Insulin profiles showed greater variability with lente insulin compared to isophane insulin in a subset of patients.
- Two-thirds of participants preferred isophane insulin, reporting better metabolic control.
Conclusions:
- Human isophane insulin offers better glycemic control in pediatric IDDM patients than lente insulin.
- Patient preference favors isophane insulin due to perceived improvements in metabolic control.
- Isophane insulin may provide more predictable insulin profiles, potentially aiding in diabetes management for children.
Abstract:
Fifty two children with insulin dependent diabetes mellitus were randomised to receive human isophane or lente insulin preparations in combination with soluble insulin in a double blind trial. Patients were seen every two months, and crossed over after four months of treatment. Control assessed by glycated haemoglobin was significantly lower in children on human isophane insulin, but fasting blood glucose and fructosamine concentrations and the number of episodes of hypoglycaemia were similar on both regimens. In five children on twice daily insulin regimens, insulin profiles throughout a 24 hour period demonstrated greater variability on lente compared with isophane insulin despite identically administered insulin doses. A questionnaire completed at the end of the study showed that two thirds of the children and/or their parents preferred the isophane insulin, and they gave perceived improvement of metabolic control as the major reason for their choice.