Lispro insulin as premeal therapy in type 1 diabetes: comparison with Humulin R

Area of Science:

• Endocrinology
• Pharmacology
• Metabolic Diseases

Background:

• Type 1 diabetes mellitus (T1DM) management requires effective insulin therapy.
• Short-acting insulin analogues aim to improve postprandial glucose control compared to regular insulins.
• Understanding the comparative efficacy and safety of lispro versus Humulin R is crucial for clinical practice.

Purpose of the Study:

• To compare the efficacy, tolerability, and safety of insulin lispro with Humulin R as premeal therapy in T1DM.
• To assess the long-term safety of lispro when administered for one year.

Main Methods:

• A multicentre crossover study involving 1008 patients, with a subset of 20 patients in Auckland.
• Patients received either lispro or Humulin R for 3-month periods, followed by an optional open-label lispro continuation phase.
• Basal insulin therapy utilized Humulin N, L, or U.

Main Results:

• No significant differences were observed in glycaemic control or hypoglycaemia incidence between lispro and Humulin R when used with basal insulins.
• Glycosylated haemoglobin (HbA1C) improved from 8.6% at baseline to approximately 7.6-7.7% with both insulins.
• During the 12-month open-label lispro continuation, HbA1C levels increased back to 8.6%.

Conclusions:

• Insulin lispro and Humulin R demonstrated similar short-term efficacy, tolerability, and safety profiles in T1DM patients.
• Both insulin types were well-tolerated, with comparable glycaemic control and incidence of adverse effects.
• Longer-term data indicated a potential deterioration in glycaemic control with sustained lispro use in this cohort.