Endocrine Abstracts

Postprandial hyperglycaemia is a cardiovascular risk factor in diabetic patients. Therefore, younger type 2 diabetic patients are best treated by intensified insulin therapy (IIT) for effective control of postprandial hyperglycaemia. It is unclear, however, whether rapid acting insulin analogues were superior to normal human insulin when used in IIT by patients with type 2 diabetes mellitus.

We carried out a randomised open intra-individual cross-over trial to compare blood glucose (BG) responsiveness to insulin analogues (preprandial versus postprandial injections of insulin lispro, aspart or glulisine) with that to normal human insulin (injected 30 min versus immediately before meal). BG was measured before and one hour after the three main meals and at bedtime. Seventy insulin-naïve type 2 diabetic patients (age, 62±2 years (mean±S.E.M.), known duration of diabetes, 7±2 years, BMI, 30.3±1.1 kg/m²) participated at this study.

Whereas, BG measured one hour after meal did not differ after preprandial versus postprandial injections of rapid acting insulin analogues, postprandial BG was lower after injections of normal human insulin 30 min versus immediately before meal (171±6 vs 167±5 mg/dl and 155±6 vs 187±7 mg/dl, respectively, P<0.05 (ANOVA)). The averages of the 7-point BG profiles were similarly different: 145±5 vs 142±4 mg/dl and 138±3 vs 154±4 mg/dl, respectively, P<0.05). Prandial insulin requirement was lower with insulin analogues (24±2 vs 30±2 IU/day, P<0.05). There was no hypoglycaemic event throughout the study.

Whereas in IIT normal human insulin should be injected 30 min before meal, both preprandial and postprandial injections of insulin analogues can be allowed. Since patients benefit from injecting prandial insulin immediately before or even after meal and since less insulin is required with rapid acting insulin analogues, insulin analogues are superior to normal human insulin in type 2 diabetes mellitus.