Endocrine Abstracts

Background: A variety of insulin analogs have been developed and used for the treatment of diabetes mellitus. We often experience elevated serum insulin levels when insulin analog is used, and thus have difficulty in assessing insulin resistance and secretion using serum insulin results. This study aimed to investigate the differences in serum fasting insulin level and insulin antibodies according to the type of insulin analogs.

Method: We conducted a retrospective study from 2007 to 2017 in Kyung Hee University Hospital at Gangdong on the Type 2 diabetes mellitus patients who were prescribed insulin analogs (insulin aspart, lipro, glulisine, detemir, glargine, and premixed insulin). We analyzed fasting insulin titers, insulin antibodies, and glycemic parameters after insulin treatment.

Results: A total of 2272 insulin users were analyzed (average age: 56.4±14.6 years, male: 54.7%). Serum fasting insulin level was higher in long-acting insulin analogs group than in other insulins group and was significantly higher in detemir group than glargine group (detemir group: 52.3±82.2, glargine group: 18.2±26.2; other insulins group: 13.3±23.5, P<0.001). The proportion of patients with fasting insulin levels above 100 μIU/ml was also higher in the detemir group than in the other groups (detemir group: 16.7%, glargine group: 1.3%, other insulins group: 0.6%, P=0.001). In addition, the positive rate of insulin antibodies was higher in detemir group than in the other groups. However, fasting glucose, C-peptide level, and HbA1c were not significantly different between groups.

Conclusions: Among insulin analogs, insulin detemir is more likely to cause fasting hyperinsulinemia than other insulins. In this case, it is necessary to examine the insulin antibodies and to consider its association.