NEW YORK (Reuters Health) – Using the rapid-acting insulin analog glulisine instead of regular human insulin at mealtimes improves glycemic control in hospitalized patients with type 2 diabetes, according to the results of a trial reported online August 30 in Diabetes Care.
Dr. Christian Meyer and colleagues at the Carl T. Hayden VA Medical Center in Phoenix, Arizona note that insulin therapy in hyperglycemic inpatients is challenging, given variable meal times in hospitals, unpredictable food intake, and medical conditions that can predispose to hypoglycemia.
The researchers tested the benefit of rapid-acting insulin in this setting in 180 patients with type 2 diabetes who were admitted for non-critical medical or surgical care for an expected stay of at least 3 days. Patients were taken off any prior diabetes medication and randomized in double-blind fashion to either rapid-acting glulisine (Apidra, Sanofi-Aventis) or regular insulin (Novolin R, Novo Nordisk) before meals, as well as insulin glargine (Lantus, Sanofi-Aventis) at bedtime.
The primary end points were glycemic control, measured by the mean daily blood glucose concentration, and the incidence of hypoglycemia.
Average blood glucose concentrations were the same, 159 mg/dL, in the two groups for the first 4 days. After day 4 however, there was a significant difference at 140 vs 162 mg/dL (p<0.0007) in the glulisine and normal insulin groups, respectively. Corresponding levels after day 7 onwards were 133 vs 164 mg/dL (p<0.0001).
As for hypoglycemia, the team found that throughout the study “there were 123 hypoglycemic events: 56 in the glulisine group and 67 in the regular insulin group.” However, Dr. Meyer and colleagues report, the number of subjects with one or more hypoglycemic episodes (30% vs 35%, p>0.5) was not significantly different.
“In summary,” the researchers conclude, “the present study provides evidence suggesting that treatment with glulisine can provide superior glycemic control compared (to) regular insulin in hospitalized T2DM patients, especially in those who have a prolonged length of stay.”
Reference:
GLULISINE VERSUS HUMAN REGULAR INSULIN IN COMBINATION WITH GLARGINE IN NON-CRITICALLY ILL HOSPITALIZED PATIENTS WITH TYPE 2 DIABETES: A RANDOMIZED DOUBLE-BLIND STUDY
Diabetes Care 2010.
Glulisine effective for non-critical inpatients with type 2 diabetes
Reuters Health • The Doctor's Channel Daily Newscast
September 21, 2010 • Diabetes, Family Medicine, Hospitalist, Internal Medicine, Medical Students, Nurses/NP/PA, Pharmacists, Reuters Health • The Doctor's Channel Newscast
