Special aspects of concentrated insulins: basic characteristics and research findings
https://doi.org/10.14341/DM10334
Abstract
The appearance of concentrated insulins in clinical practice determines the need to analyze product priorities in appropriate groups of patients with diabetes. The aim of this article is to summarize the literature on concentrated insulins (i.e. insulin lispro 200 units/mL, insulin degludec 200 units/mL, insulin glargine 300 units/mL) from randomized controlled trials, derive guidance on appropriate and safe use of these agents and demonstrate experience in real clinical practice. Severe hypoglycemia in all studies was generally low (though higher with prandial plus concentrated basal analogue therapy), and statistical improvements in other hypoglycemia categories were observed for concentrated basal insulins versus insulin glargine 100 units/mL. In all analyzed data hypoglycemic effect of insulin glargine 300 units/mL was equitable to insulin glargine 100 units/mL. Other important findings demonstrate more constant and prolonged insulin action with low within-subject/ between-day variability for insulin glargine 300 units/mL versus insulin glargine 100 units/mL, therefore, more physiological treatment might prevent from diabetic microvascular complications. The results of randomized trials are comparable with our clinical practice experience and indicate efficacious and safe glucose-lowering properties without risk of severe hypoglycemia.
About the Authors
Tatiana Y. Demidova
Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
MD, PhD, Professor
Competing Interests:
-
Olga V. Balutina
Pirogov Russian National Research Medical University
Russian Federation
Competing Interests:
Russian Federation
MD, PhD student
Competing Interests:
-
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Supplementary files
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1. Fig. 1. Reduced glycated hemoglobin [%] in people with type 2 diabetes within 6 months of treatment by subgroup (mITT population; pooled data from EDITION 1, 2 and 3). * Duration of diabetes is not available for 8 participants. BMI - body mass index; DI - confidence interval; mITT is the “modified intention to treat” population (the population includes data from all patients for whom the drug was prescribed at least once, and for whom the data of at least one follow-up visit was known). | |
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2. Fig. 2. Relative risk (RR) of confirmed (≤3.9 mmol / L) or severe hypoglycemia during the night (00: 00–05: 59 h) (a) and at any time of the day (24 h) (b), c within 6 months of treatment by subgroup (% of participants with ≥1 case; population for safety assessment; pooled data from EDITION 1, 2, and 3). * Diabetes duration not available for 8 participants | |
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3. Fig. 3. Clinical case (continuous glucose monitoring data): transfer of patient C. (age 54 years) with type 2 diabetes mellitus (duration from diagnosis to 3 years) and late complications of the disease (neuroischemic form of diabetic foot syndrome) with insulin therapy NPH (neutral protamine Hagedorn) 2 times a day for insulin glargine 300 U / ml once a day; a), b) the initial study, prolonged hypoglycemia at night; c) a repeated study, against the background of the use of insulin glargine 300 U / ml, normoglycemia is observed at night. | |
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4. Fig. 4. Clinical case (continuous glucose monitoring data): transfer of patient G. (age 80 years) with type 2 diabetes mellitus (duration from diagnosis to 3 years) and late complications of the disease (myocardial infarction and acute cerebrovascular accident) with insulin glargine therapy 100 IU / ml once a day for insulin glargine 300 IU / ml once a day in a ratio of 1: 1; a) an initial study, prolonged hypoglycemia at night; b), c) during the second study, positive dynamics are noted - against the background of the use of insulin glargin 300 IU / ml hypoglycemia at night is absent. | |
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For citations:
Demidova T.Y., Balutina O.V. Special aspects of concentrated insulins: basic characteristics and research findings. Diabetes mellitus. 2019;22(5):481-490. (In Russ.) https://doi.org/10.14341/DM10334
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