Nocturnal hypo effects of analogue and human insulins compared
Treatment with insulin analogue reduces nocturnal hypoglycaemia in people with type 1 diabetes prone to severe hypoglycaemia, research has found.
The finding was based on assessing nocturnal glucose profiles to provide a more comprehensive assessment of clinical benefit of insulin regimens compared to conventional recording of hypoglycaemia.
The study, published in Diabetic Medicine, assessed the difference between analogue and human insulin with regard to nocturnal glucose profiles and risk of hypoglycaemia in people with recurrent severe hypoglycaemia.
Researchers studied 72 people [46 men, mean ± sd age 54 ± 12 years, mean ± sd HbA1c 65 ± 12 mmol/mol (8.1 ± 1.1 per cent), mean ± sd duration of diabetes 30 ± 14 years] in the two-year randomised, crossover trial of basal-bolus therapy with insulin detemir/insulin aspart or human NPH insulin/human regular insulin (the HypoAna trial).
Participants were studied for two nights during each treatment and venous blood was drawn hourly during sleep. The primary endpoints were nocturnal glucose profiles and occurrence of hypoglycaemia (blood glucose ≤ 3.9 mmol/l).
Summarising the results, the researchers conclude: “During insulin analogue treatment, the mean nocturnal plasma glucose level was significantly higher than during treatment with human insulin (10.6 vs 8.1 mmol/l). The fasting plasma glucose level was similar between the treatments.
“Nocturnal hypoglycaemia was registered during 41/101 nights (41per cent) in the human insulin arm and 19/117 nights (16 per cent) in the insulin analogue arm, corresponding to a hazard ratio of 0.26 (95 per cent CI 0.14 to 0.45; P<0.0001) with insulin analogue.”
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