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Modification of postprandial hyperglycemia with insulin lispro improves glucose control in patients with type 2 diabetes.

Publication ,  Journal Article
Feinglos, MN; Thacker, CH; English, J; Bethel, MA; Lane, JD
Published in: Diabetes Care
October 1997

OBJECTIVE: Insulin lispro is a rapid-acting analog of human insulin that can be used to target the postprandial rise in plasma glucose. We designed an open-label randomized crossover study of type 2 diabetic patients with secondary failure of sulfonylurea therapy to determine whether improvement of postprandial hyperglycemia would affect total daily glucose control. RESEARCH DESIGN AND METHODS: Twenty-five type 2 diabetic patients who were poorly controlled on a maximum dose of sulfonylureas were studied in a university hospital clinical research center. In one arm of the study, patients continued therapy with maximum-dose sulfonylureas. In the other arm, patients used a combination therapy with insulin lispro before meals and sulfonylureas. After 4 months, patients were crossed over to the opposite arm. Fasting plasma glucose (FPG) and 1- and 2-h postprandial glucose (after a standardized meal), HbA1c, total, HDL, and LDL cholesterol, and triglyceride levels were measured at the end of each arm of the study. RESULTS: Insulin lispro in combination with sulfonylurea therapy significantly reduced 2-h postprandial glucose concentrations compared with sulfonylureas alone, from 18.6 to 14.2 mmol/l (P < 0.0001), and incremental postprandial glucose area from 617.8 to 472.9 mmol.min.1-1 (P < 0.0007). FPG levels were decreased from 10.9 to 8.5 mmol/l (P < 0.0001), and HbA1c values were reduced form 9.0 to 7.1% (P < 0.0001). Total cholesterol was significantly decreased in the lispro arm from 5.44 to 5.10 mmol/l (P < 0.02). HDL cholesterol concentrations were increased in the lispro arm from 0.88 to 0.96 mmol/l (P < 0.01). The patients weighed significantly more after lispro therapy than after sulfonylureas alone, but the difference was small in absolute terms (sulfonylurea therapy alone, 90.6 kg; lispro therapy, 93.8 kg; P < 0.0001). Two episodes of hypoglycemia (glucose concentrations, < 2.8 mmol/l) were reported by the patients while using lispro. CONCLUSIONS: Previously, it has not been possible to address the effect of treatment of postprandial hyperglycemia specifically. We have now shown that the treatment of postprandial hyperglycemia with insulin lispro markedly improves overall glucose control and some lipid parameters in patients with type 2 diabetes.

Duke Scholars

Published In

Diabetes Care

DOI

ISSN

0149-5992

Publication Date

October 1997

Volume

20

Issue

10

Start / End Page

1539 / 1542

Location

United States

Related Subject Headings

  • Triglycerides
  • Sulfonylurea Compounds
  • Postprandial Period
  • Middle Aged
  • Male
  • Insulin Lispro
  • Insulin
  • Hypoglycemic Agents
  • Humans
  • Female
 

Citation

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Feinglos, M. N., Thacker, C. H., English, J., Bethel, M. A., & Lane, J. D. (1997). Modification of postprandial hyperglycemia with insulin lispro improves glucose control in patients with type 2 diabetes. Diabetes Care, 20(10), 1539–1542. https://doi.org/10.2337/diacare.20.10.1539
Feinglos, M. N., C. H. Thacker, J. English, M. A. Bethel, and J. D. Lane. “Modification of postprandial hyperglycemia with insulin lispro improves glucose control in patients with type 2 diabetes.Diabetes Care 20, no. 10 (October 1997): 1539–42. https://doi.org/10.2337/diacare.20.10.1539.
Feinglos MN, Thacker CH, English J, Bethel MA, Lane JD. Modification of postprandial hyperglycemia with insulin lispro improves glucose control in patients with type 2 diabetes. Diabetes Care. 1997 Oct;20(10):1539–42.
Feinglos, M. N., et al. “Modification of postprandial hyperglycemia with insulin lispro improves glucose control in patients with type 2 diabetes.Diabetes Care, vol. 20, no. 10, Oct. 1997, pp. 1539–42. Pubmed, doi:10.2337/diacare.20.10.1539.
Feinglos MN, Thacker CH, English J, Bethel MA, Lane JD. Modification of postprandial hyperglycemia with insulin lispro improves glucose control in patients with type 2 diabetes. Diabetes Care. 1997 Oct;20(10):1539–1542.

Published In

Diabetes Care

DOI

ISSN

0149-5992

Publication Date

October 1997

Volume

20

Issue

10

Start / End Page

1539 / 1542

Location

United States

Related Subject Headings

  • Triglycerides
  • Sulfonylurea Compounds
  • Postprandial Period
  • Middle Aged
  • Male
  • Insulin Lispro
  • Insulin
  • Hypoglycemic Agents
  • Humans
  • Female