OBJECTIVEContinuously administered insulin is limited by the need for frequent blood glucose measurements, dose adjustments, and risk of hypoglycemia. Regimens based on glucagon-like peptide 1 (GLP-1) could represent a less complicated treatment alternative. This alternative might be advantageous in hyperglycemic patients hospitalized for acute critical illnesses, who benefit from near normoglycemic control.RESEARCH DESIGN AND METHODSIn a prospective open randomized crossover trial, we investigated eight clinically stable type 2 diabetic patients during intravenous insulin or GLP-1 regimens to normalize blood glucose after a standardized breakfast.RESULTSThe time to reach a plasma glucose below 115 mg/dl was significantly shorter during GLP-1 administration (252 ± 51 vs. 321 ± 43 min, P < 0.01). Maximum glycemia (312 ± 51 vs. 254 ± 48 mg/dl, P < 0.01) and glycemia after 2 h (271 ± 51 vs. 168 ± 48 mg/dl, P = 0.012) and after 4 h (155 ± 51 vs. 116 ± 27 mg/dl, P = 0.02) were significantly lower during GLP-1 administration.CONCLUSIONSGLP-1 infusion is superior to an established insulin infusion regimen with regard to effectiveness and practicability.

Objective: To control postprandial hyperglycemia in insulin-treated type 2 diabetic patients, prandial therapy with regular human insulin (HI) or fast acting insulin analogs is used. Postprandial hyperglycemia seems to be reduced more effectively with insulin analogs than with normal insulin, but there are no data concerning the effect on lipolysis or pancreatic insulin and proinsulin secretion of normal insulin in comparison to insulin analogs. Design and methods: We included 13 patients with type 2 diabetes mellitus (age 62.2G10.3 years) with preexisting insulin therapy in this crossover, prospective, open-labeled, randomized trial comparing regular HI with insulin aspart (IA) in the setting of a standardized breakfast and a standardized lunch 4 h later. Blood samples for determination of glucose, free fatty acids (FFA), triglycerides, C-peptide, and intact proinsulin were drawn during fasting and every 30 min until 4 h after the second test meal. Statistical analysis was performed with ANOVA for repeated measurements and paired Student's t-test. Results: The mean increase in blood glucose was significantly lower after IA (24.18G16.33 vs 34.92G29.07 mg/dl, PZ0.02) compared with HI. Both therapies reduced FFA; however, the mean reduction was significantly higher after IA than after HI (K0.47G0.16 vs K0.35G0.15 mmol/l, P!0.001). The mean increase in intact proinsulin was significantly lower after IA than after HI (10.53G5 vs 15.20G6.83 pmol/l, P!0.001). No differences were observed in the C-peptide levels between the two groups. Conclusion: In the setting of two consecutive meals, IA reduces lipolysis and proinsulin secretion more effectively than HI.

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