Biphasic Insulin Aspart Compared to Biphasic Human Insulin Reduces Postprandial Hyperlipidemia in Patients with Type 2 Diabetes

Schmoelzer, I.; Campo, A. De; Pressl, Helga; Stelzl, H; Dittrich, P; Oettl, Karl; Wascher, Thomas C.

doi:10.1055/s-2005-837521

Cited by 25 publications

(19 citation statements)

References 20 publications

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“…55 A number of studies have assessed HbA1c levels in patients treated with premixed human insulins versus those treated with premixed insulin analogs, including premixed insulin lispro formulations [57][58][59] and insulin aspart formulations. [60][61][62] While one study showed small but significant improvements in HbA1c levels after treatment with 50/50 premixed insulin lispro relative to premixed human insulins, 57 other studies failed to find similar advantages favoring premixed insulin analogs. 58,60,62 Consistently, however, patients receiving premixed insulin analogs exhibited improved PPG control relative to premixed human insulins, reflecting the higher absorption rate of the analogs.…”

Section: Clinical Effects Of Insulin Analogs Hba1cmentioning

confidence: 99%

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Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Hartman

2008

Clinical Medicine & Research

115

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Despi te 85 years of research since Banting and Best's isolation of insulin-containing extracts, 1 diabetes still remains one of the most significant causes of morbidity and mortality in the world, and its global impact is likely to accelerate over the coming decades. 2,3 Much of the medical and economic consequences of diabetes are attributable to its associated microvascular and macrovascular complications. [4][5][6] Two classic large-scale clinical studies, the Diabetes Control and Complications Trial (DCCT) 6 and the UK Prospective Diabetes Study (UKPDS), 7 demonstrated that intensive blood-glucose control policies can decrease the frequency of complications, arguing that physicians and patients should strive to mimic, as closely as possible, the serum levels of insulin produced by a healthy person. Secretion of insulin by the pancreas, however, is under complex regulation that depends on the intake of nutrients, other gastrointestinal peptides (e.g., incretins), and overall metabolic levels (i.e., exercise versus rest). 8 These physiological variables, which pose real challenges to the accurate metabolic replacement of insulin, are further complicated by the fact that diabetes requires self-management and therefore depends on the psychology, motivation, and understanding of the patient. A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns.The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile.The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure.To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment.The long-act...

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Section: Clinical Effects Of Insulin Analogs Hba1cmentioning

confidence: 99%

“…58,60,62 Consistently, however, patients receiving premixed insulin analogs exhibited improved PPG control relative to premixed human insulins, reflecting the higher absorption rate of the analogs. [58][59][60][61][62] …”

Section: Clinical Effects Of Insulin Analogs Hba1cmentioning

confidence: 99%

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Hartman

2008

Clinical Medicine & Research

115

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“…However, there is more and more evidence that postprandial hyperglycemia is a risk factor in its own right. Endothelial dysfunction can be reversed by correction of postprandial glucose excursion by acarbose specifically controlling postprandial glucose excursion and rapid-acting insulin analogues [23]. Several studies have reported that acute hyperglycemia reduces the release of NO [23] probably mediated by free radicals [18].…”

Section: Effects On Endothelial Function and Vascular Wallmentioning

confidence: 99%

“…Endothelial dysfunction can be reversed by correction of postprandial glucose excursion by acarbose specifically controlling postprandial glucose excursion and rapid-acting insulin analogues [23]. Several studies have reported that acute hyperglycemia reduces the release of NO [23] probably mediated by free radicals [18]. Glucose intolerance was also associated with abnormalities in the fibrinolytic system [24].…”

Section: Effects On Endothelial Function and Vascular Wallmentioning

confidence: 99%

Prandial hyperglycemia: Is it important to track and treat?

Hanefeld¹,

Schäper²

2005

Curr Diab Rep

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Prandial hyperglycemia comprises 16 to 18 hours in type 2 diabetes. Depending on quality of diabetes control, 30% to 70% of the variance of hemoglobin A(1c) is determined by postprandial glucose excursions. A large amount of evidence now shows that postprandial/postchallenge glucose value is an independent cardiovascular risk factor, especially for coronary heart disease. Excessive postprandial hyperglycemia initiates a cascade of proatherogenic disturbances, which leads to endothelial dysfunction and plaque instability. Measurement of 2-hour postprandial glucose after big meals should be performed once or twice a week in subjects with type 2 diabetes. Measurement of 2-hour glucose after a 75-g oral glucose tolerance test is the only way to detect subjects with impaired glucose tolerance and isolated postchallenge hyperglycemia in the diagnosis for diabetes. a-Glucosidase inhibitors, glinides, and short-acting analogue insulin allow a well-tailored control of type 2 diabetes with excessive postprandial hyperglycemia. Prospective trials have demonstrated that strict control of postprandial hyperglycemia reduces the incidence of cardiovascular events.

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“…Randomized controlled trials have demonstrated the safety and efficacy of BIAsp 30 compared with other insulins (including insulin glargine, human insulin, biphasic insulin lispro, and premixed human insulin) [6][7][8][9][10] . Moreover, observational studies have confirmed and extended such findings and yielded safety and efficacy information in 'real world' patient groups which are more clinically and racially diverse 11,12 .…”

Section: Introductionmentioning

confidence: 99%

Systematic review of the cost-effectiveness of biphasic insulin aspart 30 in type 2 diabetes

Valentine¹,

Pollock²,

Plun-Favreau

et al. 2010

Current Medical Research and Opinion

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Biphasic Insulin Aspart Compared to Biphasic Human Insulin Reduces Postprandial Hyperlipidemia in Patients with Type 2 Diabetes

Abstract: Compared to conventional human premixed insulin the prandial therapy with biphasic insulin aspart results not only in an improvement of glucose tolerance but also in a significant reduction of postprandial hyperlipemia.

Cited by 25 publications

References 20 publications

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Prandial hyperglycemia: Is it important to track and treat?

Systematic review of the cost-effectiveness of biphasic insulin aspart 30 in type 2 diabetes

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