Reduced Frequency of Severe Hypoglycemia and Coma in Well-Controlled IDDM Patients Treated With Insulin Lispro

Abstract

OBJECTIVE Several studies have suggested that use of the short-acting insulin analog, insulin lispro, in multiple injection therapy may reduce the risk of hypoglycemia in comparison with regular insulin. This effect might be more pronounced in well-controlled patients, since intensive treatment of IDDM increases the rate of severe hypoglycemic events. This study evaluated the effects of insulin lispro on glycemic control and hypoglycemia rates in well-controlled IDDM patients. RESEARCH DESIGN AND METHODS This was an open, randomized, 6-month crossover study of 199 IDDM patients. Glycemic control was evaluated by HbA1c, home blood glucose measurements, and rate and timing of hypoglycemic events. At the end of the study, patients completed an evaluation form regarding therapy-related quality of life. RESULTS HbA1c remained constant at ∼ 7.3% throughout the study. Meal-related glucose excursions were significantly lower with insulin lispro compared with regular insulin (mean −0.8 ± 1.7 vs. 1.1 ± 1.6 mmol/l, P < 0.001), as was the within-day variability (M value 27.7 ± 19.7 vs. 30.2 ± 23.1, P = 0.007). The incidence of severe hypoglycemic events (58 vs. 36, P = 0.037) including coma (16 vs. 3, P = 0.004) was significantly lower with insulin lispro than with regular insulin. Patients felt that insulin lispro increased flexibility and freedom of lifestyle. CONCLUSIONS In well-controlled IDDM patients, insulin lispro is associated with a lower risk of severe hypoglycemia and coma.