One Insulin Injection Is Better Than Three, And Patients Agree

Editor's Choice
Main Category: Diabetes
Also Included In: Clinical Trials / Drug Trials;  Public Health
Article Date: 28 Mar 2008 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

A study published in The Lancet finds that a single daily injection of insulin (insulin glargine) is just as good at helping diabetes patients control blood sugar as an injection that must be administered up to three times a day (insulin lispro). Professor Reinhard G Bretzel (Justus-Liebig-Universität Giessen, Germany) and colleagues also note that insulin users are more satisfied with the insulin glargine than the insulin lispro.

Diabetes patients control blood sugar to avoid microvascular afflictions like retinopathy (non-inflammatory damage to the retina of the eye due to bloody supply problems) and macrovascular complications. To measure how well blood sugar is controlled, analysts measure the concentration of hemoglobin A1c in the blood. Patients who have concentrations less than 7% - or even better less than 6.5% - have a greatly reduced risk of complications. The blood sugar level is directly related to the concentration of hemoglobin A1c.

Bretzel and colleagues tested the effectiveness of the insulin glargine and the insulin lispro in a randomized controlled trial called the APOLLO study. The sample consisted of 418 patients with type 2 diabetes (or adult-onset diabetes) in 69 study sites across Europe and Australia. For all patients, oral hypoglycemic drugs had been unsuccessful in adequately controlling diabetes. Each participant was randomly assigned such that for 44 weeks, 205 individuals injected insulin glargine once daily at the same time every day and 210 individuals injected (205 individuals) injected insulin lispro three times per day.

At the end of 44 weeks, the researchers noted similar reductions in hemoglobin A1c. For participants in the insulin glargine group, the average decrease was -1.7% (from 8.7% to 7.0%). For those in the insulin lispro group, they average about a -1.9% decrease in hemoglobin (from 8.7% to 6.8%).

"A therapeutic regimen involving the addition of either basal or prandial insulin analogue is equally effective in lowering haemoglobin A1c. We conclude that insulin glargine provides a simple and effective option that is more satisfactory to patients than is lispro for early initiation of insulin therapy, since it was associated with a lower risk of hypoglycaemia, fewer injections, less blood glucose self monitoring, and greater patient satisfaction than was insulin lispro," conclude the authors.

Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycaemic agents (APOLLO): an open randomised controlled trial
R G Bretzel et al.
The Lancet 371(9618). March 28, 2008.

Click Here to View Journal Website

Written by: Peter M Crosta
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today