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Glulisine provided better in-hospital glycemic control vs. regular insulin
Meyer C. Diabetes Care. 2010;33:2496-2501.
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Hospitalized patients with type 2 diabetes, especially those who have a prolonged length of stay, experienced better glycemic control with glulisine as compared with regular insulin, according to results of a randomized, double blind study.
Researchers compared the efficacy and safety of the different insulin regimens in 180 patients with type 2 diabetes who were admitted to the noncritical care medical or surgical units at Carl T. Hayden VA Medical Center in Phoenix. Patients were randomly assigned to premeal rapid-acting insulin analog glulisine (Apidra, Sanofi Aventis; n=88) or regular insulin (Novolin R, Novo Nordisk; n=92) in combination with bedtime insulin glargine (Lantus, Sanofi Aventis). Doses were adjusted to avoid hypoglycemia while obtaining a target blood glucose concentration of 130 mg/dL before meals and at bedtime. All prior diabetes medications were also discontinued.
Patients assigned to glulisine had mean blood glucose concentrations that were about 8 mg/dL lower compared with regular insulin (152.6 mg/dL vs. 160.4 mg/dL; P<.0002). According to the researchers, this improvement in blood glucose concentrations was due to 22 mg/dL lower levels after 4 days (140 mg/dL vs. 162 mg/dL; P<.0007). This improvement continued after day 4, and data showed that concentrations were 31 mg/dL lower from day 7 onward among patients assigned to glulisine.
The target blood glucose level of 130 mg/dL before meals after day 4 of treatment was achieved in 48% of patients assigned to glulisine vs. 38% assigned to regular insulin (P<.0003). In addition, 66% of all blood glucose readings were 90 mg/dL to 180 mg/dL in the glulisine group compared with 54% in the regular insulin group (P<.0001).
Regarding the safety of glulisine, the mean daily incidence of hypoglycemia was slightly lower as compared with regular insulin (0.10 episodes per day vs. 0.14 episodes per day; P>.35). However, this finding was not statistically significant.
“Further studies are needed to examine whether these results can be generalized to other populations and hospital settings, and whether the benefits of glulisine persevere with the usual standard of care for glycemic control,” the researchers concluded.
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