Comparative effects of insulin glulisine and lispro on postprandial plasma glucose and lipid profile in Japanese patient
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SHORT COMMUNICATION
Comparative effects of insulin glulisine and lispro on postprandial plasma glucose and lipid profile in Japanese patients with type 2 diabetes mellitus Mika Yamada1 · Jinya Suzuki1 · Takahiro Nakaya1 · Mai Ichikawa1 · Katsushi Yamamoto1 · Michiko Imagawa1 · Satsuki Sato1 · Miki Fujii1 · Yasuo Zenimaru1 · Tadashi Konoshita1 · Tamotsu Ishizuka1 Received: 5 August 2020 / Accepted: 25 October 2020 © The Japan Diabetes Society 2020
Abstract Objective The control of postprandial plasma glucose (PPG) excursions is critical in the prevention of diabetic complications. Controversy remains on the differences in postprandial actions of insulin glulisine and lispro. The aim of this study was to define the differences in the efficacy of these two insulin analogues on PPG. Methods The study subjects were 20 in-hospital patients with type 2 diabetes mellitus (T2DM). Plasma glucose (PG) was tightly controlled with basal insulin and insulin glulisine or lispro, and then glulisine or lispro were switched to the other insulin analog every other day for 6 study days. PG was measured before breakfast and 0.5-, 1-, and 2 h-postprandial during the study. Postprandial plasma C-peptide and lipids were analyzed in the first 2 days of the study. Postprandial increments in each parameter were compared between glulisine and lispro. Results Whereas the median value of 0.5 h-Δ-PPG was comparable in glulisine and lispro, the 1 h-Δ-PPG was significantly lower with lispro than with glulisine (41 vs 53 mg/dl, respectively, p = 0.03). Similarly, the 2 h-Δ-PPG with lispro was 10 mg/dl lower than that with glulisine (35 vs 45 mg/dl, respectively, p = 0.05). In parallel with PPG, Δ-C-peptide at 1- and 2 h-postprandial were significantly lower with lispro than glulisine (0.50 vs 0.75 ng/ml, respectively, and 0.55 vs 0.75 ng/ml, respectively). The increment in LDL-C and HDL-C was significantly lower with lispro than with glulisine at 0.5 h-postprandial. Conclusion Insulin lispro seems superior to glulisine in the control of PPG in Japanese patients with T2DM. Keywords Insulin analogue · Postprandial hyperglycemia · C-peptide · Apolipoproteins · Cardiovascular diseases
Introduction Cardiovascular diseases (CVD) is the most prevalent cause of mortality and morbidity in diabetic patients [1, 2]. Previous studies in Asian patients with type 2 diabetes mellitus (T2DM) demonstrated that 2 h-plasma glucose (PG) concentration on the 75 g oral glucose tolerance test correlates significantly with cardiovascular mortality [3]. Clinical evidence indicates that strict control of postprandial PG (PPG) is significantly effective in preventing CVD [4–7]. Postprandial hyperglycemia also correlates independently with the * Jinya Suzuki jinya@u‑fukui.ac.jp 1
Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui 910‑1193, Japan
incidence of diabetic retinopathy in Japanese patients with T2DM [8]. Other studies reported that glucose variability is associated with progression of retinopathy [9, 10]. Th
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