Submitted to: Diabetes Care
Publication Type: Peer reviewed journal
Publication Acceptance Date: 7/30/2004
Publication Date: 12/1/2004
Citation: Kaplan, W., Rodriguez, L.M., Smith, O.E., Haymond, M., Heptulla, R.A. 2004. Effects of mixing glargine and short-acting insulin analogs on glucose control. Diabetes Care. 27:2739-2740. Interpretive Summary: This study provides preliminary data that mixing glargin with lispro or aspart insulin in the same syringe and dividing the dose of largine does not adversely affect glucose concentrations. Lower nocturnal blood glucose concentrations in study mixed versus study separate and basal, although not statistically significant, should alert physicians that the evening dose of lantus may need to be titrated to prevent hypoglycemia. No serious adverse events occurred during the study. Although the mixtures turned cloudy, no complaints of increased pain or injection difficulties were reported. Long-term effects of mixing glargine and SAIs on HbA1c were not assessed in this study. In conclusion, our data suggest that mixing glargine with SAIs or twice-daily dosing does not affect short-term glycemic profile. Further studies are needed to evaluate long-term effects of these regimens.
Technical Abstract: Intensive insulin management improves glycemic control and lowers the risks of long-term microvascular complications. Several new insulin analogs are in use to improve glycemic control in type 1 diabetes. Glargine in particular is a "basal insulin" and found to be relatively peakless. Glargine is thought to provide glucose profiles similar to insulin pumps. Although some clinical studies suggest that glargine lasts 24 h in children with diabetes, to date there have been no formal pharmacokinetic and pharmacodynamic data to make that claim in the pediatric population. In fact, clinical observations in pediatric type 1 diabetes suggest that glargine action may be <24 h. This would entail twice-daily glargine dosing and short-acting insulin analogs (SAIs), such as lispro and aspart, given separately three to four times per day, resulting in improved glycemic control but compromising compliance and increasing complexity of management. In this study, we tested the hypothesis that mixing glargine with SAIs and dividing the dose of glargine into twice- versus once-daily dosing would not adversely affect glycemic control as assessed by a continuous glucose monitoring system (CGMS).