Insulin glargine versus NPH insulin in patients with type 1 diabetes.

摘要

Type 1 diabetes is associated with a number of diabetes-related complications which may be minimized by maintaining good long-term metabolic control. The current guidelines recommend that glycosylated hemoglobin levels should be targeted to below 7.0% or 6.5% to reduce the incidence of diabetic complications, including micro- and macrovascular disorders. However, this intensive metabolic control is hindered by the occurrence of hypoglycemia. The episodes of hypoglycemia are problematic for patients taking intermediate-acting insulin preparations (i.e., NPH insulin), which have traditionally formed the mainstay basal insulin treatment. With NPH insulin, the pharmacokinetic profile is such that peak insulin activity occurs 4-6 hours following administration; therefore, nocturnal hypoglycemia commonly takes place after bedtime administration of the insulin. The development of the long-acting human insulin analogue insulin glargine now provides patients with an insulin that offers a longer duration of action (up to 24 hours) and a smoother time-action profile compared with those of NPH insulin. A number of clinical trials comparing the safety and efficacy of insulin glargine and NPH insulin in patients with type 1 diabetes show that, in addition to other clinical benefits over NPH insulin, insulin glargine may also improve glycemic control and satisfaction in this patient population. (c) 2003 Prous Science. All rights reserved.