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Postprandial Insulin Lispro Is Effective But May Impair Long-Term Glycaemic Control

Administering insulin lispro postprandially appears to be a useful strategy for patients with an unpredictable eating schedule, although for continuous long-term use, the risk of poorer glycaemic control may need to be considered.

Postprandial insulin administration allows adjustment of the insulin dose according to the calories actually ingested. Therefore, this may be a useful strategy for some patients with unpredictable schedules, such as children, frequent travellers, or those with decreased gastric emptying rate.

Guntram Schernthaner, MD, with the Department of Internal Medicine, at the Rudolfstitung Hospital, in Vienna, Austria, and colleagues conducted a 6-month, crossover study comparing the metabolic effects of routine use of preprandial versus postprandial injection of bolus insulin lispro.

Thirty-one patients with type 1 diabetes injected insulin lispro either preprandially or postprandially for a 3-month period. They then switched and to the alternate regimen for a further 3 months. The researchers measured glycosylated haemoglobin (HbA1c), fructosamine, and 8-point self-determined blood glucose profiles.

With preprandial insulin lispro, mean HbA1c decreased slightly from baseline whereas it increased slightly with postprandial administration, and this resulted in a significant difference in final HbA1c level (P = .008).

Mean fructosamine also decreased slightly with preprandial insulin lispro but was almost unchanged with postprandial insulin. Overall daily blood glucose was similar between the two treatments (P = .312). However, mean preprandial glucose was lower (P = .026), whereas mean postprandial glucose was higher (P = .031) with postprandial insulin lispro administration.

In addition, mean blood glucose excursions were higher with postprandial compared with preprandial insulin lispro, indicating greater daily fluctuations. No difference in incidence of hypoglycaemia was observed with the two treatment regimens, however.

The researchers conclude that postprandial administration of insulin lispro "appears to be an acceptable treatment regimen since it adequately controls blood glucose."

However, they point out that "the daily fluctuations appear to be increased and this could result in increasing HbA1c levels with continuous postprandial administration for long periods. Therefore, HbA1c should continue to be monitored and the benefits of postprandial administration may have to be balanced against less beneficial glycaemic control," they suggest.



Diabet Med 2004 Mar;21:3:279-84. "Preprandial vs. postprandial insulin lispro-a comparative crossover trial in patients with Type 1 diabetes"

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