PMID- 21680984
OWN - NLM
STAT- MEDLINE
DCOM- 20110824
LR  - 20181201
IS  - 1941-9260 (Electronic)
IS  - 0032-5481 (Linking)
VI  - 123
IP  - 4
DP  - 2011 Jul
TI  - Iatrogenic hypoglycemia in patients with type 2 diabetes: comparison of insulin 
      analog premixes and human insulin premixes.
PG  - 7-16
LID - 10.3810/pgm.2011.07.2299 [doi]
AB  - Severe iatrogenic--or therapy-induced--hypoglycemia has been associated with 
      mortality rates as high as 10% in patients with type 2 diabetes mellitus (T2DM), 
      and is therefore one of the most significant barriers to glucose management in 
      this patient population. Therapy with modern insulin analogs has been shown to 
      cause significantly less hypoglycemic episodes than human insulins in basal-bolus 
      regimens. This systematic review examines whether a similar benefit has been 
      observed with the insulin analog premixes (aspart 70/30, lispro 75/25, or lispro 
      50/50) relative to human insulin premix (human 70/30). Consistent with a prior 
      meta-analysis, the results presented here reconfirm that overall hypoglycemia 
      risk is similar after treatment with either an analog premix or a human premix in 
      many populations of patients with T2DM. However, several studies found a benefit 
      for the analog premixes in a subset of patients who were under more challenging 
      glucometabolic conditions, in particular those later in disease progression or 
      those undergoing post-injection exercise. Pharmacokinetic and pharmacodynamic 
      studies indicate that this may occur because a larger proportion of total analog 
      premix activity is absorbed and utilized during the immediate postprandial 
      period, when it is most acutely needed, compared with human premixes. 
      Consequently, with analog premixes, less insulin activity is available during the 
      inter-meal fasting period, when hypoglycemia is most likely to occur. Given the 
      clinical significance of iatrogenic hypoglycemia, these potential hypoglycemic 
      benefits of analog premixes relative to human premixes in some patients with T2DM 
      may need to be factored into the therapeutic decision-making process.
FAU - Martorella, Andrew J
AU  - Martorella AJ
AD  - New York-Presbyterian/Weill Cornell Medical Center, Manhattan Endocrinology, 
      PLLC, New York, NY 10065, USA. md212@verizon.net
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - England
TA  - Postgrad Med
JT  - Postgraduate medicine
JID - 0401147
RN  - 0 (Insulin)
RN  - 0 (Insulin Lispro)
RN  - D933668QVX (Insulin Aspart)
SB  - IM
MH  - Clinical Trials as Topic
MH  - Diabetes Mellitus, Type 2/blood/*drug therapy
MH  - Humans
MH  - Hypoglycemia/*chemically induced
MH  - Insulin/administration & dosage/adverse effects/*analogs & 
      derivatives/pharmacokinetics/therapeutic use
MH  - Insulin Aspart
MH  - Insulin Lispro
EDAT- 2011/06/18 06:00
MHDA- 2011/08/25 06:00
CRDT- 2011/06/18 06:00
PHST- 2011/06/18 06:00 [entrez]
PHST- 2011/06/18 06:00 [pubmed]
PHST- 2011/08/25 06:00 [medline]
AID - 10.3810/pgm.2011.07.2299 [doi]
PST - ppublish
SO  - Postgrad Med. 2011 Jul;123(4):7-16. doi: 10.3810/pgm.2011.07.2299.