Comparative effects of insulin glulisine and lispro on postprandial plasma glucose and lipid profile in Japanese patients with type 2 diabetes mellitus

Abstract

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. 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 2h-postprandial during the study. Postprandial plasma C-peptide and lipids were analyzed in the first 2days of the study. Postprandial increments in each parameter were compared between glulisine and lispro. Whereas the median value of 0.5h-Δ-PPG was comparable in glulisine and lispro, the 1h-Δ-PPG was significantly lower with lispro than with glulisine (41 vs 53mg/dl, respectively, p = 0.03). Similarly, the 2h-Δ-PPG with lispro was 10mg/dl lower than that with glulisine (35 vs 45mg/dl, respectively, p = 0.05). In parallel with PPG, Δ-C-peptide at 1- and 2h-postprandial were significantly lower with lispro than glulisine (0.50 vs 0.75ng/ml, respectively, and 0.55 vs 0.75ng/ml, respectively). The increment in LDL-C and HDL-C was significantly lower with lispro than with glulisine at 0.5h-postprandial. Insulin lispro seems superior to glulisine in the control of PPG in Japanese patients with T2DM.