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Av. Diabetol. 2007;23(5):326-332

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The benefits of insulin analogues in intensive treatment of type 1 diabetes mellitus

Revisión - Vol.23 N.5  septiembre-octubre 2007
G.B. Bolli1

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Resumen

The modern goals of insulin replacement in type 1 diabetes mellitus are glycosylated haemoglobin (HbA1c) <7.0% and prevention of hypoglycaemia, as well as hypoglycaemia unawareness. In addition to appropriate education and motivation of diabetic subjects, the use of insulin analogues, both rapid- and long-acting, is critical to achieve the above goal more easily and safely, and with greater compliance on the part of diabetic subjects. The benefi ts of the rapid-acting analogues lispro, aspart and glulisine, which have superimposable pharmacodynamic effects, as compared to unmodifi ed human regular insulin are lower postprandial blood glucose, lower risk of postprandial hypoglycaemia, and better quality of life. However, rapid-acting analogues improve HbA1c only to the extent to which replacement of basal insulin is optimized by either multiple daily NPH insulin, continuous subcutaneous insulin infusion (CSII), or the long-acting insulin analogues glargine or detemir. The benefi ts of long-acting insulin analogues, as compared to the traditional NPH insulin, are lower risk of hypoglycaemia in the interprandial state, especially at night, and lower variability of blood glucose. When optimally combined, rapid- and long-acting insulin analogues are more effective in maintaining HbA1c <7.0% over the long term than human insulin, with less hypoglycaemia and better quality of life. This regimen based on insulin analogues is not inferior to CSII in terms of goals for HbA1c and prevention of hypoglycaemia.

Correspondencia

Correspondencia: Geremia B. Bolli. Department of Internal Medicine, Endocrinology and
Metabolism. University of Perugia. Via E. Dal Pozzo. 06126 Perugia (Italy).
E-mail: gbolli@unipg.it

Palabras clave

diabetes mellitus tipo 1 análogos de insulina hipoglucemia

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