We've all heard the statistics: in 2007 the number of people in the U.S. diagnosed with diabetes (approx. 17.9 million) had more than doubled in the previous 15 years, and one quarter of the people who have this life-altering illness (approx. 5.7 million) had not even been diagnosed yet.
In a recently published study, groups of adults were tested to compare the effectiveness of premixed insulin analogues with another anti-diabetic medication.
Results indicated that premixed insulin analogues provide control of blood sugar similar to that of pre-mixed human insulin and "may" provide better control than long-acting insulin analogues and oral meds.
Children with Diabetes
Just like adults, children are also becoming more obese and less physically active. Consequently they, too, are starting to develop Type II Diabetes (T2DM). Because we are more aware of these statistics, T2DM is being more successfully treated through earlier diagnosis, tighter control of blood glucose readings (through oral medication and insulin advances), improved diets, improved cholesterol and blood pressure control, and knowledge of the importance of regular physical exercise.
Insulin Development
Insulin was first identified in the late 1920s. The first insulin available for use in diabetics was manufactured from cow and pig pancreases. By the 1980s, technology was advanced to the point where human insulin could be genetically manufactured in labs.
The most recent advances enable the insulin to be changed enough that it acts the same as human insulin; however, absorption time can be sped up or delayed through changes in chemical structure. This results in insulin analogues (i.e., insulin that is similar to human insulin but different).
Rapid-acting insulin analogues (e.g., Humalog, Novolog) can be taken 15 minutes prior to a meal, peak within 30-90 minutes, and last less than five hours. The short-acting human insulins (e.g., Humulin R, Novolin R) have to be taken 30-45 minutes prior to a meal, peak in two-four hours, and last six-eight hours.
Theoretically, the rapid-acting analogues mixed with long-acting analogues (pre-mixed insulin analogues) act more like the body's natural insulin production.
Insulin Analogue Effectiveness
In a press release dated September 15, 2008, the Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Dept. of Health and Human Services, summarized a review of 45 research studies. The purpose of the review (done at Johns Hopkins University) was to evaluate the effectiveness and safety of insulin analogues when compared to other anti-diabetic agents prescribed for T2DM. Conclusion: pre-mixed insulin analogues provide control of blood sugar similar to that of pre-mixed human insulin and "may" provide better control than long-acting insulin analogues and oral meds.
Pre-mixed insulin analogues were more likely to cause hypoglycemia (dangerously low blood sugar) when compared to oral meds and long-acting insulin analogues. Weight gain was another side effect that was studied, but results there were inconclusive. The rapid onset of the analogues did control after-meal blood sugars more effectively and allowed more flexibility in timing of meals.
However, the benefit of this was unclear since data on actual patient outcome is very limited. Studies showing long-term follow-up and real clinic results are needed.
For further information, refer to "Systematic Review: Comparative Effectiveness and Safety of Premixed Insulin Analogues in Type 2 Diabetes," Qayyum, R MD; Bolen, S MD MPH; Maruthur, N MD MHS; Feldman, L MD; Wilson, L ScM; Marinopoulos, S MD MBA; Ranasinghe, P MD MPH; Amer, M MD; Bass, E MD MPH; Annals of Internal Medicine, Oct 21, 2008, Volume 149, Issue 8.
