Use of rapid-acting insulin analogues in the treatment of patients with type 1 and type 2 diabetes mellitus: insulin pump therapy versus multiple daily injections.

BACKGROUND: Replicating endogenous insulin production is the goal of treatment for diabetes mellitus (DM) and is necessary to minimize the risk of vascular complications. The 2 main methods of achieving this goal are continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDIs) comprising basal and prandial injections.

OBJECTIVE: The objective of this article was to discuss the use of a rapid-acting insulin analogue, insulin aspart, in CSII and MDI compared with other insulins in adult patients with type 1 or type 2 DM.

METHODS: This article was based on a presentation given by the author at a satellite symposium entitled "Realising the Value of Modern Insulins: Reaching Further with Rapid-Acting Insulin Analogues" that was convened during the XIXth World Diabetes Congress, December 3, 2006, in Cape Town, South Africa.

RESULTS: In patients with type 1 DM, CSII using the rapid-acting insulin analogue insulin aspart has been reported in clinical trials to improve glycemic control compared with MDI therapy using neutral protamine Hagedorn plus insulin aspart (for basal and mealtime coverage, respectively). In patients with type 2 DM, the CSII and MDI regimens offered similar efficacy and tolerability; CSII therapy may be less burdensome, however, with fewer social limitations than MDIs. Not all insulins are equally suited for use in CSII treatment. Although the efficacy of insulin aspart in CSII was comparable to other rapid-acting insulins, the frequency of hypoglycemia was shown to be significantly lower with insulin aspart compared with human insulin or insulin lispro in patients with type 1 DM. The compatibility of insulin aspart and insulin lispro for use in CSII pumps was compared in an 8-week, double-blind, 2-period, crossover study of patients with type 1 DM. The overall adverse-effect score was significantly lower (P<0.005) with insulin aspart than with insulin lispro, as were scores for pain/burning and inflammation (both, P<0.01) and dermal redness (P<0.001). Furthermore, a stability study reported on the suitability of insulin aspart for use in CSII pumps. Quality-of-life scores with CSII have been reported to be higher than with MDI therapy.

CONCLUSION: CSII with the rapid-acting insulin analogue insulin aspart is a viable choice for patients with type 1 or type 2 DM who want close-to-physiologic insulin treatment.