Comparison of Rapid-Acting Insulin Analogues in Basal-Bolus Insulin Therapy for Type 2 Diabetes Using Continuous Glucose Monitoring

Abstract

We investigated the effects of ultra-rapid acting insulin (URI). Thirty patients with type 2 diabetes were randomly classified into 3 groups. Upon admission during study period, the preprandial and bedtime glucose levels (PBGLs) were stabilized at 80-89 mg/dL by basal-bolus insulin therapy. Group 1: The PBGLs were stabilized. Then, the same dose of glulisine was administered. Next, patients wore a flash glucose monitoring device (FGM), and glycemic variability (GV) was evaluated on days 3 and 4; glulisine was switched to lispro (at the same dose) on day 5, and the GV was evaluated on days 8 and 9. Lispro was switched to aspart (at the same dose) on day 10, and the GV was evaluated on days 13 and 14. Following the same regimen, URI was administered in the order of lispro, aspart, and glulisine in Group 2 and aspart, glulisine, and lispro in Group 3. The highest postprandial GL, postprandial glucose gradient, coefficient of variation and area over the curve of glucose (<70 mg/dL) were all significantly lower in the patients who received glulisine, lispro, and aspart-in that order. Glulisine may be the most effective insulin analogues for reducing GV.