jueves, 26 de febrero de 2009

Analogues of insulin versus human insulin.

An interesting meta-analysis published by the CMAJ of February helps us to understand the role of insulin analogues on the management of diabetes mellitus.

What was known about the issue?

The novel insulin analogues (lispro, aspart, glardine) obtained by genetic engineering have been proposed as advanced substitution of classical insulin (NPH, regular).

There are some clinical trials that show some advantages of the analogues when compared with the human insulin, specially for the prevention of hypoglicemias.

What does this article add?

After performing a meta-analysis of all the available studies, the authors concluded that:

- the quality of the trials is low, with a big disparity in the results.
- the insulin analogues provide a better control of glycemic-hemoglobin but with a scarce magnitude, non clinically relevant (although statistically significant): -0,09% in diabetes type I and non-significant in type II.
- the analogues of insuline seem to produce less hypoglicemias for some subgroup of patients, but this finding is not consistent for all the groups.

Which importance has this publication for a family medicine resident?

The use of insuline analogues is being promoted by the industry. However there are not strong evidences that support the generalized use of those analogues, as far as similar glycemic controls are reached with classical insulins and the risk of hypoglicemia is minimal if a diabetic education program is provided.

The analogues can be selected as a second line therapy for patients with a high risk of hypoglicemia or those patients for whom the administration way of the analogues is more convenient in terms of quality of life.

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