Prospective audit of conversion from regular to lispro insulin during routine clinical care.
BACKGROUND
Randomized controlled trials show that lispro insulin has the potential to improve glycaemic control. Observational, practice-based studies provide information that is complementary to that obtained from randomized controlled trials and results of both types of studies are of relevance when advising patients of likely outcomes during routine clinical care.


OBJECTIVE
This prospective audit aimed to determine whether conversion from regular (short-acting, soluble) preprandial insulin to lispro during routine clinical care improved glycated haemoglobin.


METHODS
Eligible patients were those using regular insulin before main meals and a basal neutral protamine Hagedorn (NPH) insulin. Study group patients were those who chose to convert to lispro insulin. Patients who elected not to change their regimen were used as a comparison group. Follow up was for a minimum of 1 year.


RESULTS
Glycated haemoglobin (HbA(1c)) and body mass index showed no change in either the study or comparison groups. Post-hoc analysis revealed that the patients most likely to improve their HbA(1c) on lispro were those with a higher baseline HbA(1c). Patients using lispro reported a decreased frequency of hypoglycaemia and improved convenience of use.


CONCLUSIONS
Administration of lispro insulin was perceived by patients as convenient to use and was also associated with less hypoglycaemia when compared with the use of regular insulin. There was, however, no improvement in HbA(1c). This finding may be informative when advising patients during routine clinical care of the likely metabolic outcome of changing their insulin regimen.
Lunt
H
H
Diabetes Centre and Department of Medicine, Christchurch Hospital, Christchurch, New Zealand. helen.lunt@cdhb.govt.nz
Kendall
D
D
Moore
M P
MP
Scott
R S
RS
Cole
D
D
Frampton
C M
CM
Cullens
M
M
D015992:Body Mass Index; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007328:Insulin / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D061268:Insulin Lispro; D008485:Medical Audit; D011446:Prospective Studies
D006442:Glycated Hemoglobin; D007328:Insulin; D061268:Insulin Lispro