title: Glucose-lowering effect and glycaemic variability of insulin glargine, insulin detemir and insulin lispro protamine in people with type 1 diabetes.
abstract: OBJECTIVE
  To compare, using a continuous glucose monitoring (CGM) system, the effect on glycaemic variability of insulin glargine, detemir and lispro protamine.
  
  
  METHODS
  A total of 49 white people with type 1 diabetes, not well controlled by three times daily insulin lispro, taken for at least 2 months before study and on a stable dose, were enrolled. The study participants were randomized to add insulin glargine, detemir or lispro protamine, once daily, in the evening. We used a CGM system, the iPro Digital Recorder (Medtronic MiniMed, Northridge, CA, USA) for 1 week. Glycaemic control was assessed according to mean blood glucose values, the area under the glucose curve above 3.9 mmol/l (AUC(>3.9)) or above 10.0 mmol/l (AUC(>10.0)), and the percentage of time spent with glucose values >3.9 or >10.0 mmol/l. Intraday glycaemic variability was assessed using standard deviation (s.d.) values, the mean amplitude of glycaemic excursions and continuous overlapping of net glycaemic action. Day-to-day glycaemic variability was assessed using the mean of daily differences.
  
  
  RESULTS
  The s.d. was found to be significantly lower with insulin lispro protamine and glargine compared with insulin detemir. AUC(>3.9) was higher and AUC(>10.0) was lower with insulin lispro protamine and glargine compared with detemir. The mean amplitude of glycaemic excursions and continuous overlapping net glycaemic action values were lower with insulin lispro protamine and glargine compared with detemir. In addition, the mean of daily differences was significantly lower with insulin lispro protamine and glargine compared with detemir. Fewer hypoglycaemic events were recorded during the night-time with insulin lispro protamine compared with glargine and detemir.
  
  
  CONCLUSIONS
  The results suggest that insulin lispro protamine and glargine are more effective than detemir in reducing glycaemic variability and improving glycaemic control in people with type 1 diabetes. Insulin lispro protamine seems to lead to fewer hypoglycaemic events than other insulin regimens.
authors.affiliation: Department of Internal Medicine and Therapeutics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.|Centre for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy.
authors.forename: G
authors.identifier: http://orcid.org/0000-0003-3573-4760
authors.initials: G
authors.lastname: Derosa
authors.affiliation: Metabolic Unit, S. Antonio Abate Hospital, Gallarate, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Franzetti
authors.affiliation: Ospedale Pesenti Fenaroli, Alzano Lombardo, Bergamo, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Querci
authors.affiliation: Department of Internal Medicine and Therapeutics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Romano
authors.affiliation: Department of Internal Medicine and Therapeutics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: D'Angelo
authors.affiliation: Department of Internal Medicine and Therapeutics, Fondazione IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy.|PhD School in Experimental Medicine, University of Pavia, Pavia, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Maffioli
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D019540:Area Under Curve; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000069057:Insulin Detemir / Q000627:therapeutic use*; D000069036:Insulin Glargine / Q000627:therapeutic use*; D061268:Insulin Lispro / Q000627:therapeutic use*; D008297:Male; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D061268:Insulin Lispro; D000069036:Insulin Glargine; D000069057:Insulin Detemir
keywords: continuous glucose monitoring system; glycaemic variability; insulin detemir; insulin glargine; insulin lispro protamine