Agency News and Notes

Modified insulin is most effective for controlling postmeal blood sugar levels

Premixed insulin analogues, a modified form of conventional premixed human insulin, are more effective than long-acting analogues for controlling high blood sugar levels after meals in patients with type 2 diabetes, according to a report funded by the Agency for Healthcare Research and Quality (AHRQ). Conventional premixed human insulin, however, appears to be equally as effective as premixed insulin analogues for lowering blood sugar levels when patients go 8 or more hours without eating, according to the report.

Type 2 diabetes accounts for more than 90 percent of diabetes. The number of Americans diagnosed with type 2 diabetes tripled from 5.6 million in 1980 to 15.8 million in 2005. Obesity increases the risks of developing type 2 diabetes. Diabetes can cause serious problems with the heart, kidneys, eyes, and nerves. Many patients with type 2 diabetes control their blood sugar through diet and use of oral medications. Recent research suggests that good blood glucose control can reduce loss of sight, kidney failure, and heart disease.

The new report was compiled by the Johns Hopkins University Evidence-based Practice Center in Baltimore, 1 of 14 such centers funded by AHRQ through its Effective Health Care program. The report represents a systematic review of 45 research studies and is intended to provide unbiased, evidence-based information so that patients, clinicians, and others can make the best possible treatment decisions. Premixed insulin analogues are a modified form of conventional premixed human insulin.

AHRQ's report compared premixed insulin analogues with conventional premixed human insulin, oral diabetes drugs, and two other kinds of insulin analogues—long-acting (or "basal") analogues, and rapid-acting (or "bolus") analogues. Although noninsulin oral medications are used as a first-line treatment for patients with type 2 diabetes, insulin is frequently required at some stage during the course of the disease. Under such circumstances, some patients are controlled with long-acting insulin alone while others need a combination of long-acting and rapid-acting insulins to control blood sugar levels after meals, especially meals with high sugar content.

The report, Comparative Effectiveness, Safety and Indications of Pre-mixed Insulin Analogues for Adults With Type 2 Diabetes, is available at http://effectivehealthcare.ahrq.gov.

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