Lispro insulin in people with non-alcoholic liver cirrhosis and type 2 diabetes mellitus. (March 2016) - Gentile, S.
Highlights: Glycemia and insulin dosage must be frequently monitored and adjusted in people with T2DM and CLD. By acting faster, lispro analog might reduce the risk of hypoglycemia and provide efficient liver signaling. A guideline is not available concerning insulin preparations for people with CLD and T2DM. For the first time we show that lispro regulates glucose better than regular insulin in people with CLD and T2DM. Abstract: Aims: To compare metabolic control under lispro and recombinant regular human insulin (RHI) in people with diet-unresponsive type 2 diabetes mellitus (T2DM) and compensated non-alcoholic liver disease (CLD). Methods: 108 people with T2DM and CLD were randomly allocated to RHI or lispro according to a 12 + 12 week cross-over protocol. A 1-week continuous glucose monitoring (CGM) session was performed at the end of each treatment period followed by a standard meal test with a 12 IU lispro or RHI shot ahead. Results: CGM showed higher glycemic excursions under RHI than under lispro ( p < 0.01) with lower glucose levels in the late post-absorption phase ( p < 0.05) and even more during the night ( p < 0.01). Post-challenge incremental areas under the curve (ΔAUC) were undistinguishable for insulin but lower for glucose, while insulin peaked higher and earlier and glycemic excursions were lower with lispro than with RHI (0.05 < p < 0.001). Conclusions: Lispro granted lower early postprandial glucose levels and late postprandial hypoglycemic rates and therefore might represent the treatment of choice for people with T2DM and compensated CLD. This might depend on its faster/shorter–living effects, as well as, on the lower liver glucose output expected from its earlier hepatic distribution.