Ulrik Pedersen-Bjergaard et al. The Lancet Diabetes & Endocrinology. Doi: 10.1016/S2213-8587(14)70073-7
Despite most diabetes clinicians accepting the concept that insulin analogues are superior to traditional human insulin, payors have been less easy to convince due to the higher cost and lack of an evidence base in the populations in whom the analogues could be of most benefit. This study examines such a group; patients with type 1 diabetes and recurrent, severe hypoglycaemia. Patients were randomly assigned to basal-bolus therapy with either analogue insulin (detemir and aspart) or human insulin in a crossover design (they received one treatment regime and then the other). The primary endpoint was number of episodes of severe hypoglycaemia (need for third-party assistance). 136 episodes were reported with human insulin and 105 episodes with insulin analogues, a relative rate reduction of 29% (95% CI 11—48; p=0•010). This study confirms what most clinicians feel is a reasonable extrapolation of data from registration studies (which do not include this type of complex case). Analogue insulins can provide a more stable level of glycaemia which translates into less clinically relevant hypoglycaemia in real life.