Biphasic insulin analogues vs. premixed human insulin — clinically significant differences. Diabetologist’s and cardiologist’s point of view

Abstract

The article presents two different points of view regarding clinical use of biphasic insulin analogues and premixed human insulin: diabetologist and cardiologist.
The common focus areas for both specialities are postprandial hyperglycaemia as a key factor responsible for macrovascular complications and hypoglycaemia and its potential influence on cardiovascular system.
The prandial insulin response is an independent risk factor for cardiovascular disease. Recent clinical studies have strengthened the evidence for a causal relationship between postprandial hyperglycaemic peaks and macrovascular disease. PPG is targeted as an important parameter in treatment strategy. In several studies use of biphasic insulin analogues resulted in better postprandial plasma glucose control than similar regimens of premixed human insulin. Severe hypoglycaemia can lead to serious CV events. Episodes of mild and severe hypoglycaemia deteriorate the prognosis in diabetic patients with cardiovascular disorders to the same extent as hyperglycaemia.
Biphasic insulin analogues therapy achieved better safety profile with the reduced number of major and nocturnal hypoglycaemic episodes compared to premixed human insulin.
The optimal treatment of type 2 diabetic patients, especially these with cardiovascular diseases, should concentrate on avoiding postprandial hyperglycaemia and concomitant rapid glycaemic excursions, especially hypoglycaemia. In both aspects biphasic insulin analogues show clinically significant advantages compared with premixed human insulin.
(Diabet. Prakt. 2011; 12, 2: 31–41)