Insulin and glucose excursion following premeal insulin lispro or repaglinide in cystic fibrosis-related diabetes

Citation
A. Moran et al., Insulin and glucose excursion following premeal insulin lispro or repaglinide in cystic fibrosis-related diabetes, DIABET CARE, 24(10), 2001, pp. 1706-1710
Citations number
23
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Endocrynology, Metabolism & Nutrition","Endocrinology, Nutrition & Metabolism
Journal title
DIABETES CARE
ISSN journal
0149-5992 → ACNP
Volume
24
Issue
10
Year of publication
2001
Pages
1706 - 1710
Database
ISI
SICI code
0149-5992(200110)24:10<1706:IAGEFP>2.0.ZU;2-6
Abstract
OBJECTIVE - Insulin and glucose levels in response to premeal insulin lispr o or repaglinide were evaluated in adult patients with cystic fibrosis-rela ted diabetes (CFRD) without fasting hyperglycemia. RESEARCH DESIGN AND METHODS - Seven patients with CFRD were fed 1,000 kcal liquid mixed meals. Three study conditions were administered in random orde r on separate mornings: 1) no premeal diabetes medication, 2) insulin lispr o, 0.1 unit/kg body wt premeal and 3) repaglinide 1 mg, premeal. Glucose an d insulin levels were measured every 20 min for 5 h. RESULTS - Fasting insulin and glucose levels were normal in patients with C FRD, but the peak glucose level was elevated. Insulin lispro significantly decreased the peak glucose level (P = 0.0004) and the 2-h (P = 0.001) and 5 -h (P < 0.0001) glucose area under the curve (AUC). Repaglinide significant ly decreased the 5-h glucose AUC (P = 0.03). Neither drug completely normal ized cystic fibrosis glucose excursion at the doses used for this study. In sulin lispro significantly increased the 5-h insulin AUC (P = 0.04). CONCLUSIONS - In response to subcutaneous insulin lispro, postprandial gluc ose excursion was significantly diminished and insulin secretion was enhanc ed compared with a control meal in which no medication was given to patient s With CFRD. The oral agent repaglinide resulted in lesser corrections in t hese parameters. Neither drug completely normalized glucose or insulin leve ls, suggesting that the doses chosen for this study were suboptimal. Placeb o-controlled longitudinal studies comparing the effectiveness of repaglinid e and insulin on glucose metabolic control as well as overall nutrition and body weight are needed to help determine optimal medical treatment of CFRD .