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
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
.