Effects of a short-acting insulin analog (insulin Lispro) versus regular insulin on lipid metabolism in insulin-dependent diabetes mellitus

• Published in: Metabolism, clinical and experimental Vol. 47; no. 4; pp. 371 - 376
• Main Authors: Caixàs, Assumpta, Pérez, Antonio, Payés, Amalia, Otal, Carles, Carreras, Gemma, Ordóñez-Llanos, Jordi, Reviriego, Jesús, Anderson, James H., de Leiva, Alberto
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-1998; Elsevier
• Subjects: Adult; Biological and medical sciences; Cross-Over Studies; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Fasting - blood; Female; Heparin - pharmacology; Hormones. Endocrine system; Humans; Hypoglycemic Agents - therapeutic use; Insulin - analogs & derivatives; Insulin - therapeutic use; Insulin Lispro; Lipids - blood; Lipolysis - drug effects; Lipoproteins, VLDL - blood; Male; Medical sciences; Pharmacology. Drug treatments; Postprandial Period; Europe; Spain; Endocrinopathy; Pancreatic hormone; Replacement therapy; Cholesterolemia; Autoimmune disease; Esterases; Lipoprotein lipase; Blood plasma; Assay; Insulin lispro; Protein hormone; Hypoglycemic agent; Hemoglobin A1c; Adult; Triglyceridemia; Human; Immunopathology; Enzyme; Treatment efficiency; Insulin; Carboxylic ester hydrolases; Chemotherapy; Analog; Insulin dependent diabetes; Hydrolases; Comparative study
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/S0026-0495(98)90045-2

Insulin Lispro (IL) is a short-acting insulin analog that better reproduces the physiological postprandial insulin profile. The aim of this study was to compare the effects of intensive insulin therapy on lipid metabolism using preprandial IL and regular insulin (RI) in 10 insulin-dependent diabetes mellitus (IDDM) subjects. The mean hemoglobin A
1c (HbA
1c) at baseline was 7.13% ± 1.2% and did not change after both treatments. In IDDM patients, total cholesterol and triglyceride levels appeared lower after RI than after IL. The low-density lipoprotein (LDL) to high-density lipoprotein (HDL) ratio significantly decreased only after RI (baseline, 2.01 ± 0.6; IL, 1.88 ± 0.6; RI, 1.71 ± 0.5,
P < .05). Although no very—low-density lipoprotein (VLDL) composition abnormalities were observed at baseline, the protein content was lower (
P < .05) after IL (8.13% ± 2.93%) than after RI (11.93% ± 3.41%). Intermediate-density lipoprotein (IDL) protein depletion at baseline (6.14% ± 6.84%) was normalized after both treatments (IL, 11.09% ± 12.14%; RI, 10.38% ± 16.68%,
P < .05). LDL, HDL, HDL
2, and HDL
3 composition abnormalities were similar after both treatments and did not normalize. IDDM and control subjects showed similar LDL subtraction distribution at baseline and after both treatments. Two-hour postprandial VLDL composition alterations, although improved after RI, completely normalized after IL (
P < .05). Lipoprotein lipase (LPL) and cholesteryl ester transfer protein (CETP) activities were similar to the control group and did not change after both treatments. Hepatic lipase (HL) activity was lower in diabetic patients (39.6 ± 35.2
v 87.0 ± 27.1 U/L,
P < .01) and remained lower after both treatments. In conclusion, in IDDM patients, IL (injected immediately before the meal) may offer small different effects on lipoprotein metabolism versus RI (injected 30 minutes before the meal) that, taken together, do not seem relevant.