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Long-acting insulin takes about one hour to begin lowering blood sugar levels and lasts up to 26 hours, while intermediate-acting insulin takes one to three hours to begin lowering blood sugar levels and lasts up to 16 hours.
However, while the current study found in favor of long-acting insulin formulations, "larger head-to-head studies comparing the long-acting insulins available will be helpful for physicians to make the best patient-management decisions," said Mezitis, an endocrinologist at Lenox Hill Hospital in New York City.
In the new review, researchers led by Dr. Andrea Tricco of St. Michael's Hospital in Toronto analyzed data from 39 studies. The studies compared once- and twice-daily doses of the long-acting and intermediate-acting insulin and concluded that the long-acting version was safer and more effective.
"In patients with type 1 diabetes, we found that long-acting insulin is superior to intermediate-acting insulin when it came to controlling blood sugar, preventing weight gain and treating severe hypoglycemia," Tricco said in a hospital news release.
Compared to intermediate-acting insulin, long-acting insulin significantly improved hemoglobin A1C levels, a standard blood test measure of blood sugar control.
"Those taking intermediate-acting insulin were more likely to gain weight," said Tricco, who is assistant professor in the University of Toronto's School of Public Health. "They gained an average of four to six pounds more than the participants who took most long-acting insulin doses."
The researchers also found that people with type 1 diabetes who took long-acting insulin were 38 percent less likely to develop extremely low blood sugar (severe hypoglycemia) than those who took intermediate-acting insulin.
"With this information, patients and their doctors should tailor their choice of insulin according to preference, cost and accessibility," Tricco said in the news release.
Mezitis believes that "the practicing physician should consider this data when tailoring an effective insulin regimen for a type 1 diabetic patient." He added that certain brands of long-acting insulin also deliver the medication via a pen, which is more user-friendly for patients.
Another expert in type 1 diabetes said she wasn't surprised by the Toronto team's findings.
"The conclusions posed by the authors echoes what happens in the real world in the U.S.," said Virginia Peragallo-Dittko, a registered nurse and executive director of the Diabetes and Obesity Institute at Winthrop-University Hospital in Mineola, N.Y.
"Providers match the insulin choice to the patient's needs," she explained. "Those needs include the insulin action that best matches the patient's blood glucose patterns, lifestyle considerations -- including number of injections required and the choice of insulin pen versus syringe -- plus financial considerations including insurance reimbursement, co-pays or out-of-pocket expense."
The findings were published Oct. 1 in the BMJ.
-- E.J. Mundell
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