Review ArticleContinuous Subcutaneous Infusion of Insulin Lispro in Children and Adolescents with Type 1 Diabetes Mellitus
Section snippets
INTRODUCTION
Intensive management of diabetes delays the onset and progression of microvascular and cardiovascular complications associated with type 1 diabetes mellitus (1,2).
Rapid-acting insulin analogues, with a faster absorption rate, an earlier and higher peak insulin concentration, and a shorter duration of action than regular human insulin (3,4), have more physiologic pharmacokinetic, and pharmacodynamic profiles that may facilitate intensive management of diabetes. Humalog (insulin lispro injection,
Literature Search Criteria
Literature searches were conducted in PubMed using the search terms “pediatric,” “adolescent,” “insulin,” “pump,” “insulin infusion,” “continuous subcutaneous insulin infusion (CSII),” and “lispro” to identify relevant studies. Studies were also obtained from references included in individual articles and review articles. Only articles that specifically mentioned lispro as the insulin used and that evaluated CSII in a clinical setting of a primary pediatric or adolescent population (defined as
RESULTS
Twenty-six studies met final inclusion criteria: 10 were randomized controlled trials (8., 9., 10., 11., 12., 13., 14., 15., 16., 17.) (RCTs); 7 were prospective, nonrandomized studies (18., 19., 20., 21., 22., 23., 24.); and 9 were retrospective studies (25., 26., 27., 28., 29., 30., 31., 32., 33.). A total of 2521 patients were enrolled in these studies: 526 in RCTs, 471 in prospective studies, and 1524 in retrospective studies. Based on this enrollment, in an RCT setting, 220 pediatric
DISCUSSION
Insulin lispro administered via CSII, vs studied comparators, consistently demonstrated similar or improved efficacy and safety in children and adolescents with type 1 diabetes. This review encompassed multiple RCTs, including prospective and retrospective studies, with comparators including other rapid-acting insulin analogues, MDI therapy, and prepump therapy periods, with more than 2500 pediatric patients evaluated in a formal study setting and more than 1000 patients specifically receiving
CONCLUSION
Despite the study’s limitations, this clinical review of insulin lispro administered via CSII in pediatric and adolescent patients with type 1 diabetes demonstrates that CSII with insulin lispro compared with current alternatives provides similar or improved efficacy in conjunction with a similar or improved safety profile, as measured by incidence of severe hypoglycemia or DKA. As further therapeutic advancements in insulin formulations, insulin administration technologies, and monitoring
DISCLOSURE
Kevin Kaiserman, MD, is a paid consultant and speaker for Eli Lilly and Company and a paid consultant, researcher, and speaker for Medtronic. Henry Rodriguez, MD, is a paid consultant and speaker for Eli Lilly and Company. Amanda Stephenson, RN, and Jessie L. Fahrbach, MD, are full-time employees and minor stockholders of Lilly USA, LLC, and Eli Lilly and Company respectively. Linda Wolka, BS, MT(ASCP)SH, is a retired employee of Lilly USA, LLC.
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