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Management of Diabetes Mellitus

Defining the Role of Insulin Lispro Mix75/25 (Humalog® Mix75/25™)

  • Drugs in Disease Management
  • Published:
Disease Management and Health Outcomes

Abstract

Abstract

Diabetes mellitus is a common metabolic disorder characterized by high blood glucose levels resulting from an insulin deficiency (type 1 diabetes mellitus) or a combination of insulin deficiency and insulin resistance (type 2 diabetes mellitus). The chronic hyperglycemia associated with diabetes mellitus can cause damage to the eyes, kidneys, heart and peripheral circulation, resulting in substantial morbidity, premature mortality and considerable healthcare costs.

In both type 1 and type 2 diabetes mellitus, quality of glycemic control has been shown to be a major factor in the prevention of microvascular complications, and tight blood glucose control is the primary goal for all patients with diabetes mellitus.

In patients with type 1 diabetes mellitus, multiple daily injections of exogenous insulin and frequent monitoring of blood glucose levels are required to achieve tight glycemic control. Patients with type 2 diabetes mellitus may achieve initial glycemic control with diet and lifestyle interventions alone; however, a large percentage of patients will require pharmacological therapy, first with an oral antidiabetic agent and, ultimately, with insulin.

Premixed insulin formulations, consisting of fixed ratios of short- and intermediate-acting insulins, are a convenient and effective treatment option which account for ≈40% of insulin use worldwide. Until recently, the only premixed formulations available contained varying proportions of human regular insulin and human isophane insulin suspension (NPH). However, new premixed formulations containing insulin lispro (a rapid-acting insulin analog) and insulin lispro neutral protamine suspension (NPL) [an intermediate-acting insulin analog] are now available.

Insulin lispro mix75/25 (Humalog® Mix75/25™) is a premixed formulation containing 25% insulin lispro and 75% NPL which has been investigated for use in patients with type 1 and with type 2 diabetes mellitus. Administered twice daily immediately before breakfast and dinner, insulin lispro mix75/25 provides better control of postprandial blood glucose, provides similar overall glycemic control, appears to be preferred by patients and may reduce nocturnal hypoglycemia compared with a similar premixed formulation containing 30% human regular insulin and 70% NPH (human insulin 70/30; Humulin® 70/30, Novolin® 70/30). Insulin lispro mix75/25 has a rapid onset of action, allowing for administration immediately before a meal, whereas patients need to administer human insulin 70/30 30 to 60 minutes prior to meals. Insulin lispro mix75/25 also improves glycemic control in patients whose type 2 diabetes mellitus is not well controlled by oral agents.

Conclusion

Insulin lispro mix75/25 is suitable for patients wishing to use premixed insulin formulations and may offer several benefits over human insulin 70/30.

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  1. Adis International Limited, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, Auckland 10, New Zealand

    Christine R. Culy & Blair Jarvis

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  1. Christine R. Culy
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Correspondence to Christine R. Culy.

Additional information

Various sections of the manuscript reviewed by: A.J. Ahmann, Oregon Health & Science University, Portland, Oregan, USA; M.G. Cavallo, Istituto di Terapia Medica Sistematica, University of Rome La Sapienza, Rome, Italy; G. Dranitsaris, Department of Pharmaceutical Services, The University Health Network/Princess Margaret Hospital, Toronto, Ontario, Canada; A. Krentz, Department of Diabetes and Endocrinology, Southhampton General Hospital, Southhampton, UK; T.R. Pieber, Department of Internal Medicine, Karl-Franzens University, Graz, Austria; E. Torlone, Dipartimento di Medicina Interna e Scienze Endocrine e Metabolic, Universita di Perugia, Perugia, Italy.

Data Selection

Sources: Medical literature published in any language since 1980 on Humalog Mix25, identified using Medline, supplemented by AdisBase (a proprietary database of Adis International). Additional references were identified from the reference lists of published articles. Bibliographical information, including contributory unpublished data, was also requested from the company developing the drug.

Search strategy: AdisBase search terms were ‘diabetes-mellitus’ and (‘guideline’ or ‘guideline-utilisation’ or ‘practice-guideline’ or ‘disease management- programmes’ or ‘treatment-algorithms’ or ‘reviews-on-treatment’ or ‘drug-evaluations’ or ‘epidemiology’ or ‘cost-of-illness’ or ‘pathogenesis’), or ‘Humalog Mix25’ (insulin lispro and neutral protamine lispro) and (‘review’ or ‘clinical-study’). Medline search terms were ‘diabetes-mellitus’ and (‘guidelines’ or ‘decision-making’ or ‘health-policy’ or ‘managed-care-programmes’ or ‘epidemiology’ or ‘outcome-assessment- health-care’ or ‘clinical-protocols’ or ‘guideline in pt’ or ‘practice-guideline in pt’), or ‘Humalog Mix25’ and ‘review in pt’. Searches were last updated 18 September 2001

Selection: Studies in patients with diabetes who received insulin lispro/Humalog Mix25. Inclusion of studies was based mainly on the methods section of the trials. When available, large, well controlled trials with appropriate statistical methodology were preferred. Relevant pharmacodynamic, pharmacokinetic, pharmacoeconomic and epidemiological data are also included.

Index terms: diabetes mellitus, Humalog Mix25, disease management, review on treatment.

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Culy, C.R., Jarvis, B. Management of Diabetes Mellitus. Dis-Manage-Health-Outcomes 9, 711–730 (2001). https://doi.org/10.2165/00115677-200109120-00005

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