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Abstract
Purpose. To review the literature examining the mixing of insulin glargine with rapid-acting insulin (RAI).
Methods. A literature search was conducted via PubMed and Medline (from 1948 to August 2012) using the search terms "diabetes," "insulin glargine," "short acting insulin," "rapid acting insulin," and "mixing." Literature was limited to English-language articles reporting on human studies. Studies with data describing mixing glargine with any short-acting insulin or RAI were included. Four studies met inclusion criteria.
Results. Of the four studies assessing mixing glargine, one was a pharmacokinetic study. The other three assessed clinical outcomes in "real-world" settings. All of these studies were conducted in pediatric patients with type 1 diabetes.
Two of the clinical outcomes studies did not report significant differences in A1C levels or preprandial, postprandial, or nocturnal blood glucose levels from mixing glargine and RAI. One of the clinical outcome studies reported improved blood glucose control (A1C and fasting blood glucose) with RAI mixed with glargine compared to RAI mixed with NPH insulin. There were no significant differences in hypoglycemia in any of the clinical outcome trials at any time measured.
Conclusion. Initial small clinical trials indicate that there are no significant changes in clinical outcomes (blood glucose levels, A1C levels, and hypoglycemia) when mixing glargine with RAI. Additional studies with larger patient populations and longer trial durations are needed before mixing glargine with RAI can be recommended on a routine basis in clinical practice.
Type 1 diabetes accounts for about 5-10% of patients with diabetes; however, 75% of patients diagnosed with type 1 diabetes are < 18 years of age.1 The benefits of intense insulin therapy to lower A1C and prevent diabetes-related complications are well documented.
Insulin glargine, the first once-daily basal insulin approved by the U.S. Food and Drug Administration (FDA), is used in regimens to treat patients with type 1 or type 2 diabetes.2 The clear, colorless solution of glargine is buffered to a pH of 4 and is completely soluble at this level. After injection, a microprecipitate forms at the injection site that delays and prolongs glargine's action. The FDA warns against mixing glargine with other insulins because of its pH and solubility.2 Therefore, basal-bolus therapy with glargine increases the number of daily injections compared to regimens using...