Researchers have revealed that the benefits of the long-acting insulin analog "glargine" in reducing episodes of hypoglycemia in diabetic patients in resource-limited countries may not appear until a year after starting treatment
This adds new data to the debate about the feasibility of using modern insulin analogs compared to traditional human insulin in these environments.
The study, conducted by researchers from the University of Pittsburgh, included 400 children and young adults aged 7 to 25 with type 1 diabetes in Bangladesh and Tanzania, with the aim of comparing the effectiveness of conventional human insulin with the long-acting insulin analog "glargine".
The results showed that after six months of treatment, there were no differences between the two groups in the two main study outcomes: the time patients spent within the target range for blood sugar levels, and the time they spent in the range of severe hypoglycemia.
However, the picture changed after 12 months, as the duration and number of severe hypoglycemic episodes decreased in patients who received glargine compared to those who received conventional treatment. Conversely, the study did not find statistically significant differences between the two groups in glycated hemoglobin (HbA1c) levels, rates of diabetic ketoacidosis, or episodes of severe or symptomatic hypoglycemia.
The use of glargine has also been associated with a reduction in the total daily insulin dose and the number of daily injections, benefits that may ease the burden on patients and their families, as well as reduce the pressure on health systems.
Dr. Jing Lu, associate professor of medicine at the University of Pittsburgh and lead author of the study, said the question is not just whether newer insulins are better than older ones, but whether the benefits they provide justify their higher cost when making drug purchasing decisions and setting treatment guidelines in resource-limited countries.
These findings are particularly important given the continuing global disparities in access to type 1 diabetes treatments. According to the researchers, an estimated 9.5 million people worldwide have the disease, with approximately 3.2 million of them relying solely on conventional human insulin. The majority of these individuals live in low- and middle-income countries, where the high cost and limited availability of modern insulin analogs remain significant obstacles to their widespread use.
Although the World Health Organization included long-acting insulin analogs, such as glargine, in its Model List of Essential Medicines in 2021, researchers believe that further studies are needed to understand the effects of switching from conventional human insulin to insulin analogs on long-term blood sugar control in resource-limited settings.
The study was published in the journal "The Lancet Diabetes & Endocrinology".
