Use of the rapid acting insulin analogue lispro and its protamine retarded form (Humalog Mix 25) in a clinical setting

We conducted a retrospective clinical audit of clinical outcomes (effect on glycaemic control, weight and rates of hypoglycaemia) in patients who were switched from premixed conventional insulin therapy to a premixed, biphasic preparation of a rapid acting insulin analogue (viz Humalog Mix 25 [HM25]) for one of the following reasons: poor long‐term glycaemic control/occurrence of hypoglycaemic episodes/complaints of weight gain. Our aim was to analyse clinical outcomes in these patients after 12 months of such therapy. In total, 56 patients were identified over a 16‐month period. Clinical indications for the switch to HM25 were poor glycaemic control in 30, documented hypoglycaemic episodes in 19, and excessive weight gain while on insulin in two of these patients (the reason was not documented in the remaining five patients). The follow up was for 12‐months with outcomes compared at baseline (i.e. prior to the switch), at two to seven months and at eight to 12 months. After eight to 12 months of therapy, there was an improvement of 0.98% in the overall mean HbA1c levels and of 1.2% in patients with poor glycaemic control (10.3% vs 9.1%; p=0.03). In those switched for occurrence of hypoglycaemia, the proportion still experiencing episodes fell from 100% at baseline to 36% at the end of eight to 12 months with only four of the initial 19 (21.05%) continuing to report any related symptoms. When used in patients for certain specific problems, HM25 can improve long‐term glycaemic control and reduce the risk of hypoglycaemic episodes. Copyright © 2004 John Wiley & Sons, Ltd.