Efficacy of a continuous GLP-1 infusion compared with a structured insulin infusion protocol to reach normoglycemia in nonfasted type 2 diabetic patients: a clinical pilot trial.

Abstract

Continuously administered insulin is limited by the need for frequent blood glucose measurements, dose adjustments, and risk of hypoglycemia. Regimens based on glucagon-like peptide 1 (GLP-1) could represent a less complicated treatment alternative. This alternative might be advantageous in hyperglycemic patients hospitalized for acute critical illnesses, who benefit from near normoglycemic control. In a prospective open randomized crossover trial, we investigated eight clinically stable type 2 diabetic patients during intravenous insulin or GLP-1 regimens to normalize blood glucose after a standardized breakfast. The time to reach a plasma glucose below 115 mg/dl was significantly shorter during GLP-1 administration (252 +/- 51 vs. 321 +/- 43 min, P < 0.01). Maximum glycemia (312 +/- 51 vs. 254 +/- 48 mg/dl, P < 0.01) and glycemia after 2 h (271 +/- 51 vs. 168 +/- 48 mg/dl, P = 0.012) and after 4 h (155 +/- 51 vs. 116 +/- 27 mg/dl, P = 0.02) were significantly lower during GLP-1 administration. GLP-1 infusion is superior to an established insulin infusion regimen with regard to effectiveness and practicability.