Association between hypoglycemia and the type of insulin in diabetic patients treated with multiple injections: an observational study

INTRODUCTION Hypoglycemia may have serious health consequences; therefore, it is important to expand knowledge on the factors that increase its prevalence.
OBJECTIVES The aim of the study was to evaluate the effect of the type of insulin—human vs. analogue—on the incidence of mild and severe hypoglycemia, body weight, and hemoglobin A1c (HbA1c) levels. 
PATIENTS AND METHODS A total of 203 diabetic patients treated with intensive insulin therapy completed the questionnaire on hypoglycemia at baseline and at 3 and 6 months of the follow‑up. Body weight and HbA1c levels were measured at baseline and at 6 months. Incidence of mild and severe hypoglycemia, body weight, and HbA1c levels were compared between patients treated with short‑acting analogue and those treated with short‑acting human insulin (regardless of the type of long‑acting insulin used) and between patients receiving short- and long‑acting analogue insulin and those receiving short- and long‑acting human insulin. A multiple logistic regression analysis was used to find independent risk factors of severe hypoglycemia.
RESULTS At baseline, mild hypoglycemia was more common in patients receiving insulin analogue. There were no differences between the subgroups in the incidence of severe hypoglycemia, HbA1c levels, and body weight. Male sex, older age, and the dose of long‑acting insulin were independently associated with a higher incidence of severe hypoglycemia. Type 2 diabetes and higher body weight were associated with a lower risk of severe hypoglycemia. 
CONCLUSIONS Our results suggest that use of insulin analogues may predispose to more frequent episodes of mild hypoglycemia, but it does not increase the incidence of severe hypoglycemia in patients on intensive insulin therapy. Insulin analogues are not different from human insulin in terms of the effects on HbA1c levels and body mass.