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June 14, 2004

Insulin Analogs

Question from Kabala Kolokotroni, Greece:

Professor Chantelau from the University of Dusseldorf maintains that Lantus and some other insulin analogs, such as Humalog, are suspicious of carcinogenic potential and retinitis. How reliable is it? My eight year old son has been using Lantus since October 2003 and he is very well regulated. I wonder if it wwould be better to stop Lantus and return to his old classic insulins, Protophane mixed with Actrapid, with which he had many highs and lows. Before the use of Lantus, his A1c was 7 and now is 6. Please help me to take the right decision.

Answer:

In my experience, there is no such evidence. I am now treating about 40 patients (aged 2-18 years) with this long-acting insulin analog with a stable profile of action. The first patients began to use glargine at the end of 2001, just after its release, so it has been awhile that some of they are using it, without any problems or inconvenience.

After reviewing the peer-reviewed publications on Medline, insulin glargine appears to be a well-tolerated and safe basal insulin preparation for patients with type 1 or type 2 diabetes, including pediatric patients. In the only study that addressed the evaluation of the carcinogenic potential of insulin glargine, that I find, is a reference to this in rats and mice and was published in 2002 by the Aventis Company, the manufacturer. They concluded that in mice, there was no difference in the incidence of mammary tumors reported in both mice and rats when comparing the insulin glargine groups with the NaCl, vehicle-control, or the NPH insulin groups. Moreover, in these studies, there were no neoplastic findings to indicate that insulin glargine had a systemic carcinogenic potential in mice or rats. I have not found any similar study in humans, but, in my experience, I don’t think that Lantus is in any way harmful; and I think that I would discontinue this useful insulin in any of my patients.

AS