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June 5, 2001

Insulin Analogs

Question from Davis, California, USA:

What's the latest on Lantus? Our pediatric endocrinologist says it's now available in the U.S., but there's a study showing it might have a mitogenic effect (carcinogenic) on some cells, so he's not quite ready to recommend it. What's the talk in diabetic medical circles here? [My daughter is 17 and was diagnosed 14 weeks ago.]

Answer:

Lantus is indeed available. Its role is as a long-acting insulin, providing baseline insulin between meals and at night. Its long duration of action allows it to be given only once a day.

From information reported on the package insert, it has been tested in children 5-15 years of age with type�1 diabetes, and apparently, it was found safe in that group. The carcinogenic potential of the medication was studied. The insert indicates that male rats had histiocytomas at injection sites, but females did not. Glargine was not mitogenic in tests for detections of gene mutations and in tests for detection of chromosomal aberrations. Tests were conducted with doses which resulted in much higher levels than those seen in humans.

I look for this insulin to be used initially as an alternative to twice a day NPH or Ultralente insulin.

JTL
Additional comments from Dr. Stuart Brink:

Lantus is just becoming available in the United States this month (June 2001). There are some questions about interactions with something called the IGF-1 receptor and therefore the concerns about possible growth promotion of cells, like tumors.

Preliminary studies in animals and short term studies in humans have looked very promising for this new analog. Your pediatric endocrinologist has told you the latest information so you should stay in close contact.

SB
Additional comments from Dr. Donough O’Brien:
For what it’s worth, I share an office with a nurse educator who has diabetes and was on an insulin pump for years. She now feels that she has much better control with Lantus (insulin glargine) once a day, even though it has to be given in a separate syringe and Humalog has be given at meal time. This approach seems to be catching on with other patients as well. There are no reports in MEDLINEplus of any carcinogenic effect.

DOB