Clinical efficacy and patient satisfaction with U-500 insulin use

Aims: The prevalence of highly insulin-resistant diabetes is increasing and treatment requires the use of very high doses of insulin. This study was performed to analyze efficacy and patient satisfaction with use of U-500 concentrated insulin. Methods: The medical records of 40 patients using U-500 insulin for at least 3 months were reviewed. A quality of life questionnaire was administered 6 or more months after U-500 was initiated. Effects of U-500 use on HbA1c, weight, total daily insulin use, hypoglycemia, and patient satisfaction were measured. Results: Patients had uncontrolled diabetes for 3 years prior to U-500 initiation despite insulin titration. Subjects required continued insulin titration to attain glycemic control even after U-500 initiation, but HbA1c decreased by 1.5% within 3 months. Subjects gained weight with insulin titration. Hypoglycemic symptoms increased early after transition to U-500 insulin, but patients reported fewer hypoglycemic episodes on the quality of life questionnaire. Patient satisfaction with diabetes care and control was significantly improved following transition to U-500 insulin. Conclusions: Use of U-500 insulin assists with attaining glycemic control in highly insulin-resistant subjects, but at the cost of weight gain and increased insulin doses. However, patient satisfaction is improved with U-500 insulin use.