The study, led by researchers at the University of Pittsburgh, was announced today. lancet diabetes endocrinology This adds nuance to the question of whether insulin is as effective as insulin analogs in older adults in low-resource settings.
The randomized clinical trial, which enrolled 400 participants with type 1 diabetes between the ages of 7 and 25 in Bangladesh and Tanzania, found that the long-acting analog insulin glargine was associated with a shorter time to dangerous hypoglycemia and fewer nocturnal hypoglycemic events, but the benefits did not emerge until a year into the trial. The findings point to a more complex picture than a simple head-to-head victory for the new insulin.
The real question is not simply whether the new insulin is better, but whether the benefits we observe are compelling enough to inform purchasing, access, and guideline decisions in places where options are limited. That’s the conversation this research helps move forward. ”
Jing Luo, MD, MPH, first author, associate professor of medicine at the University of Pittsburgh
At six months, the researchers found no evidence of a difference between the insulin analog glargine and geriatric insulin in the trial’s secondary outcome, time spent in the very low blood sugar range versus time spent in the target blood sugar range. However, at 12 months, participants assigned to glargine spent less time in the very low blood sugar range and had fewer nocturnal hypoglycemic events than those assigned to usual care. Researchers found no significant differences in HbA1c, diabetic ketoacidosis, severe hypoglycemic events, or time in the range of symptomatic hypoglycemic events at 12 months.
Although glargine did not improve the study’s primary outcome at 6 months, the 12-month data suggest that benefits associated with severe hypoglycemia may emerge more gradually in real-world, low-resource care settings. Glargine is also associated with lower total daily insulin use and fewer injections per day, which may be important factors for patients, families, and healthcare systems alike.
The World Health Organization added long-acting insulin analogs such as glargine to its model list of essential medicines in 2021. Yet, treatment of type 1 diabetes remains highly inequitable worldwide. Of the estimated 9.5 million people with type 1 diabetes worldwide, approximately 3.2 million are treated with geriatric insulin alone, and most live in low- and middle-income countries. Long-acting insulin analogs such as glargine are widely used in high-income settings, but high cost and limited availability have delayed widespread adoption in other regions.
“In many parts of the world, children do not have access to treatments that are considered standard in other countries,” Luo said. “These findings add new data to the global debate about whether resource-constrained health systems should prioritize access to new insulin formulations, despite their higher costs.”
Researchers say additional research is needed to better understand long-term glycemic outcomes after switching from geriatric insulin to analogue insulin in patients in resource-poor settings.
Co-authors include Chung-Chou H. Chang, PhD, Christina M. Lalama, MS, Jill Kirsch, MS, Abigail Foulds, PhD, and Bruce L. Rollman, MD, MPH. All live in Pitt. Dr. Sylvia Kehlenbrink of Brigham and Women’s Hospital. Eimhin Ansbro, Master of Hygiene and Tropical Medicine, London School of Hygiene. Margaret L. Prust MPH and Alana Garvin MPH, both members of the Clinton Health Access Initiative; Bedowra Zabeen, MBBS, Ajmina Hasan Flabe, MS, MPH, both Bangladesh Diabetes Association. Dr. Edna Majaliwa of Tanzania Diabetes Association and Muhimbili National Hospital; Dr. Kaushik Ramaiya of Tanzania Diabetes Association and Shree Hindu Mandal Hospital; Dr. Neema Kayange, Catholic College of Health and Allied Sciences Bugand; Dr. Renatus Fabiano Nyarubamba, MPH, Tanzania Diabetes Association; Graham D. Ogle, MBBS, Life for a Child, Australia.
This research was funded by the Leona M. Helmsley and Harry B. Helmsley Charitable Trust.
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Reference magazines:
Luo, J. Others. (2026). Comparison of human insulin versus analogue insulin for children and young adults with type 1 diabetes in low-resource settings (HumAn-1): A multicenter, open-label, randomized controlled trial. Lancet Diabetes and Endocrinology. DOI: 10.1016/S2213-8587(26)00097-5. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(26)00097-5/abstract
