***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND AIM While lispro insulin has been reported to lower postpr and ial blood glucose concentrations , less consistent effects have been shown for glycosylated hemoglobin ( HbA1c ) levels . Aim of this study was to determine whether pre-meal association of NPH , an intermediate-acting insulin , with lispro improves overall glycemic control in type 1 diabetic patients . METHODS AND RESULTS Eighty-five type 1 diabetic patients were studied in a multicenter r and omized comparative ( human regular vs lispro insulin ) crossover ( 3-month ) study in which NPH insulin was given as a dinner or bedtime injection and at breakfast and lunch if necessary . The number of injections was kept constant : 42 % and 58 % of patients injected insulin 3 and 4 times per day , respectively . Fasting and prepr and ial blood glucose levels were similar , while postpr and ial levels improved after lispro compared to human regular insulin ( breakfast : 8.28 + /- 2.39 vs 9.28 + /- 2.72 mmol/l ; lunch : 8.33 + /- 2.67 vs 9.06 + /- 2.67 mmol/l , dinner : 8.06 + /- 2.72 vs 9.28 + /- 2.44 mmol/l , ANOVA : p = 0.003 ) . HbA1c also improved after lispro : 8.1 + /- 0.9 vs 8.3 + /- 0.8 % , p < 0.05 . The rate of hypoglycemia was similar . Patients showed better acceptance of lispro treatment ( p < 0.001 ) . CONCLUSIONS Lispro improves overall blood glucose control in type 1 diabetic patients without increasing the incidence of hypoglycemia . This can be achieved by an optimal combination of lispro insulin with NPH whenever the time intervals between meals are too long BACKGROUND Although insulin lispro ( insulin LP ) has been shown to improve postpr and ial blood glucose ( BG ) control and reduce hypoglycemic episodes in adult patients with type I diabetes , there appear to have been few clinical studies focusing on its use in adolescents . OBJECTIVE This study compared the effects of insulin LP with those of regular human insulin ( insulin R ) on postpr and ial BG control and hypoglycemia in adolescents with type diabetes . METHODS In this crossover , open-label study , adolescents between the ages of 9 and 18 years who had reached Tanner stage II puberty were r and omized to receive either insulin LP immediately before meals or insulin R 30 to 45 minutes before meals , in addition to daily intermediate-acting insulin . After 4 months , patients were switched to the alternate treatment sequence . Eight-point BG profiles , hypoglycemia rate , and glycosylated hemoglobin ( HbA1c ) were measured at baseline and end point . RESULTS Four hundred eighty-one adolescents participated in the study at 53 investigative sites in 15 countries ; 463 were r and omized to treatment ( 228 insulin LP , 235 insulin R ) , and 457 completed the study .  Insulin LP given before breakfast result ed in significantly lower mean ( + /-SD ) 2-hour postpr and ial BG levels compared with insulin R ( 9.7 + /- 4.0 mmol/L vs 10.6 + /- 4.3 mmol/L , respectively ; P < 0.001 ) . Insulin LP given before dinner result ed in significantly lower 2-hour postpr and ial BG levels compared with insulin R ( 8.6 + /- 3.5 mmol/L vs 9.3 + /- 3.7 mmol/L ; P = 0.003 ) . No differences were seen between treatments in 2-hour postpr and ial BG levels after the midday meal . Mean baseline HbA1c values were similar between sequence groups , and no between-group difference in HbA1c was observed at end point ( insulin LP , 8.69 % + /- 1.52 % ; insulin R , 8.70 % + /- 1.65 % ) . Treatment with insulin LP result ed in a significantly lower incidence of hypoglycemic episodes per patient per 30 days compared with insulin R ( 4.02 + /- 4.5 vs 4.37 + /- 4.5 , respectively ; P = 0.023 ) and significantly fewer hypoglycemic episodes between midnight and 6 AM ( 1.0 + /- 1.9 vs 1.7 + /- 2.6 ; P < 0.001 ) . CONCLUSIONS In adolescents with type 1 diabetes , insulin LP significantly improved postpr and ial glycemic control and reduced episodes of nocturnal hypoglycemia compared with insulin R. Insulin LP was well tolerated and effective as part of an intensified insulin regimen in this study population Lispro ( LP ) and regular human ( HR ) insulins were compared in Type 1 diabetic ( T1DM ) patients on either a Mediterranean diet or normal diet . Twelve T1DM patients were recruited and r and omized into two groups of 6 , groups A and B. They were treated in different sequences ( in 3-month intervals for 1 year ) . Group A : LP insulin and normal diet , LP insulin and Mediterranean diet , regular insulin and Mediterranean diet , regular insulin and normal diet . Group B : regular insulin and normal diet , regular insulin and Mediterranean diet , LP insulin and Mediterranean diet , LP insulin and normal diet . Each patient was treated with rapid acting insulin , either LP insulin or HR insulin , before each main meal and a dose of slow acting insulin at bedtime . Every 15 days the glycemic control , the incidence and frequency of hypoglycemic episodes , and any adverse events were evaluated . Every 3 months , hematology and a chemistry panel , pre- and post-pr and ial glycemic and insulinemic profiles were evaluated in all patients . HbA1c levels significantly decreased in LP patients on normal diet , post-pr and ial glycemic levels were significantly lower in LP than in HR patients from 30 min onwards , 15-min post-pr and ial insulin levels higher in LP- than in HR-treated patients , and hypoglycemic episodes were significantly less in LP- than in HR-treated patients . LP insulin , irrespective of the type of diet , results in more effective glycemic control , significantly reduces hypoglycemic episodes as opposed to traditional insulin therapy and seems to be more effective with a normal diet than with a Mediterranean diet The absorption of regular human insulin from subcutaneous injection sites is delayed due to the self-association of insulin to multimeric forms . The insulin analogue insulin lispro has a weak self-association and a fast absorption rate . We examined the safety and efficacy of insulin lispro in the premeal treatment of patients with diabetes mellitus . A 12-month study was performed in 336 patients with insulin-dependent diabetes mellitus ( IDDM ) and 295 patients with non-insulin-dependent diabetes mellitus ( NIDDM ) . The patients were r and omized to inject either regular human insulin 30 to 45 minutes before eating , or insulin lispro immediately before each meal , in addition to basal insulin . The postpr and ial rise in serum glucose was lower in patients receiving insulin lispro than in those receiving regular human insulin therapy . At end point the increment was significantly lower at 1 hour ( 35 % ) and at 2 hours ( 64 % ) after the meal in IDDM patients ; in NIDDM patients , the increment was nonsignificantly lower at 1 hour ( 19 % ) and significantly lower at 2 hours ( 48 % ) . IDDM patients receiving insulin lispro achieved significantly lower glycated hemoglobin ( HbA1c ) levels in patients receiving regular human insulin ( 8.1 % vs 8.3 % ) . In NIDDM patients , HbA1c levels decreased equally in both treatment groups . Due to its fast absorption rate , insulin lispro improves postpr and ial control in diabetes . Insulin lispro can be considered one step toward optimal insulin therapy and improved patient convenience Summary  Recombinant DNA technology allows the production of insulin analogues with faster absorption rates from subcutaneous tissue as compared to soluble human insulin . The human insulin analogue B10Asp ( mono/dimeric ) is absorbed twice as fast as soluble human insulin ( hexameric ) . A double blind , r and omised crossover study with a 1-month run-in period and two 2-month treatment periods was performed in 21 male insulin-dependent diabetic ( IDDM ) patients aged 18–40 years in order to compare the metabolic control obtained with equimolar doses of the analogue B10Asp vs soluble human insulin ( Actrapid ) given as mealtime insulin and intermediate acting isophane insulin ( Protaphane ) at bedtime . At the end of each 2-month study period , the patients were admitted to the metabolic ward . We found significantly higher plasma insulin/analogue levels after breakfast , lunch and dinner with B10Asp as compared to Actrapid ( p<0.05 ) . The plasma insulin/analogue levels were significantly lower before lunch and dinner with B10Asp as compared to Actrapid ( p<0.05 ) . Also , the plasma insulin/analogue level tended to be lower at bedtime when comparing B10Asp to Actrapid . The 24-h blood glucose profiles showed identical fasting blood glucose , significantly lower blood glucose after breakfast with the analogue ( p<0.05 ) , no differences in blood glucose after lunch and dinner but a significantly higher blood glucose at midnight using the analogue ( p<0.05 ) . The overall 24-h mean blood glucose concentrations , the daily insulin dose , HbA1c , diet , home blood glucose monitoring and frequency of hypoglycaemia were almost identical in the two treatment periods . In conclusion , the overall glycaemic control remained unchanged and quite good when Actrapid was exchanged dose for dose with the insulin analogue B10Asp in IDDM patients treated with a basal bolus regime IMPORTANCE Type 1 diabetes has historically been associated with a significant reduction in life expectancy . Major advances in treatment of type 1 diabetes have occurred in the past 3 decades . Contemporary estimates of the effect of type 1 diabetes on life expectancy are needed . OBJECTIVE To examine current life expectancy in people with and without type 1 diabetes in Scotl and . We also examined whether any loss of life expectancy in patients with type 1 diabetes is confined to those who develop kidney disease . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort of all individuals alive in Scotl and with type 1 diabetes who were aged 20 years or older from 2008 through 2010 and were in a nationwide register ( n=24,691 contributing 67,712 person-years and 1043 deaths ) . MAIN OUTCOMES AND MEASURES Differences in life expectancy between those with and those without type 1 diabetes and the percentage of the difference due to various causes . RESULTS Life expectancy at an attained age of 20 years was an additional 46.2 years among men with type 1 diabetes and 57.3 years among men without it , an estimated loss in life expectancy with diabetes of 11.1 years ( 95 % CI , 10.1 - 12.1 ) . Life expectancy from age 20 years was an additional 48.1 years among women with type 1 diabetes and 61.0 years among women without it , an estimated loss with diabetes of 12.9 years ( 95 % CI , 11.7 - 14.1 ) . Even among those with type 1 diabetes with an estimated glomerular filtration rate of 90 mL/min/1.73 m2 or higher , life expectancy was reduced ( 49.0 years in men , 53.1 years in women ) giving an estimated loss from age 20 years of 8.3 years ( 95 % CI , 6.5 - 10.1 ) for men and 7.9 years ( 95 % CI , 5.5 - 10.3 ) for women . Overall , the largest percentage of the estimated loss in life expectancy was related to ischemic heart disease ( 36 % in men , 31 % in women ) but death from diabetic coma or ketoacidosis was associated with the largest percentage of the estimated loss occurring before age 50 years ( 29.4 % in men , 21.7 % in women ) . CONCLUSIONS AND RELEVANCE Estimated life expectancy for patients with type 1 diabetes in Scotl and based on data from 2008 through 2010 indicated an estimated loss of life expectancy at age 20 years of approximately 11 years for men and 13 years for women compared with the general population without type 1 diabetes AIMS Despite considerable experience with insulin lispro , few blinded comparisons with soluble insulin are available . This study compared insulin lispro with human soluble insulin in patients with Type 1 diabetes m 
    Output:
    
Conclusions Short-acting insulin analogues are superior to regular human insulin in T1DM patients for the following outcomes : total hypoglycemic episodes , nocturnal hypoglycemia , severe hypoglycemia , postpr and ial glucose , and HbA1c