HumAn-1 was an open-label randomised trial at one site in Bangladesh and two in Tanzania. It assigned 400 children and young people aged 7-25 with type 1 diabetes to insulin glargine or to continue usual care, which meant human isophane insulin or premixed 70/30. Both co-primary outcomes were measured at six months with blinded continuous glucose monitors, so the assessment did not depend on what anyone reported.
Neither outcome favoured glargine. Time in very low range, below 3 mmol/L, was 3.6% with glargine and 3.4% with usual care, an adjusted difference of 0.22% (97.5% CI -0.83 to 1.27). Time in target range was 40.5% against 38.1%, an adjusted difference of 0.55% (97.5% CI -2.78 to 3.89). Serious adverse events were uncommon in both arms, with five participants affected on glargine and 13 on usual care.
This matters most where the analogue costs several times what human insulin does. The trial does not say analogues never help; it says that in this population, at this dose structure, they did not improve either hypoglycaemia or time in range. Where a family is choosing between an analogue they can afford intermittently and a human insulin they can afford continuously, continuity is now the better-supported option.
- No difference in time below 3 mmol/L or time in target range at six months
- Both co-primary outcomes measured on blinded CGM, not self-report
- Serious adverse events uncommon in both arms
- Where cost limits supply, human insulin is a defensible first choice, not a compromise
The statistics, in plain English
Both confidence intervals comfortably span zero, and they are 97.5% intervals rather than 95% because two co-primary outcomes were tested, which raises the bar for calling either one positive. A difference of 0.55% in time in target range is about eight minutes a day: even the most favourable end of the interval, 3.89%, is under an hour. This is a genuinely negative result rather than an underpowered one, which is what makes it usable.
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