Glargine did not beat human insulin for young people with type 1 diabetes in low-resource settings

Design

Randomised, open-label, parallel-group trial at three sites

Population

400 people aged 7–25 with type 1 diabetes in Bangladesh and Tanzania

Primary outcome

Time in very low range and time in range on blinded CGM at 6 months

Effect

Very low range 3.6% vs 3.4%, difference 0.22% (97.5% CI −0.83 to 1.27); time in range 40.5% vs 38.1%, difference 0.55% (−2.78 to 3.89)

HumAn-1 randomised 400 children and young adults aged 7–25 with type 1 diabetes at sites in Bangladesh and Tanzania. Participants either switched basal insulin to glargine or continued isophane (NPH) or premixed 70/30 human insulin. Coprimary outcomes, measured on blinded CGM at 6 months, were time in very low range (below 54 mg/dL) and time in target range (70–180 mg/dL). The trial was published in July 2026.

There was no difference on either outcome. Time in very low range was 3.6% with glargine and 3.4% with usual care; time in range was 40.5% and 38.1%. Serious adverse events were few in both groups: five participants on glargine and 13 on usual care.

For Indian practice, where many young people with type 1 diabetes rely on human insulin because of cost, this is a useful counterweight. Where analogues are unaffordable, well-supported human insulin is not clearly worse for hypoglycaemia or time in range over 6 months. The low time in range in both arms suggests education, glucose monitoring and access to supplies still matter more than the choice of basal insulin.

• Do not assume a switch to glargine alone will fix control or hypoglycaemia where resources are limited
• Put effort into education, dose adjustment and access to glucose testing
• Where cost forces human insulin, reassure families it is not clearly inferior on these outcomes
• Note the open-label design and 6-month duration when counselling

Why it matters

This challenges the assumption that analogue basal insulin is essential for safe type 1 care where resources are limited.

Don't overread it

Six months of CGM outcomes cannot rule out differences in long-term complications or severe hypoglycaemia events.

The statistics, in plain English

The adjusted difference in time in very low range was 0.22 percentage points (97.5% CI −0.83 to 1.27), and in time in range 0.55 points (−2.78 to 3.89). Both intervals include zero and are narrow, so a clinically meaningful benefit from glargine over 6 months is unlikely. Fewer serious adverse events with glargine is a small, unpowered observation.

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