Design: Multicentre, open-label RCT
Population: 400 people aged 7–25 with type 1 diabetes in Bangladesh and Tanzania
Primary outcome: Time <3 mmol/L and time 3.9–10 mmol/L on blinded CGM at 6 months
Effect: Very low range +0.22% (97.5% CI −0.83 to 1.27); time in range +0.55% (−2.78 to 3.89)

HumAn-1 randomised 400 children and young people aged 7 to 25 with type 1 diabetes, at one site in Bangladesh and two in Tanzania, to insulin glargine or continued human isophane or premixed 70/30 insulin. Outcomes were measured with blinded CGM at 6 months. It was published in July.

Time in very low range was 3.6% with glargine and 3.4% with usual care (adjusted difference 0.22%, 97.5% CI −0.83 to 1.27). Time in range was 40.5% versus 38.1% (difference 0.55%, 97.5% CI −2.78 to 3.89). Serious adverse events were few: 5 of 199 on glargine, 13 of 201 on usual care.

Where cost limits supply, this is evidence that switching to an analogue alone does not buy better glucose. Time in range around 40% in both groups is the real finding: the gap lies in education, monitoring and supply, not in the basal molecule.

Do not assume a switch to analogue basal insulin will fix poor control on its own.
Prioritise glucose monitoring access, education and reliable supply.
Keep human insulin as a legitimate option where analogue cost threatens continuity.
Glargine may still suit individuals with nocturnal hypoglycaemia; decide case by case.

Why it matters

It challenges the assumption that analogue insulin is the first upgrade low-resource clinics should buy.

The statistics, in plain English

Both confidence intervals cross zero and are narrow, so a meaningful difference in either direction is unlikely over 6 months. The trial was open-label, but CGM was blinded, which protects the glucose outcomes. The difference in serious adverse events is too small in number to interpret.