Innovative insulins--where do analogues fit?
BACKGROUND
Problems with traditional bolus insulins include delayed time to onset and offset, and with basal insulins, an overnight peak and poor reproducibility. Analogue insulins have been formulated to better emulate physiologic insulin secretion and improve glycaemic control without increasing hypoglycaemia.


OBJECTIVE
This article discusses analogue insulins and outlines their role in current diabetes management.


CONCLUSIONS
Analogue insulins do offer some advantages over traditional insulins. The bolus and basal analogues offer flexibility, and basal analogues reduce nocturnal hypoglycaemia. However, there is limited evidence supporting improved glycaemic control with analogue insulins. No study has looked at long term outcomes and hard endpoints. Rapid acting analogues are widely used, generally in type 1 diabetes. The basal analogues glargine and detemir are significantly more expensive compared to traditional basal insulins, but were listed on the Pharmaceutical Benefits Scheme on 1 October 2006. Glargine is available for patients with type 1 and insulin requiring type 2 diabetes, while detemir has been recommended only for patients with type 1 diabetes. Patients with type 1 diabetes, particularly those with hypoglycaemic unawareness, may be expected to derive most benefit from the new basal analogues.
Phillips
Liza K
LK
Royal Adelaide Hospital, South Australia.
Phillips
Patrick J
PJ
D003920:Diabetes Mellitus / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D007328:Insulin