Insulin analog therapy: improving the match with physiologic insulin secretion.
BACKGROUND
Among the growing population of individuals with type 2 diabetes mellitus, many patients are failing to meet glycemic targets and are therefore at increased risk of complications.
Rapid-acting insulin analogs (ie, aspart, lispro, glulisine) have a pharmacokinetic profile that mirrors endogenous insulin more closely than regular human insulin. These insulin analogs can also be given closer to mealtimes and are less likely to cause hypoglycemia. Long-acting insulin analogs (ie, detemir, glargine) have relatively flat time-action profiles and last up to 24 hours, thus simulating endogenous basal insulin more precisely than neutral protamine Hagedorn insulin and producing less nocturnal hypoglycemia. The simplicity and efficacy of insulin analogs should help facilitate a patient's transition to insulin therapy. Current guidelines advocate starting insulin therapy in patients who have not achieved glycemic targets or those with glycated hemoglobin greater than 8.5% and adjusting doses as necessary. Two case studies illustrate the benefits of insulin analog therapy.


CONCLUSIONS
Insulin analogs offer many benefits over human insulins, including improved physiologic profile, greater convenience, reduced risk of hypoglycemia, and, in some instances, less weight gain. Combined, these elements may increase a patient's adherence to treatment, potentially increasing the level of glycemic control and improving the prognosis in patients with type 2 diabetes mellitus.
Freeman
Jeffrey S
JS
Division of Endocrinology and Metabolism, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131-1633, USA. jeffreyfreemando@aol.com
D000465:Algorithms; D000682:Amyloid / Q000008:administration & dosage; D001786:Blood Glucose / Q000032:analysis; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D004359:Drug Therapy, Combination; D000077270:Exenatide; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics / Q000494:pharmacology; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000378:metabolism; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D000078790:Insulin Secretion; D049528:Insulin, Long-Acting; D058228:Islet Amyloid Polypeptide; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism; D010349:Patient Compliance; D010455:Peptides / Q000008:administration & dosage; D014688:Venoms / Q000008:administration & dosage
D000682:Amyloid; D001786:Blood Glucose; D000077270:Exenatide; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D058228:Islet Amyloid Polypeptide; D010455:Peptides; D014688:Venoms; C105254:pramlintide