title: The evolution of insulin glargine and its continuing contribution to diabetes care.
abstract: The epoch-making discovery of insulin heralded a new dawn in the management of diabetes. However, the earliest, unmodified soluble insulin preparations were limited by their short duration of action, necessitating multiple daily injections. Initial attempts to protract the duration of action of insulin involved the use of various additives, including vasoconstrictor substances, which met with limited success. The subsequent elucidation of the chemical and three-dimensional structure of insulin and its chemical synthesis and biosynthesis allowed modification of the insulin molecule itself, resulting in insulin analogs that are designed to mimic normal endogenous insulin secretion during both fasting and prandial conditions. Insulin glargine was the first once-daily, long-acting insulin analog to be introduced into clinical practice more than 10 years ago and is specifically designed to provide basal insulin requirements. It has a prolonged duration of action and no distinct insulin peak, making it suitable for once-daily administration and reducing the risk of nocturnal hypoglycemia that is seen with intermediate-acting insulins. Insulin glargine can be used in combination with prandial insulin preparations and non-insulin anti-diabetic agents according to individual requirements.
authors.affiliation: Institute of Biochemistry, Center for Structural and Cell Biology in Medicine and Center for Brain, Behavior and Metabolism, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany, hilgenfeld@biochem.uni-luebeck.de.
authors.forename: Rolf
authors.initials: R
authors.lastname: Hilgenfeld
authors.forename: Gerhard
authors.initials: G
authors.lastname: Seipke
authors.forename: Harald
authors.initials: H
authors.lastname: Berchtold
authors.forename: David R
authors.initials: DR
authors.lastname: Owens
mesh_terms: D000818:Animals; D003692:Delayed-Action Preparations; D003920:Diabetes Mellitus / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D003692:Delayed-Action Preparations; D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine