title: Modern insulins, old paradigms and pragmatism: choosing wisely when deciding how to treat type 1 diabetes.
abstract: There is a clinical imperative to improve metabolic control in the treatment of patients with type 1 diabetes, but in doing so, hypoglycemia should be avoided at all costs. Insulin analogues and the assumption they would better mimic the pharmacokinetic profile of endogenous insulin secretion emerged as a magic bullet in the treatment of patients with type 1 diabetes. However, although insulin analogues have pharmaceutical properties, such as pharmacodynamic stability, reproducibility of action, and a more physiological timing of action, which could possibly facilitate insulin use, the results obtained in clinical practice have not been as good as expected. Like all clinical decisions, the decision regarding which insulin would be better for the patient should be, if possible, evidence based. Here, we briefly discuss evidence for the use of insulin analogues and the different views with respect to the available evidence that lead to different interpretations and decisions regarding the use of this new technology.
authors.affiliation: Endocrine Division, Hospital de Clínicas de Porto Alegre and Medical Faculty, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, prédio 12, 4° andar, Porto Alegre, RS 90035-003 Brazil.
authors.forename: Beatriz D
authors.initials: BD
authors.lastname: Schaan
authors.affiliation: Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Rafael Selbach
authors.initials: RS
authors.lastname: Scheffel