Insulin therapy has been strongly influenced by the results of the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS), both of which support intensive
antidiabetic therapy. Conventional
insulin therapy can be limited, due to the difficulty in achieving tight
glycemic control in people with diabetes, which is crucial to reducing the risk of long-term complications associated with diabetes. In recent years, three
short-acting (insulin lispro, insulin aspart and
insulin glulisine) and two
long-acting (insulin glargine and
insulin detemir) recombinant analogues of regular human
insulin have been developed for the management of diabetes.
Short-acting insulin analogues are an alternative to regular human
insulin before meals. Compared with regular human
insulin, these new
short-acting insulin analogues show faster subcutaneous absorption, a more rapid onset of activity and a shorter duration of action. As a result of these pharmacokinetic differences, an improved postprandial
glycemic control is achieved, without increasing the risk of
hypoglycemia. In addition, these
insulin analogues can be administered immediately before a meal, thereby synchronizing
insulin administration and food absorption. The
long-acting insulin analogue
insulin glargine was developed to provide basal
insulin levels for 24 h when administered once daily at bedtime. Compared with previous intermediate- or long-acting conventional
insulin,
insulin glargine shows a flat profile of plasma
insulin levels with no prominent peak. The use of this
long-acting insulin analogue appears to be associated with a reduced incidence of
hypoglycemia, especially at night.
Insulin detemir is another basal
insulin that may reduce nocturnal
hypoglycemia and variability in glycemic values. The availability of these new
insulin analogues has the potential to significantly improve long-term control over
blood glucose in diabetic patients.