The currently available basal
insulin does not completely mimic the endogenous insulin secretion. This has continued to promote the search for ideal basal
insulin. The newer basal
insulin have primarily focused on increasing the duration of action, reducing variability, and reducing the incidence of
hypoglycemia, particularly nocturnal. However, the changing criteria of
hypoglycemia within a short span of a few years along with the surprising introduction of major
cardiac events as another outcome measure has not only clouded the assessment of basal
insulin but has also polarized opinion worldwide about the utility of the newer basal
insulin. A critical review of both the pre and post FDA analysis of all the basal
insulin in this article attempts to clear some of the
confusion surrounding the issues of
hypoglycemia and
glycemic control. This article also discusses all the trials and meta-analysis done on all the current basal
insulin available along with their head-to-head comparison with particular attention to
glycemic control and
hypoglycemic events including severe and nocturnal
hypoglycemia. This in-depth analysis hopes to provide a clear interpretation of the various analyses available in literature at this point of time thereby acting as an excellent guide to the readers in choosing the most appropriate basal
insulin for their patient.