Insulin glargine

1. Insulin glargine (Lantus) is a long-acting human insulin analogue, which is prepared by modifying the chemical structure of insulin to allow more consistent release during the day, thereby mimicking natural basal insulin release. Insulin glargine is licensed for people with type 1 and type 2 diabetes where treatment with insulin is required.

2. Insulin glargine, injected subcutaneously, maintains a basal concentration of insulin in the blood that can be raised by supplementary injections of a short-acting insulin as required. Therefore, insulin glargine provides the basal component of basal- bolus insulin regimens. The prolonged absorption profile of insulin glargine, with no pronounced peaks over 24 hours, allows for once-daily dosing. Furthermore, as it does not require re-suspension prior to administration (because of its soluble formulation), it has the potential to reduce inter-and intra-user variability.

A review concerning use of insulin analogues in diabetes concluded that (2):

• insulin glargine and insulin detemir both seem to result in glycaemic control that is at least comparable to that with isophane insulin
  • insulin detemir appears to reduce nocturnal hypoglycaemia and result in less weight gain than does isophane insulin in patients with type 1 diabetes
  • insulin glargine seems to reduce nocturnal hypoglycaemia in patients with type 1 or type 2 diabetes

Reference:

1. NICE (December 2002). Guidance on the use of long-acting insulin analogues for the treatment of diabetes - insulin glargine
2. Drug and Therapeutics Bulletin (2004); 42(10):77-80.