Insulin analogues

• insulin analogues are available as:
  • short-acting analogues - insulin aspart and insulin lispro
    • short-acting analogues, insulin lispro and insulin aspart, in comparison to conventional human insulins, result in a small decrease in haemoglobin A1c levels in patients with type 1, but not type 2, diabetes mellitus (1)
    • the short-acting insulin analogues also appear to reduce the incidence of severe hypoglycaemia but not the overall likelihood of hypoglycaemia (1)
  • longer-acting analogues - insulin glargine and insulin detemir
    • both longer-acting insulin analogues seem to produce glycaemic control that is at least comparable to that with isophane insulin
    • insulin detemir seems to reduce nocturnal hypoglycaemia and result in less weight gain than does isophane insulin in patients with type 1 diabetes
    • insulin glargine appears to reduce nocturnal hypoglycaemia in patients with type 1 or type 2 diabetes
• a review (1) concluded that there is no convincing evidence to justify switching patients from existing conventional therapy to analogues if they have appropriate glycaemic control without troublesome hypoglycaemia
• long acting insulin analogues do not reduce HbA1c concentrations more than coventional human insulin but do reduce nocturnal hypoglycaemia (2)

Reference:

• (1) Drug and Therapeutics Bulletin (2004); 42(10):77-80.
• (2) Banerjee S et al. Long-acting insulin analogues for diabetes mellitus: meta-analysis of clinical outcomes and assessment of cost-effectiveness. Technology Report 92.Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH); 2007.