Insulin analog therapy: improving the match with physiologic insulin secretion.

CONTEXT: Among the growing population of individuals with type 2 diabetes mellitus, many patients are failing to meet glycemic targets and are therefore at increased risk of complications. DATA OVERVIEW: Rapid-acting insulin analogs (ie, aspart, lispro, glulisine) have a pharmacokinetic profile that mirrors endogenous insulin more closely than regular human insulin. These insulin analogs can also be given closer to mealtimes and are less likely to cause hypoglycemia. Long-acting insulin analogs (ie, detemir, glargine) have relatively flat time-action profiles and last up to 24 hours, thus simulating endogenous basal insulin more precisely than neutral protamine Hagedorn insulin and producing less nocturnal hypoglycemia. The simplicity and efficacy of insulin analogs should help facilitate a patient's transition to insulin therapy. Current guidelines advocate starting insulin therapy in patients who have not achieved glycemic targets or those with glycated hemoglobin greater than 8.5% and adjusting doses as necessary. Two case studies illustrate the benefits of insulin analog therapy.
CONCLUSIONS: Insulin analogs offer many benefits over human insulins, including improved physiologic profile, greater convenience, reduced risk of hypoglycemia, and, in some instances, less weight gain. Combined, these elements may increase a patient's adherence to treatment, potentially increasing the level of glycemic control and improving the prognosis in patients with type 2 diabetes mellitus.