Current usage of long-acting insulin analogs in patients with type 2 diabetes mellitus

ABSTRACT

Introduction

Insulin treatment is fundamental to diabetes management. Basal insulin therapy reduces intraday glycemic fluctuations upon reaching a steady state. Besides better blood glucose regulation and achieving target HbA1c values in patients, it also offers protection from diabetes complications. In this review, we aimed to compare basal-acting insulins in light of the literature.

Areas covered

We reviewed current evidence related to diabetes treatment with basal insulins. This includes discussions on clinical trials and meta-analyses concerning first and second-generation ultra-long-acting basal insulins. Treatment indications for long-acting basal insulins, which have shown benefits and are considered superior or comparable to others in the literature, are derived from current clinical studies and meta-analyses, which form the basis of the recommendations in this review.

Expert opinion

First and second-generation basal insulins do not show much superiority over each other in terms of blood glucose regulation and reaching the target HbA1c. However, second-generation basal insulins cause fewer hypoglycemic events. We recommend using the appropriate basal insulin in patient-based, individualized treatments. Basal insulin Icodec may become more widely used over time, owing to its association with less hypoglycemia and a reduction in the number of injections.

KEYWORDS:

• Diabetes mellitus
• basal insulin
• diabetes treatment
• long acting insulin
• analog insulin

Article highlights

• Although there is no obvious difference in glycemic control between first-generation basal insulin analogues and NPH in some studies, the frequency of hypoglycemia is lower with first-generation basal insulins than with NPH.

• Compared with Detemir insulin NPH and insulin Glargine U-100, the effect of weight gain is significantly less.

• Insulin Glargine U-300 is longer-acting and causes less hypoglycemia than Glargine U-100. Degludec is also more potent than Glargine U-300.

• Since second generation basal insulins (including Degludec and Glargine U-300) cause fewer hypoglycemic events than first generation basal insulins (including Detemir and Glargine U-100), they are primarily preferred in diabetes, especially in the prevention of cardiac complications.

• Icodec insulin is a candidate to become the primary basal insulin by increasing patient compliance because it can be administered once a week and causes fewer hypoglycemic events.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.