The role of the new basal insulin analogs in addressing unmet clinical needs in people with type 1 and type 2 diabetes

Abstract

Background: Despite improvements in anti-hyperglycemic therapies, there are many unmet clinical needs that hinder successful glycemic control in people being treated with current basal insulin analogs.

Objective: This paper reviews the unmet needs associated with current basal insulin therapy and describes the most recent basal insulins for the treatment of diabetes.

Methods: PubMed was searched for articles on basal insulin analogs published between 2000 and April 2016.

Results: Although long-acting insulin analogs, such as insulin glargine 100 units/mL and insulin detemir, have come towards approximating physiologic basal insulin levels, limitations such as hypoglycemia and intra- and inter-individual variability are associated with their use resulting in glycemic fluctuations. Some basal insulins lack 24 hour coverage, requiring some patients to split their dose, increasing the number of injections required to maintain glycemic control. Fear of hypoglycemia and the need for additional injections often leads to poor compliance and suboptimal glycemic control. Long-acting insulin analogs, such as insulin glargine 300 units/mL and insulin degludec, have improved upon the shortcomings of the current basal insulin analogs. Improved pharmacodynamic/pharmacokinetic profiles afford lower intra-patient variability and an extended duration of action, providing full and stable 24 hour basal insulin coverage with once daily dosing, and comparable efficacy to insulin glargine with lower rates of hypoglycemia.

Conclusion: The improved pharmacodynamic/pharmacokinetic profiles of new long-acting insulin formulations provide greater glycemic control with once daily dosing. With the growing number of therapeutic choices available, physicians have more scope to individualize patient options for basal insulin therapy.

Keywords:

• Basal insulin
• hypoglycemia
• insulin degludec
• insulin detemir
• insulin glargine
• insulin glargine 300 units/mL

Transparency

Declaration of funding

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication.

Author contributions: R.L., E.C. and R.J.T. all contributed to the concept and the writing of this manuscript, including critical review and editing of each draft and approval of the final version. All authors agree to be accountable for all aspects of the work.

Declaration financial/other relationships

R.L. has disclosed that she holds a scientific advisorship to Boehringer Ingelheim, Novo Nordisk, Valeritas, and Sanofi. E.C. has disclosed that she has received speaker fees from Novo Nordisk, and is a scientific advisor for Lexicon. R.J.T. has disclosed that he has received research support from Novo Nordisk and Sanofi and has been on an advisory board for Monarch Medical and InSpark.

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

Acknowledgments

The authors received writing/editorial support in the preparation of this manuscript which was provided by Nicola Truss PhD of Excerpta Medica, funded by Sanofi US Inc.