Clinical appraisal of deficiencies of the basal analog insulin

Abstract

The attributes of a perfect basal insulin should include: the ability to provide basal glucose levels at target range; once-daily injection; suitable to be injected at any time of day and still cover the intervening period (up to 48 h); cause no hypoglycemia, weight gain or other serious side effects such as cancer; be consistent in its action; and be inexpensive. Following protamine zinc insulin, neutral protamine Hagedorn was introduced approximately 60 years ago. protamine zinc insulin’s highly variable action was reduced, but not eliminated, by neutral protamine Hagedorn. A total of 10 years ago, insulin glargine was introduced to the American market. It quickly gained market share due the relative lack of a peak action and therefore its lower risk of hypoglycemia, and also due to its long duration of action of 24 h or longer, at least in some patients. Then, 5 years ago, insulin detemir was introduced. Although it still may be questioned as to whether its duration of action is 24 h, it appears to have less variability in action and results in less weight gain than insulin glargine. Can we say that these insulins are the perfect basal insulin? The answer is no, and this article will discuss their shortcomings.

Keywords::

• afternoon phenomenon
• basal insulin
• dawn phenomenon
• insulin detemir
• insulin glargine
• insulin treatment
• Type 1 diabetes
• Type 2 diabetes

Acknowledgements

The author would like to acknowledge help in preparing the manuscript from Gary Wolfe, Dawn Clark and Valeria Kay King.

Financial & competing interests disclosure

The author has received research grants, consulted for and has been a speaker for Novo Nordisk, Sanofi Aventis and Eli Lilly and Company. The author has no other 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 apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.