HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) All Versions of this Article: cmr.2008.793v1 cmr.2008.793v2 6/2/54    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hartman, I. Search for Related Content PubMed PubMed Citation Articles by Hartman, I.

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Assistant Professor, Internal Medicine Department, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas

Reprint Requests: Israel Hartman, MD, Medical Director, Multiple Health Research, 501 Rita Lane, Suite 113, Arlington, TX 76014, Tel: 817-467-0305, Fax: 817-468-9358, Email:isyfanny{at}aol.com

Abstract

A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns. The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile. The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure. To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment. The long-acting basal analog insulin detemir has the additional advantage of producing less weight gain, which has been considered until now an almost inevitable consequence of insulin replacement.

Key Words: Diabetes complications • Diabetes mellitus • Hypoglycemia • Insulin • Patient non-adherence • Pharmacokinetics • Quality of life

This article has been cited by other articles:

				D. Russell-Jones Current developments in the treatment of diabetes: the incretin therapies The British Journal of Diabetes & Vascular Disease, January 1, 2010; 10(1): 21 - 30. [Abstract] [PDF]