Abstract
There is a clinical imperative to improve metabolic control in the treatment of patients with type 1 diabetes, but in doing so, hypoglycemia should be avoided at all costs. Insulin analogues and the assumption they would better mimic the pharmacokinetic profile of endogenous insulin secretion emerged as a magic bullet in the treatment of patients with type 1 diabetes. However, although insulin analogues have pharmaceutical properties, such as pharmacodynamic stability, reproducibility of action, and a more physiological timing of action, which could possibly facilitate insulin use, the results obtained in clinical practice have not been as good as expected. Like all clinical decisions, the decision regarding which insulin would be better for the patient should be, if possible, evidence based. Here, we briefly discuss evidence for the use of insulin analogues and the different views with respect to the available evidence that lead to different interpretations and decisions regarding the use of this new technology.
Highlights
A few years after the first insulin preparations were launched on the market, long-acting insulins were developed (NPH, lente and ultralente insulins) and later animal insulins were replaced by biosynthetic human insulins
Intensive treatment is probably able to amend the chances of survival, as has been shown in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT): after 27 years, mortality was significantly lower among those who had received intensive vs. conventional therapy [2]
Insulin analogues more closely mimic the pharmacokinetic profile of endogenous insulin, leading to the widespread assumption that they would substantially improve the treatment of patients with type 1 diabetes
Summary
Compared with the general population, at age 20 years, life expectancy in patients with type 1 diabetes is shorter by approximately 11 years for men and 13 years for women [1]. Intensive treatment is probably able to amend the chances of survival, as has been shown in the long-term follow-up of the Diabetes Control and Complications Trial (DCCT): after 27 years, mortality was significantly lower among those who had received intensive vs conventional therapy [2]. Strict glycemic control is associated with a higher incidence of hypoglycemia, an undesired and harmful side effect of treatment [3], which, by itself, can lead to fear, anxiety, poor sleep quality, loss of work productivity, impaired functioning the following day, and treatment nonadherence [4,5,6]. Great advances have been made over the last century in terms of the technologies available to treat diabetes, with glucose measurement devices, insulin pens, insulin pumps and modified insulins, among others, providing the possibility of greater metabolic control with fewer hypoglycemic episodes and better quality of life. We briefly discuss evidence for the use of insulin analogues and the different views with respect to the available evidence that lead to different interpretations and decisions regarding the use of this new technology
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