Novel and Emerging Insulin Preparations for Type 2 Diabetes.

Abstract

The prevalence of type 2 diabetes is rising in Canada, and the burden of this disease on our healthcare system is getting heavier each year and is reflected by the alarming morbidity and mortality associated with it. Insulin has been a pivotal player in the management of selected patients with type 2 diabetes; however, currently available insulin preparations have their limitations. To date, a few emerging basal insulins, such as degludec, peglispro and Gla-300, will soon be available for use and show promising results in multiple phase 3 clinical trials in a broad spectrum of individuals with type 2 diabetes. The major benefits of these new insulin preparations are the reduction of risk for hypoglycemia due to their flatter profile and the allowance of flexibility owing to their longer duration of action. Despite these advantages, subcutaneous insulin injections are considered by patients to be invasive and inconvenient. In particular, prandial insulin, which requires frequent injections, is not well accepted by them. Also, local effects of insulin on injection sites, such as lipodystrophy and allergy, hinder the use of subcutaneous insulin in a proportion of patients. Newer strategies involving clever devices and formulations, such as inhaled, buccal, transdermal and oral insulins are in the pipeline. With all these options becoming available in the near future, physicians have to be reminded that the ultimate treatment regime should be based on the efficacy, side-effect profiles, patients’ options and cost-effectiveness of the drugs. The importance of individualized risk stratification and personalized care in order to maximize benefits and minimize harm should always be kept in mind. Rising Prevalence and Burden of Diabetes in Canada