The Pharmaceutical Journal
Vol 277 No 7412 p169-172
5 August 2006

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An update on insulin analogues

Recombinant DNA technology has enabled the production of insulin analogues. In this article, Irene Gummerson discusses the products and their benefits over standard formulations

Continuing professional development articles

SUMMARY

An insulin analogue is an insulin molecule whose composition has been altered in order to yield some advantage over standard human insulin, while retaining its biological effect. In the 1990s, insulin lispro (Humalog) was the first analogue to be licensed in the UK. Insulin glulisine is the latest.

People with type 1 diabetes have no endogenous insulin secretory capacity and, require insulin therapy for survival. Ideally, the insulin regimens used should mimic the 24-hour insulin profile of non-diabetic individuals: post prandial spikes and basal (low-level background) levels, preventing hyperglycaemia without inducing hypoglycaemia.

In type 2 diabetes, glycaemic control can be achieved by a combination of diet and increased physical activity, with or without oral antidiabetic drugs (OADs). However, where the diabetes cannot be adequately controlled in this way, insulin therapy should be considered, either in addition to, or in place of OADs.

Chronic hyperglycaemia is associated with increased microvascular complications. Intensive insulin treatment can result in near normoglycaemia and so reduce the likelihood or severity of such complications. However using standard (non-analogue) human insulin formulations to achieve such diabetic control is, in some patients, limited by the increased likelihood of severe hypoglycaemia, which is a significant cause of morbidity. Nocturnal hypoglycaemic episodes can be a particular problem.

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