Will the next generation of basal insulins offer clinical advantages?

Diabetes Obes Metab. 2014 Jun;16(6):483-91. doi: 10.1111/dom.12219. Epub 2013 Oct 31.

Abstract

The 21st century has seen the arrival of several insulin analogue products and the refinement of insulin regimens, with widespread advocacy of continuous titration algorithms and earlier initiation of supplementary insulin therapy (predominantly using basal insulins) in type 2 diabetes. Nevertheless, many insulin-treated diabetes patients remain in poor glycaemic control. This might reflect insufficient titration effort or lax adherence, but these issues could in some cases result from concerns about hypoglycaemia. Certainly there is scope for improving the pharmacokinetic/pharmacodynamic (PK/PD) profile of basal insulin, and three new products offer this prospect. Insulin degludec, now in clinical use, and PEGylated insulin lispro, in development, have greatly extended action profiles that result from two very different, but unique, mechanisms. With once-daily dosing, these insulins produce stable PK/PD profiles at steady state, associated with a low incidence of hypoglycaemia. The feasibility of varied daily dose timing has also been confirmed with insulin degludec. High strength formulations of insulin glargine and insulin degludec offer the prospect of a reduced injection number/volume in high dose users, and in the case of glargine, the PK/PD profile might also be favourably modified. This review considers critically the clinical evidence and expectations we should have for these new basal insulins.

Keywords: U300 glargine; basal insulin; diabetes; insulin degludec; pegylated insulin lispro.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Diabetes Mellitus, Type 1 / drug therapy*
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / analogs & derivatives*
  • Insulin / therapeutic use
  • Insulin Glargine
  • Insulin Lispro / therapeutic use*
  • Insulin, Long-Acting / therapeutic use*
  • Polyethylene Glycols / therapeutic use

Substances

  • Hypoglycemic Agents
  • Insulin
  • Insulin Lispro
  • Insulin, Long-Acting
  • insulin, polyethylene glycol(B1)-
  • Insulin Glargine
  • Polyethylene Glycols
  • insulin degludec