Insulin Analogs—Are They Worth It? Yes!

Abstract

The availability of insulin analogs has offered insulin replacement strategies that are proposed to more closely mimic normal human physiology. Specifically, there are a considerable number of reports demonstrating that prandial insulin analogs (lispro, aspart, glulisine) have pharmacokinetic and pharmacodynamic profiles closer to normal, with resulting faster onset and offset of insulin effect when compared with regular human insulin. In addition, basal insulin analogs (glargine, detemir) have been reported to offer longer duration of action, less variability, more predictability, less hypoglycemia (especially nocturnal), and a favorable effect on weight. However, an argument against use of analog insulins as compared with use of regular or NPH insulin is one that states that the effectiveness and risk of hypoglycemia are the only two valid clinical outcomes that should be used to compare the analog and human insulins. Thus, there remains a debate in some circles that analog insulins are no more effective than human insulins, yet at a much higher financial cost. To provide an in-depth understanding of both sides of the argument, we provide a discussion of this topic as part of this two-part point-counterpoint narrative. In the counterpoint narrative, Dr. Davidson provides his argument and defends his opinion that outside of a few exceptions, analog insulins provide no clinical benefit compared with human insulins but cost much more. In the point narrative presented here, Dr. Grunberger provides a defense of analog insulins and their value in clinical management and suggests that when evaluating the “cost” of therapy, a much more global assessment is needed. —William T. Cefalu Editor in Chief, Diabetes Care

Diabetes and Ramadan: Practical guidelines

“…The use of insulin analogues (basal, prandial and premix) is recommended over regular human insulin due to a number of advantages, including lower rates of hypoglycaemia [51]. Although a number of small randomised trials and observational studies have been conducted to assess some insulin regimens during Ramadan (Table S1), large RCT data in this area are lacking.…”

An international, multicenter, observational survey to evaluate diabetes control in subjects using insulin for the treatment of type 1 and type 2 diabetes mellitus in the Czech Republic and Slovak Republic: study protocol for a cross-sectional survey

“…20,21 Similarly unclear is the contribution of routinely used basal analogs, and the results of the studies cited herein, perhaps, slightly favor insulin glargine, especially with respect to type 2 diabetes. [22][23][24] This observational study could help answer these questions as well as questions related to the results of glycemic control for different types of insulin regimens in combination with oral antidiabetic agents in the treatment of type 2 diabetes.…”

Response to Comment on Grunberger “Insulin Analogs—Are They Worth It? Yes!” Diabetes Care 2014;37:1767–1770 and Davidson “Insulin Analogs—Is There a Compelling Case to Use Them? No!” Diabetes Care 2014;37:1771–1774

“…As I stated in my article: "Clearly, patients are paying for the gamesmanship between the government regulatory bodies and big pharma politics" (2). And, in the current state of affairs, it is mainly the patients in the U.S. who are carrying the brunt of the global insulin costs as Giugliano et al document.…”