The case for basal analogue insulins as first‐line insulins: back to the future?

Abstract

S ince the launch of glargine insulin (Lantus) at the start of this century and the arrival of detemir insulin (Levemir) insulin in 2004, there has been a reduction in the amount of neutral protamine Hagedorn (NPH) insulin used. The majority of new prescriptions for basal insulins over the last few years in the UK have been for glargine or detemir and these insulins now account for between 38 and 97% of basal insulin prescriptions (excluding biphasic insulins) in the UK. 1 Is this justified on clinical or monetary grounds?The claims made of the newer basal insulin analogues are that they are better than NPH both in terms of predictability and duration of action as well as in lowering the risk of hypoglycaemia; 2,3 and in the case of detemir, as well as this, there seems to be less weight gain associated with its use compared with glargine. [3][4][5] Both glargine and detemir are licensed in the European Union for once-aday administration. What is the utility of these attributes in the real world of diabetes management?