Drug and Therapeutics Bulletin 2004;42:77-80; doi:10.1136/dtb.2004.421077
Copyright © 2004 by the BMJ Publishing Group Ltd.

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Update on insulin analogues

Relevant BNF section: 6.1.1

Four recombinant human insulin analogues are currently available in the UK. In reviewing the first of these, insulin lispro, in 1997, we concluded that "it has a more rapid onset, time to peak and shorter duration of action than soluble human insulin" but "does not appear to alter overall control (haemoglobin A_1c levels) and it is not clear whether it reduces the occurrence of hypoglycaemia compared with soluble human insulin".¹ Recombinant analogues marketed in the UK since then include another short-acting analogue, insulin aspart (NovoRapid - Novo Nordisk), and two longer-acting analogues, insulin glargine (Lantus - Aventis Pharma) and insulin detemir (Levemir - Novo Nordisk). In addition, there are two biphasic formulations that contain both a short-acting analogue and a longer-acting protamine suspension of that analogue: biphasic insulin lispro (Humalog Mix25, Humalog Mix50 - Lilly) and biphasic insulin aspart (NovoMix 30 - Novo Nordisk). Here we review insulin analogues and consider what advantages, if any, they offer over conventional human insulin preparations.