Update on insulin analogues

doi:10.1136/dtb.2004.421077

Drug and Therapeutics Bulletin 2004;42:77-80; doi:10.1136/dtb.2004.421077

Update on insulin analogues

Relevant BNF section: 6.1.1

Four recombinant human insulin analogues are currently availablein the UK. In reviewing the first of these, insulin lispro,in 1997, we concluded that "it has a more rapid onset, timeto 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 occurrenceof hypoglycaemia compared with soluble human insulin".¹ Recombinantanalogues marketed in the UK since then include another short-actinganalogue, ${blacktriangledown}$ insulin aspart (NovoRapid - Novo Nordisk), and twolonger-acting analogues, ${blacktriangledown}$ insulin glargine (Lantus - AventisPharma) and ${blacktriangledown}$ insulin detemir (Levemir - Novo Nordisk). In addition,there are two biphasic formulations that contain both a short-actinganalogue and a longer-acting protamine suspension of that analogue:biphasic insulin lispro (Humalog Mix25, Humalog Mix50 - Lilly)and biphasic ${blacktriangledown}$ insulin aspart (NovoMix 30 - Novo Nordisk). Herewe review insulin analogues and consider what advantages, ifany, they offer over conventional human insulin preparations.