Abstract

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.