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 A1c 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.
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