Insulin glargine in the treatment of type 1 and type 2 diabetes

Abstract

Insulin glargine is an analogue of human insulin that is modified to provide a consistent level of plasma insulin over a long duration. Pharmacokinetic and pharmacodynamic studies show that a single injection of insulin glargine leads to a smooth 24-hour time-action profile with no undesirable pronounced peaks of activity. In clinical trials, this profile has been associated with at least equivalent, if not better, glycemic control than other traditional basal insulins and a significantly lower rate of overall and nocturnal hypoglycemia. The convenience of a once-daily injection, a lack of need for resuspension (insulin glargine is a clear solution when injected), and lower rates of hypoglycemia should translate into improvements in patient treatment satisfaction. This review appraises the evidence for the view that insulin glargine represents an advance in basal insulin therapy for both type 1 and type 2 diabetes patients.

Figure 1

Serum insulin profiles for insulin glargine and NPH insulin in healthy volunteers. Mean serum insulin concentrations ± SEM after subcutaneous injections of 0.4 U/kg body weight of insulin glargine and NPH insulin on three different study days in 15 healthy volunteers, corrected for serum insulin concentrations seen with placebo. Reproduced from Heinemann et al 2000. Copyright © American Diabetes Association. From Diabetes Care, 23: 644–9. Reprinted with permission from The American Diabetes Association. Abbreviations: NPH, neutral protamine Hagedorn; SEM, standard error of the mean.

Figure 2

Serum insulin profiles for four different basal insulins in patients with type 1 diabetes. Free plasma insulin concentrations after subcutaneous injection of insulin glargine, NPH insulin, Ultralente and continuous subcutaneous infusion of insulin lispro. Reproduced from Lepore et al 2000. Copyright © 2000 American Diabetes Association. From Diabetes, 49:2142–8. Reprinted with permission from The American Diabetes Association. Abbreviations: NPH, neutral protamine Hagedorn.