New insulins and new insulin regimens: a review of their role in improving glycaemic control in patients with diabetes

Abstract

Effective glycaemic control can reduce and potentially prevent the microvascular and macrovascular complications of diabetes. Insulin is the mainstay of treatment for type 1 diabetes and is indicated in patients with type 2 diabetes who do no achieve optimal glycaemic control despite the use of oral hypoglycaemic agents. The advent of the so-called "designer" insulins, the insulin analogues, has offered new opportunities in the clinical management of diabetes. This review examines the efficacy of the different analogue insulins introduced thus far and goes on to explain their pharmacodynamics and pharmacokinetics. The review also examines the different types of insulin regimen currently used in clinical practice and discusses some of the factors that influence the choice of a particular insulin regimen. Further, irrespective of the insulin regimen used, the importance of prompt initiation and ongoing titration of insulin treatment to achieve optimal glycaemic targets is emphasised.