Insulin analogues: What's all the fuss?

Insulin analogues are modified human insulins developed to address the limitations of human insulins which do not always respond to increased blood glucose levels in the same way as insulin that is naturally secreted by the body.

A comprehensive systematic review by Sumeet Singh and colleagues http://www.cmaj.ca/press/pg385.pdf. looked at outcomes associated with the use of rapid- and long-acting insulin analogues in adult and childhood type 1 and type 2 diabetes as well as gestational diabetes.

"Our results suggest that differences between conventional insulins and insulin analogues are minimal in the management of type 1, type 2 and gestational diabetes," write Mr. Singh and coauthors. They suggest that insulin analogues may be useful for some patients with problematic hypoglycemia.

In a companion research study http://www.cmaj.ca/press/pg400.pdf looking at cost-effectiveness of insulin analogues, CADTH researchers found that the routine use of long-acting insulin analogues in adults with type 1 or type 2 diabetes or use of rapid-acting analogues in patients with type 2 diabetes is not likely to be economically viable in a health care system with finite resources.

However, for adults with type 1 diabetes, rapid-acting insulin analogues can make sense as they appear to be cost-effective over human insulin.

"In light of the increasing prevalence of this disorder, and increased acquisition costs, particularly for long-acting insulin analogues, consideration must be given to the economic burden of providing these agents to all patients with diabetes," write Chris Cameron and Heather Bennett of CADTH.

Researchers from the Medical University of Graz, Austria write in a related commentary http://www.cmaj.ca/press/pg369.pdf that these findings are similar to other studies of insulin analogues. Based on the study by Singh and colleagues and other studies, "older conventional insulins remain effective. Therefore, the extensive promotion of insulin analogues is not justified," write Dr. Johannes Plank and coauthors. They recommend educational programs to help people manage their diabetes as they have greater impact in managing sugar levels than insulin analogues.