Insulin Glargine
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Drugs 2000 Feb; 59 (2): 261-262 0012-6667/00/0002-0261/$25.00/0 © Adis International Limited. All rights reserved.
Insulin Glargine A Viewpoint by Matthew C. Riddle Division of Endocrinology, Diabetes & Clinical Nutrition, Oregon Health Sciences University, Portland, Oregon, USA
Insulin glargine will be the first available longacting analogue of human insulin. Unlike Neutral Protamine Hagedorn (NPH) and lente insulins, insulin glargine does not cause plasma insulin peaks and troughs and, unlike human ultralente insulin, it lasts well over 24 hours and seems to have little day-to-day variability of absorption. Theoretically, insulin glargine could be injected at any time of the day at any site. It may allow equal glycaemic control with less hypoglycaemia, or better glycaemic control with similar hypoglycaemia, compared with current treatment approaches. A true basal insulin is much needed, especially for type 1 diabetes mellitus. Trials of insulin lispro, a rapid-acting analogue that provides plasma levels just for meals, have shown how imperfect our previous tactics for delivering basal insulin have been. To cope with this problem, some diabetologists use NPH insulin with each meal and at bedtime, plus insulin lispro with meals. Others prefer a small dose of ultralente insulin once or twice daily, some-
times supplemented by NPH or lente insulins at bedtime, plus insulin lispro with meals. These intricate regimens permit slightly better levels of glycosylated haemoglobin (HbA1c) compared with those achieved with regular insulin instead of insulin lispro (i.e. 7% rather than 7.5% HbA1c). Insulin glargine may allow equal or better results with a simpler regimen: one dose of insulin glargine daily plus insulin lispro with meals. In addition, it may reduce the need for pump therapy. Insulin glargine may also have a role in the management of type 2 diabetes mellitus. The Kumamoto, UK Prospective Diabetes Study (UKPDS) and Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) findings all suggest that good glycaemic control with insulin does not increase, and probably reduces, cardiovascular events. Adding a small dose of long-acting insulin to oral therapies is a simple and reliable way to defend the 7% HbA1c level. This approach should work better with an improved basal insulin. In the future, inhaled insulin with each meal plus a daily dose of insulin glargine may provide unlimited therapeutic power for patients with type 2 diabetes mellitus with a single injection.
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