FROM INSULIN TO INSULIN ANALOGS - PROGRESS IN THE TREATMENT OF TYPE-1DIABETES

The aim of modern diabetes management is euglycemia, to be achieved by the faithful imitation of normal insulin physiology. This is characte rized by a basal level of insulin secretion and postprandial surges. G ood glycemic control prevents the microvascular complications of diabe tes, but the achievement of sustained euglycemia in most diabetic pati ents has remained elusive. The last seven decades have seen tremendous progress in the areas of insulin purification, preparation, and admin istration. Research continues into novel routes of administration of i nsulin in an attempt to improve the nonphysiological profile of insuli n obtained after subcutaneous injection. Intraperitoneal release of in sulin by implantable pumps seems promising, but it is still hampered b y technical problems and high cost. Recently, progress has been made i n the development of insulin analogs with specific amino acid changes and specific pharmacokinetic properties. These properties allow for a more physiological profile of glucose and insulin after subcutaneous i njection. Development of a basal insulin analog is proceeding more slo wly. This review summarizes recent advances made with insulin administ ration and insulin analogs, with an emphasis on clinical studies. New developments and continuing research are making the goal of sustained euglycemia in diabetic patients more achievable than ever before.