Rapid and long-acting analogues as an approach to improve insulin therapy:An evidence-based medicine assessment

This review summarizes the results of clinical trials with the currently av ailable insulin analogues (i.e., insulin lispro, insulin aspart, and insuli n glargine) and evaluates their clinical benefit applying the standards of evidence-based medicine. All analogues show a more physiological time-actio n profile with either a shorter onset and shorter duration of action (insul in lispro and insulin aspart) or a more constant effect lasting at least 24 hours (insulin glargine). These advantages in the time-action profiles hav e been shown to improve various surrogate parameters (e.g., postprandial bl ood glucose concentrations) in a number of randomized controlled trials. On ly a few studies are available, however, demonstrating a benefit on patient -oriented clinical endpoints as decrease in glycated hemoglobin (HbA(1c)), reduction of hypoglycemic episodes, and improvement in quality-of-life. Thi s review focuses on the impact of the use of insulin analogues on these end points. Provided that insulin therapy is optimized as a whole (rather than just switching from human insulin to insulin analogues) all 3 analogues sho w (modest) beneficial impact on these endpoints, Finally, we review the rel evant data concerning the safety aspects of the various analogues, thus all owing the reader to perform an individual risk-benefit-assessment.