Clinical Impact of Newer Insulins for the Management of Type 2 Diabetes

Achieving good glycaemic control while avoiding hypoglycaemia, in order to delay or prevent the long term complications in patients with type 1 or 2 diabetes mellitus is important. Although, insulin plays a vital role in the management of diabetes, conventional human basal insulins like NPH have certain limitations, which have led to the development of more stable and peak less analogues. Although the first generation basal insulin analogues, insulin glargine and insulin detemir are an improvement over NPH, they still exhibit subtle peak effect and some patients may need twice daily administration. Insulin degludec (Tresiba®) is an ultra-long acting basal insulin analogue with flat, stable glucose lowering profile with half-life of >25 hours and duration of action of > 42 hours and less within patient day-to-day variability compared to long acting insulin analogue insulin glargine. A coformulation of insulin degludec with rapid acting insulin aspart (Insulin degludec/Insulin Aspart) [Ryzodeg®] is also available, comprising 70% insulin degludec and 30% insulin aspart. This article reviews the clinical impact of these newer insulins in the management of Type 2 diabetes. INTRODUCTION Diabetes is a global epidemic with estimated 415 million individuals currently living with diabetes. By 2040, this number is projected to reach 642 million1. Good glycaemic control significantly and importantly reduces the risk of long-term complications of both type 1 and type 2 diabetes. The benefits of tight glycaemic control have been confirmed by the DCCT (Diabetes Control and Complications Trial)/EDIC (Epidemiology of Diabetes Interventions and Complications) in type 1 diabetes and UKPDS (United Kingdom Prospective Diabetes Study) trials in type 2 diabetes, respectively2-4. Intensive glucose lowering therapy was associated with significantly reduced risks of myocardial infarction, stroke and heart failure in an epidemiological analysis of the follow-up to the UKPDS study3. Although, benefits of good glycaemic control have been emphasized, action is needed to increase the proportion of individuals achieving recommended glycaemic goals. Insulin therapy continues to play a vital role in the treatment of patients with diabetes mellitus. Basal insulin has been an important treatment option for patients with diabetes mellitus (DM) and, has undergone major improvements in terms of purity and similarity to the action of physiologic human insulin. Lente and Ultralente C H A P T E R 174 Clinical Impact of Newer Insulins for the Management of Type 2 Diabetes