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Article
Insulin Analog Therapy: Improving the Match with Physiologic Insulin Secretion
The Journal of the American Osteopathic Association
  • Jeffrey S. Freeman, Philadelphia College of Osteopathic Medicine
Document Type
Article
Publication Date
1-1-2009
Abstract
CONTEXT: Among the growing population of individuals with type 2 diabetes mellitus, many patients are failing to meet glycemic targets and are therefore at increased risk of complications. DATA OVERVIEW: Rapid-acting insulin analogs (ie, aspart, lispro, glulisine) have a pharmacokinetic profile that mirrors endogenous insulin more closely than regular human insulin. These insulin analogs can also be given closer to mealtimes and are less likely to cause hypoglycemia. Long-acting insulin analogs (ie, detemir, glargine) have relatively flat time-action profiles and last up to 24 hours, thus simulating endogenous basal insulin more precisely than neutral protamine Hagedorn insulin and producing less nocturnal hypoglycemia. The simplicity and efficacy of insulin analogs should help facilitate a patient's transition to insulin therapy. Current guidelines advocate starting insulin therapy in patients who have not achieved glycemic targets or those with glycated hemoglobin greater than 8.5% and adjusting doses as necessary. Two case studies illustrate the benefits of insulin analog therapy. CONCLUSIONS: Insulin analogs offer many benefits over human insulins, including improved physiologic profile, greater convenience, reduced risk of hypoglycemia, and, in some instances, less weight gain. Combined, these elements may increase a patient's adherence to treatment, potentially increasing the level of glycemic control and improving the prognosis in patients with type 2 diabetes mellitus.
PubMed ID
19193822
Comments

This article was published in Journal of the American Osteopathic Association, Volume 109, Issue 1, January 2009, Pages 26-36.

The published version is available at http://www.jaoa.org/content/109/1/26.long

Copyright © 2009 by the American Osteopathic Association

Citation Information
Jeffrey S. Freeman. "Insulin Analog Therapy: Improving the Match with Physiologic Insulin Secretion" The Journal of the American Osteopathic Association Vol. 109 Iss. 1 (2009) p. 26 - 36
Available at: http://works.bepress.com/jeffrey_freeman/6/