Insulin analogs: Glimpse on contemporary facts and future prospective.

Insulin remains a predominant life-saving medication for type 1 and type 2 Diabetes Mellites. Natural insulin secretion limits the fluctuation of the narrow and high surge of blood glucose levels. However, imitating the same by external insulin remains a challenge as a variety of insulin analogs (rapid acting, short acting, intermediate acting and long-acting) have different pharmacokinetic (PK) and pharmacodynamic (PD) properties. Inconsistent reduction in overall hyperglycemia level and nocturnal hypoglycemia due to variable absorption time and time action profile predominantly highlights the need of revisiting the PK/PD of insulin analogs as single analog is not yet sufficed to replace internal insulin exogenously. Combination therapy with basal and prandial insulins or intensification of hypoglycemic therapy with premixed insulins are of prime importance in managing diabetes effectively, imitating the natural insulin secretion. Therefore, the knowledge of PK/PD properties might help a practitioner to design, implement and manage insulin replacement therapy effectively and averting adverse events. Present study reports the comparative analysis of PK/PD profile of various insulin analogs based on the concurrent information about clinical aspects. Moreover, study interlinks the major concerns of therapeutic efficacy of insulin analogs with their respective onset of action and duration of effectiveness and reported adverse drug reaction which explore the scope of improvement.

Science of premix insulin: where have we reached?

Diabetes is a progressive disease and by achieving and maintaining optimal glycemic control, the onset of complications can be prevented or delayed. Insulin is most effective at any stage of diabetes. Although basal-bolus therapy is the gold standard treatment, it has its own limitations such as multiple pricks, close monitoring and cost. Premixed insulin on the other hand is convenient, requires fewer injections, is a single device and delivers both the basal and bolus component till the next meal. Although premixed insulin analogs have the advantages of mealtime flexibility, compliance and better post-prandial glucose control, no significant differences have been observed in HbA1c reduction and overall hypoglycemia when compared to premixed human insulin. This review will attempt to analyze the efficacy, safety and limitations of currently available premix human insulin and premix analogs including recent advancements in the area.