How Important are Insulin Analogues in the Treatment of Diabetes?

german translation / full article

Günther Egidi

Keywords: clinical endpoints diabetes mellitus human insulin hypoglycemia; insulin analogues

Background The proportion of prescribed insulin analogues has more than doubled in Germany in the last ten years and increased to 69 % of the volume of all insulin prescriptions. The question arises: are there good arguments for such prescription behavior?Search methodResearch in Medline and Cochrane with the term insulin analogues.Main messagesShort-acting analogues have a faster onset of action and are usually shorter than regular insulin. The effect of long-acting analogues lasts longer than that of NPH insulin. There is no evidence of benefits of insulin analogues for clinically relevant endpoints. Even with regard to intermediate endpoints, no advantage could be proven. For regular insulin, an injection-meal-interval is not required. The reduction of nocturnal hypoglycaemia by nearly 20 % (relative reduction) remains relevant for regular insulin only when low HbA1c targets are pursued. Severe hypoglycaemia is not less common with insulin analogues.ConclusionsWith the exception of a few special groups of people with type 1 diabetes, insulin analogues have nearly no value; their prescription is uneconomic in most cases.Keywordsdiabetes mellitus; insulin analogues; human insulin; hypoglycemia; clinical endpoints

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