Effects of rapid-acting insulin analogs on overall glycemic control in type 1 and type 2 diabetes mellitus

The altered pharmacokinetics of new rapid-acting insulin analogs make them very effective in controlling blood glucose peaks after meals. However, simple replacement of regular human insulin by rapid-acting analogs may not be sufficiently effective for overall daily glycemic control. Both basal and bolus insulins need to be addressed with overall changes in insulin regimens for long-term reductions of glycated hemoglobin (HbA(1c)) levels. Clinical studies in patients with type 1 diabetes have shown that better control of postprandial peaks together with optimal use of basal insulin, in multiple injection regimens or with continuous subcutaneous insulin infusion, resulted in improved HbA(1c) levels of 0.3-0.4% in comparison with regular human insulin. In patients with type 2 diabetes the combination therapy of insulin lispro with an oral agent improved metabolic control in the range of 1.5-2.5%. Such decreases in HbA(1c) should lead to a reduction in risk of complications with both type 1 and type 2 diabetes. The better overall metabolic control with rapid-acting insulin analogs was not accompanied by any increased risk for hypoglycemia.