Insulin therapy: unmet needs and new perspectives

Insulin therapy is the most physiological and effective glucose-lowering treatment for diabetic patients, in which the risk of complications increases proportionally to HbA1c levels. Intensive glucose therapy has been demonstrated to be capable of reducing microvascular risk, a benefit maintained in the long period and also accompanied by a reduction in risk of cardiovascular (CV) disease, but increasing hypoglycaemic episodes. The aim of this review is to provide an overview starting from the burden of disease and critical aspects of acceptance and self-management of insulin therapy, and a comparison of the clinical pharmacology of human and insulin analogues available at present. Insulin is an important component of intensive type 2 diabetes management but some patient/physician barriers - hypoglycemia, fear of reduced quality of life (QoL), absence of insulin preparations that allow one to fully tailor treatment to individual needs, etc. - don't make it possible to obtain an optimal insulin therapy and often also produce a low compliance with the insulin regimen (missing injections have to be considered when analyzing the reasons for suboptimal glycaemic control). Current rapid and long-acting analogues only partially solve problems linked to insulin therapy like flexibility and QoL, but hypoglycaemia still represents an important cause of hospitalization, increased health expenditure and CV mortality. New insulin preparations, like degludec, should be helpful in the future for getting over barriers linked to insulin therapy.