Modern basal insulin analogs: An incomplete story

The currently available basal insulin does not completely mimic the endogenous insulin secretion. This has continued to promote the search for ideal basal insulin. The newer basal insulin have primarily focused on increasing the duration of action, reducing variability, and reducing the incidence of hypoglycemia, particularly nocturnal. However, the changing criteria of hypoglycemia within a short span of a few years along with the surprising introduction of major cardiac events as another outcome measure has not only clouded the assessment of basal insulin but has also polarized opinion worldwide about the utility of the newer basal insulin. A critical review of both the pre and post FDA analysis of all the basal insulin in this article attempts to clear some of the confusion surrounding the issues of hypoglycemia and glycemic control. This article also discusses all the trials and meta-analysis done on all the current basal insulin available along with their head-to-head comparison with particular attention to glycemic control and hypoglycemic events including severe and nocturnal hypoglycemia. This in-depth analysis hopes to provide a clear interpretation of the various analyses available in literature at this point of time thereby acting as an excellent guide to the readers in choosing the most appropriate basal insulin for their patient.