[Future of ultra long-acting insulin analogues]

Optimal insulin therapy should mimic endogenous insulin secretion in healthy subjects and maintain normal glycemic control. Short- or rapid-acting insulin is used to mimic the response of insulin secretion after meal. Basal insulin restrains hepatic glucose production in fasting state, and should be mimicked by neutral protamine Hagedorn (NPH) or long-acting insulin. Long-acting basal insulin analogues offer some advantage over the NPH insulin in terms of less glycemic variability when used once daily. Various scientific associations recommend once-daily basal insulin when starting insulin therapy; therefore, long-acting basal insulin analogues play important part of continual and optimal insulin therapy. In this article, we review long-acting basal insulin analogues currently available in Japan and new basal insulin in research and development phase.