Insulin glargine: a basal insulin for the management of diabetes

The prevalence of diabetes mellitus has been increasing steadily in the last 30 years and it is predicted that there will be 300 million people affected by 2025. Insulin deficiency is a feature of both Type 1 and 2 diabetes; insulin treatment, obligatory in Type 1, will also be required in many Type 2 patients. Insulin glargine is the first available synthetic insulin that can truly be described as basal - administered as a once-daily subcutaneous injection it raises the background, or basal, insulin level without a significant peak action and less hypoglycemia than previously used basal insulins. Insulin glargine is the first basal insulin that can be administered as a single injection daily as part of an intensive basal-bolus insulin regimen in Type 1 diabetes. In Type 2 diabetes, insulin glargine, administered once daily with one or two oral hypoglycemic drugs, can enable more than 50% of patients to achieve an A_1c of less than 7%. The titration of the insulin glargine dose to an appropriate level over a period of weeks is essential to its successful use in Type 2 diabetes.