Potential Advantages of a Basal–Bolus Regimen Using Insulin Glulisine as Prandial Insulin
Several interventional studies have demonstrated that achieving near-normal glycaemic control by means of intensive insulin therapy is the best strategy to avoid and slow the progression of chronic complications in type 1 and type 2 diabetes. 1-3 Interestingly, the benefits of intensive treatment seem to extend over time, at least in people with type 1 diabetes, as shown in the Epidemiology of Diabetes and Interventions and Complications (EDIC) trial. 4 However, intensive insulin therapy using
... ulin therapy using multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) increased the risk of severe hypoglycaemia about three-fold. 1 One of the probable explanations behind this observation was the use of unphysiological insulin formulations, because both regular human insulin (RHI) and isophane insulin (NPH) are far from ideal as insulin replacements. In the last 15 years, new insulin formulations have been coming into the market. First, short-acting insulin analogues (SAIAs) were developed to reproduce the physiological prandial insulin response, which is rapid, powerful and of short duration. 5 More recently, long-acting insulin analogues (LAIAs) were introduced to replace basal insulin secretion, which is peakless, sustained and necessary to avoid excessive hepatic glucose production. 5 Insulin glulisine is the most recently marketed SAIA -beside insulin lispro and insulin aspart -and is available to be used as prandial insulin in adults with type 1 and type 2 diabetes. In this article, the potential advantages of insulin glulisine will be discussed, as well as its role as prandial insulin in a basal-bolus regimen.