Newer Insulins in Search of a Niche
Authors: Sachin Majumdar
Journal: Annals of Internal Medicine (2008)

Editorials21 October 2008Newer Insulins in Search of a NicheSachin Majumdar, MD and Eugene Barrett, MD, PhDSachin Majumdar, MDFrom University of Virginia, Charlottesville, VA 22908.Search for more papers by this author and Eugene Barrett, MD, PhDFrom University of Virginia, Charlottesville, VA 22908.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-149-8-200810210-00011 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 2007, diabetes was estimated to affect 7.8% of Americans (23.6 million) (1), and among persons older than age 60 years, the prevalence exceeded 23% (1). Diabetes is a major contributor to blindness, renal failure, limb amputation, stroke, and heart disease. Beyond these dire health-related complications, the annual direct and indirect cost of diabetes in America increased to about $174 billion by 2007 (2).Several large trials have shown that improving glycemic control decreases diabetes-associated complications. The DCCT (Diabetes Complications and Control Trial) showed that in patients with type 1 diabetes, intensive versus usual insulin therapy decreased hemoglobin A1c (HbA1c) ...References1. National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health. National Diabetes Statistics, 2007. Accessed at diabetes.niddk.nih.gov/dm/pubs/statistics/#pre-diabetes on 16 September 2008. Google Scholar2. American Diabetes Association. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008;31:596-615. [PMID: 18308683] CrossrefMedlineGoogle Scholar3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977-86. [PMID: 8366922] CrossrefMedlineGoogle Scholar4. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643-53. [PMID: 16371630] CrossrefMedlineGoogle Scholar5. Hypoglycemia in the Diabetes Control and Complications Trial. The Diabetes Control and Complications Trial Research Group. Diabetes. 1997;46:271-86. [PMID: 9000705] CrossrefMedlineGoogle Scholar6. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53. [PMID: 9742976] CrossrefMedlineGoogle Scholar7. Wright AD, Cull CA, Macleod KM, Holman RR; The UKPDS Group. Hypoglycemia in Type 2 diabetic patients randomized to and maintained on monotherapy with diet, sulfonylurea, metformin, or insulin for 6 years from diagnosis: UKPDS73. J Diabetes Complications. 2006;20:395-401. [PMID: 17070446] CrossrefMedlineGoogle Scholar8. Becker RH, Frick AD. Clinical pharmacokinetics and pharmacodynamics of insulin glulisine. Clin Pharmacokinet. 2008;47:7-20. [PMID: 18076215] CrossrefMedlineGoogle Scholar9. Chapman TM, Noble S, Goa KL. Insulin aspart: a review of its use in the management of type 1 and 2 diabetes mellitus. Drugs. 2002;62:1945-81. [PMID: 12215068] CrossrefMedlineGoogle Scholar10. Holleman F, Hoekstra JB. Insulin lispro. N Engl J Med. 1997;337:176-83. [PMID: 9219705] CrossrefMedlineGoogle Scholar11. Oiknine R, Bernbaum M, Mooradian AD. A critical appraisal of the role of insulin analogues in the management of diabetes mellitus. Drugs. 2005;65:325-40. [PMID: 15669878] CrossrefMedlineGoogle Scholar12. Riddle MC, Rosenstock J, Gerich J; Insulin Glargine 4002 Study Investigators. The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care. 2003;26:3080-6. [PMID: 14578243] CrossrefMedlineGoogle Scholar13. Vague P, Selam JL, Skeie S, De Leeuw I, Elte JW, Haahr H, et al. Insulin detemir is associated with more predictable glycemic control and reduced risk of hypoglycemia than NPH insulin in patients with type 1 diabetes on a basal-bolus regimen with premeal insulin aspart. Diabetes Care. 2003;26:590-6. [PMID: 12610006] CrossrefMedlineGoogle Scholar14. Heise T, Nosek L, Rønn BB, Endahl L, Heinemann L, Kapitza C, et al. Lower within-subject variability of insulin detemir in comparison to NPH insulin and insulin glargine in people with type 1 diabetes. Diabetes. 2004;53:1614-20. [PMID: 15161770] CrossrefMedlineGoogle Scholar15. Holleman F, Gale EA. Nice insulins, pity about the evidence [Editorial]. Diabetologia. 2007;50:1783-90. [PMID: 17634918] CrossrefMedlineGoogle Scholar16. Esposito K, Ciotola M, Maiorino MI, Gualdiero R, Schisano B, Ceriello A, et al. Addition of neutral protamine lispro insulin or insulin glargine to oral type 2 diabetes regimens for patients with suboptimal glycemic control. A randomized trial. Ann Intern Med. 2008;149:531-9. LinkGoogle Scholar17. Roach P, Woodworth JR. Clinical pharmacokinetics and pharmacodynamics of insulin lispro mixtures. Clin Pharmacokinet. 2002;41:1043-57. [PMID: 12403642] CrossrefMedlineGoogle Scholar18. Qayyum R, Bolen S, Maruthur N, Feldman L, Wilson LM, Marinopoulos SS, et al. Systematic review: comparative effectiveness and safety of premixed insulin analogues in type 2 diabetes. Ann Intern Med. 2008;149:549-59. LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Virginia, Charlottesville, VA 22908.Disclosures:Honoraria: E. Barrett (Novo Nordisk Speakers' Bureau [until 2006]).Corresponding Author: Sachin Majumdar, MD, University of Virginia, PO Box 800870, Charlottesville, VA 22908; e-mail, [email protected]edu.Current Author Addresses: Dr. Majumdar: University of Virginia, PO Box 800 870, Charlottesville, VA 22908.Dr. Barrett: University of Virginia, 415 Ray C. Hunt Drive, Charlottesville, VA 22903. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Comparative Effectiveness and Safety of Premixed Insulin Analogues in Type 2 Diabetes Rehan Qayyum , Shari Bolen , Nisa Maruthur , Leonard Feldman , Lisa M. Wilson , Spyridon S. Marinopoulos , Padmini Ranasinghe , Muhammed Amer , and Eric B. Bass Addition of Neutral Protamine Lispro Insulin or Insulin Glargine to Oral Type 2 Diabetes Regimens for Patients with Suboptimal Glycemic Control Katherine Esposito , Miryam Ciotola , Maria Ida Maiorino , Roberto Gualdiero , Bruno Schisano , Antonio Ceriello , Flora Beneduce , Giovanni Feola , and Dario Giugliano Metrics Cited ByCost-effectiveness of switching to biphasic insulin aspart from human premix insulin in a US setting 21 October 2008Volume 149, Issue 8Page: 586-588KeywordsGlucoseHbA1cHypoglycemiaHypoglycemicsInsulinProtaminesSafetyType 2 diabetes ePublished: 21 October 2008 Issue Published: 21 October 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...