Intensive insulin therapy aimed at achieving normoglycaemia is becoming increasingly accepted in the treatment of type 2 diabetes
(T2DM) to reduce the risk of diabetes-related complications. Insulin therapy is increasingly combined with oral antidiabetic
drugs (OADs) to moderate insulin dosage, reduce weight gain and confer cardiovascular protection. However, traditional insulins
are associated with limitations that may act as barriers to initiation, and intensive use of insulin therapy. The advent of
newer, longer-acting, basal insulin analogues, such as insulin glargine (glargine) and insulin detemir (detemir), offer improved
pharmacokinetic and pharmacodynamic profiles compared with neutral protamine Hagedorn insulin (NPH). This potentially provides
concomitant improvements in safety, efficacy and variability of glycaemic control. This paper reviews the properties of these
new long-acting, basal insulin analogues and their potential roles in facilitating the initiation and optimisation of insulin
therapy. Studies that reported the use of insulin and insulin analogues for the treatment of T2DM were identified using Medline.
Key search terms included: ‘insulin glargine’, ‘insulin detemir’, ‘NPH insulin’, ‘basal insulin’, ‘long-acting insulin’, ‘insulin
analogue’, ‘pharmacokinetics’, ‘pharmacodynamics’, ‘dose titration’, ‘algorithms’ and ‘type 2 diabetes’. Abstracts presented
at the American Diabetes Association and the European Association for the Study of Diabetes annual congresses were also searched.
The data show that the long-acting insulin analogues glargine and detemir both offer a low risk of hypoglycaemia and improved
glycaemic control. Aggressive dose titration with glargine and detemir facilitates attainment of glycaemic control targets.
The goal of achieving good glycaemic control with a low risk of hypoglycaemia may be more feasible with newer insulin therapies
as part of a simple basal insulin regimen with continued OADs.
Keywords Insulin glargine - Insulin detemir - NPH insulin - Basal insulin - Type 2 diabetes