Getting closer to physiologic insulin secretion

Background:The goal of insulin replacement therapy in diabetes mellitus (DM) is to recreate a normal physiologic insulin supply throughout the day.Objective: This article reviewed the use of rapidacting insulin analogues in recreating physiologic postprandial insulin responses.Methods: This review article was based on a presentation at a satellite symposium entitled “Realising the Value of Modern Insulins: Reaching Further with Rapid-Acting Insulin Analogues” that was convened during the XIXth World Diabetes Congress, December 3, 2006, in Cape Town, South Africa.Results: In the context of mealtime insulin supply, recreating physiologic postprandial insulin responses requires rapid availability of insulin within a short time of eating and a duration of action that does not extend into the late postprandial period. Conventional human insulin is not ideally suited to SC injection, with its slow onset of action and dose-dependent duration of action. The rapid-acting insulin analogues have been designed to address these deficiencies, with more rapid onset of action, higher maximal effects, and consequently better postprandial glycemic control. These properties have been reported in patients with type 1 and type 2 DM, as well as in nondiabetic individuals in euglycemic clamp studies. Rapid-acting insulin analogues are also of particular interest in people with diabetic nephropathy, women with gestational DM, and elderly patients with DM.Conclusions: Compared with soluble human (regular) insulin, rapid-acting insulin analogues have a more rapid onset of action and a shorter duration of action. Their potential in special patient groups is now being established in clinical research and in everyday practice.