ADVANCEMENT OF INSULIN THERAPY IN TREATMENT OF DIABETIC PATIENTS: A REVIEW

Dr. Salama Asaa Ali, Akanganyira Kasenene and Prof. Xu Yancheng*

ABSTRACT

The main goals for the treatment of diabetes mellitus are the avoidance of hyperglycemia to prevent the development or progression of diabetes complications (microvascular and macrovascular), the avoidance of hypoglycemia and maintaining a better quality of life. For type 1 diabetes, insulin is the mainstay of treatment and is indicated in patients with type 2 diabetes who do not achieve optimal glycemic control despite the use of oral hypoglycemic agents. The new insulin analogs including the bolus-analogs (aspart, lispro, glulisine in a group of short and rapid insulin), and the long-acting basal analogs (glargine, detemir), and the premixed insulin analog preparations which allow for a closer replication of a standard insulin profile. The bolus-analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations while the basal-acting analogs come close to the ideal of a smooth relatively flat 24-hour basal insulin supply. The insulin analogs have been shown to have lower risks of hypoglycemia, lower levels of postprandial glucose fluctuations, better patient adherence, more excellent quality of life, and higher satisfaction with treatment. In this review, we will look at the efficacy of different types of insulin analogs introduced and their pharmacodynamics and pharmacokinetics together with different kinds of insulin regimen currently used in clinical practice and discuss some of the factors that influence the choice of a particular insulin regimen.

Keywords: Insulin analogs, diabetes mellitus, basal insulin; bolus insulin, blood glucose.