Rapid-acting Insulin Analogs

Presented by Satish Garg, MD
Session III – Alternate Routes of Insulin Administration
Saturday, October 30, 2004

Reviewed by Joelle Escoffery, PhD

It is well established that the incidence of type 2 diabetes is dramatically increasing. Although less well known, the incidence of type 1 diabetes is also increasing at the rate of 5% per year. The benefits of tight glucose control for the prevention of complications have been clearly demonstrated, but only 25% of people are meeting glycemic targets. The average A1C among patients treated by primary care physicians is 9.7%, and the average A1C of patients treated by endocrinologists is only modestly better at 9.3%. These lackluster results may be partially attributable to the fact that only 38% of patients perform self-monitoring of blood glucose at least once daily. Although there has been an increase in the number of monitors owned, that increase reflects the rapid increase in diabetes, but actual testing frequency is declining.

There are a variety of reasons why glycemic targets are not achieved, including hypoglycemia, weight gain, burnout, and inadequate postprandial control. The development of newer rapid-acting insulin analogs, such as lispro, aspart, and glulisine, have reduced some of the barriers to achieving glycemic targets. These insulins no longer require patients to administer them 30 to 45 minutes prior to eating. They have a rapid onset (10 to 15 minutes) and peak in about an hour, compared with regular human insulin, which has its onset between 30 and 60 minutes and peaks between 2 and 3 hours. All 3 insulin analogs provide greater dosing flexibility and better postprandial control, and they also reduce the need for mid-morning snacks to avoid hypoglycemia.