The pharmacokinetics and pharmacodynamics of rapid‐acting insulin analogues and their clinical consequences
- 9 March 2012
- journal article
- research article
- Published by Wiley in Diabetes, Obesity and Metabolism
- Vol. 14 (9), 780-788
- https://doi.org/10.1111/j.1463-1326.2012.01580.x
Abstract
Postprandial glucose excursions can inhibit achievement of good glycaemic control, and possibly have a specific effect on the risk of vascular comorbidities. Rapid‐acting analogues control these excursions better than human insulin because their pharmacokinetic/pharmacodynamic (PK/PD) profile is closer to that of meal‐time endogenous insulin secretion. Review of the findings of PK/PD studies and clinical trials suggests that the three marketed rapid‐acting analogues—insulin lispro, insulin aspart and insulin glulisine—are equally efficacious and safe. In comparison with human insulin when using the same basal insulin, they provide comparable glycaemic control with a reduced risk of hypoglycaemia, although the combination of rapid‐acting and basal analogues reduces glycated haemoglobin (HbA1c) more than human meal‐time insulin combined with neutral protamine Hagedorn (NPH) insulin. Some studies have suggested that insulin glulisine has a slightly faster onset of action compared with insulin lispro or insulin aspart, but this has not been translated into demonstrable clinical benefit. Treatment satisfaction in patients with diabetes has been higher when therapy with a rapid‐acting analogue is used instead of human insulin, perhaps due to differences in advised timing of injection. The largest benefits in efficacy, hypoglycaemia incidence, treatment satisfaction and quality of life have occurred when patients receive an all‐analogue meal‐time plus basal regimen as compared with an all‐human insulin regimen. No new safety issues have been identified with the marketed rapid‐acting analogues, and their insulin‐like growth factor 1receptor affinity and mitogenic activity are comparable to human insulin.Keywords
This publication has 73 references indexed in Scilit:
- Comparative pharmacodynamic and pharmacokinetic characteristics of subcutaneous insulin glulisine and insulin aspart prior to a standard meal in obese subjects with type 2 diabetesDiabetes, Obesity and Metabolism, 2011
- Standards of Medical Care in Diabetes—2011Diabetes Care, 2011
- Metabolic consequences of incorrect insulin administration techniques in aging subjects with diabetesActa Diabetologica, 2010
- Risk for nocturnal hypoglycemia with biphasic insulin aspart 30 compared with biphasic human insulin 30 in adults with type 2 diabetes mellitus: A meta-analysisClinical Therapeutics, 2009
- Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort studyDiabetologia, 2009
- Effect of Age of Infusion Site and Type of Rapid-Acting Analog on Pharmacodynamic Parameters of Insulin Boluses in Youth With Type 1 Diabetes Receiving Insulin Pump TherapyDiabetes Care, 2009
- Long-term efficacy and safety of biphasic insulin aspart in patients with type 2 diabetesEuropean Journal of Internal Medicine, 2004
- Insulin AdministrationDiabetes Care, 2004
- Differences in Pharmacokinetics and Pharmacodynamics of Insulin Lispro and Aspart in Healthy VolunteersExperimental and Clinical Endocrinology & Diabetes, 2002
- Injection Site Effects on the Pharmacokinetics and Glucodynamics of Insulin Lispro and Regular InsulinDiabetes Care, 1996