Abstract
Introduction Since insulin analogs have pharmacological properties that are similar to the normal
physiological action of insulin, it has been suggested that they provide better glucose
control and less rates of hypoglycemia compared to human insulins.
Methods We performed a narrative, nonsystematic review of the literature including clinical
trials, systematic reviews, meta-analyses, and professional guidelines related to
the comparison of human insulins and insulin analogs in terms of glucose control,
safety profile, and cost.
Results Long-acting basal insulins result in mild improvement in glucose control and less
rates of nocturnal hypoglycemic compared to neutral protamine Hagedorn insulin, mainly
among patients with type 1 diabetes. Rapid-acting insulin analogs provide better glucose
control and lower rates of hypoglycemia compared to regular insulin among patients
with type 1 diabetes, whereas no advantage has been shown for insulin analogs among
patients with type 2 diabetes for glucose control or hypoglycemia. Premixed insulin
analogs provided no advantage in glucose control and inconsistent benefit in lowering
the rates of hypoglycemia compared to human premixed insulins among patients with
type 2 diabetes. The cost of insulin analogs is significantly higher than human insulins,
and favorable cost-effectiveness has only been demonstrated for rapid-acting insulin
analogs in type 1 diabetes.
Conclusion Currently available evidence supports the use of rapid-acting insulin analogs and
possibly long-acting basal insulin over human insulins for patients with type 1 diabetes.
For patients with type 2 diabetes, the use of long-acting insulin analogs may be recommended
for selected patients who are at an increased risk of significant hypoglycemia, while
no clear benefits of meal insulin analogs over human insulins have been observed.
Keywords
diabetes mellitus - insulin analogs - human insulins
