Article

New insulin preparations: A primer for the clinician

Luigi Meneghini, MD, MBA
Cleveland Clinic Journal of Medicine May 2016, 83 (5 suppl 1) S27-S33; DOI: https://doi.org/10.3949/ccjm.83.s1.05

Article Figures & Data

Figures

  • FIGURE 1
    FIGURE 1

    Serum insulin concentrations and glucose infusion rate of inhaled insulin for inhaled vs insulin lispro in patients with type 1 diabetes.

    Data from Afrezza (insulin human) inhalation powder [package insert]. Danbury, CT: MannKind Corp; 2014.

  • FIGURE 2
    FIGURE 2

    Example of time to reach steady state without inappropriate accumulation of basal insulin using a simplified one-compartment model (10 U, with half-life ~24 hours). Because dosing frequency is approximately equal to half-life, insulin only accumulates until steady state is reached, at which time the daily injected dose is balanced by elimination. SC = subcutaneous; t1/2 = half-life.

    Reprinted from Endocrine Practice (Heise T, Meneghini LF. Insulin stacking versus therapeutic accumulation: Understanding the differences. Endocr Pract 2014; 20:75–83), © 2014 with permission from the American Association of Clinical Endocrinologists.

Tables

  • TABLE 1

    Insulin products marketed in the United States

    InsuIin (Brand)
    Rapid-acting
    Insulin aspart (NovoLog)
    Insulin lispro (Humalog)
    Insulin glulisine (Apidra)
    Short-acting
    Regular insulin (Humulin R, Novolin R/ReliOn R)
    Intermediate, basal
    NPH insulin (Humulin N, Novolin N/ReliOn N)
    Basal analogues
    Insulin glargine U-100 (Lantus, Basaglar)
    Insulin detemir (Levemir)
    Longer-acting basal analogues
    Insulin glargine U-300 (Toujeo)
    Insulin degludec (Tresiba)
    Premixed
    75% Insulin lispro protamine/25% insulin lispro (Humalog mix 75/25)
    50% Insulin lispro protamine/50% insulin lispro (Humalog mix 50/50)
    70% Insulin lispro protamine/30% insulin aspart (Novolog mix 70/30)
    70% NPH insulin/30% regular insulin (Humulin, Novolin/ ReliOn)
    70% Insulin degludec/30% insulin aspart (Ryzodeg 70/30)
    Inhaled
    Technosphere insulin oral-inhalation system (Afrezza)

    • NPH = neutral protamine Hagedorn.

  • TABLE 2

    Metabolic control results from meta-analysis of studies comparing short-acting insulin analogues with human regular insulin in patients with type 1 or type 2 diabetes mellitus (DM)

    Patients
    Type 1 DMType 2 DM
    HbA1c
    No. studies225
    WMD (95% CI)−0.1%a
    (−0.2 to −0.1)    		0.0%
    (−0.1 to 0.0)
     Continuous SC injection subgroup (7 studies)−0.2%a
    (−0.3 to −0.1)    		—
    —
     Multiple dose injections subgroup (15 studies)−0.1%
    (−0.1 to 0.0)    		—
    —
    Overall hypoglycemia
    No. studies1010
    WMD mean events/pt/mo (95% CI)−0.2%
    (−1.1 to 0.7)    		−0.2%
    (−0.5 to 0.1)
    Severe hypoglycemia
    No. studies, 28Not reportedNot reported
    Median events/100 person-years, insulin analogue vs regular insulin21.8 vs 46.10.3 vs 1.4

    • ↵a Statistically significant in favor of insulin analogues vs regular insulin.

    • CI = confidence interval; SC = subcutaneous; WMD = weighted mean difference.

    • Based on data in Siebenhofer A, Plank J, Berghold A, et al. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev 2006; 19:CD003287.

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