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Insulin Analogue Therapy

Medication

In combination with lifestyle measures (weight control, proper nutrition, and adequate exercise), medications, such as insulin, play an important role in managing type 1, type 2, or gestational diabetes mellitus. Insulin is a human hormone that regulates the amount of glucose (sugar) found in the blood.

However, treatment with human insulin does not always replicate how our bodies normally secrete insulin, so this might not be the best way to control blood glucose levels. To address this limitation, insulin analogues were developed. Insulin analogues differ slightly in their chemical makeup from human insulins. Two main types of insulin analogues are available:

  • Rapid-acting (or bolus) insulin analogues taken at mealtimes to control spikes in glucose
  • Long-acting (or basal) insulin analogues taken to keep glucose levels steady in the background,

Need for Recommendations

Health care providers, consumers, and policy-makers require timely, evidence-based information they can rely on to help treat diabetes.

Because insulin analogues cost more than conventional human insulins, and health care dollars play a significant role in the sustainability of our health care system, the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) Advisory Committee (one of CADTH’s former committees representing Canadian health jurisdictions) recommended that we review the clinical and economic evidence regarding the role of rapid-acting and long-acting insulin analogues in the treatment of diabetes mellitus.

Scope of CADTH Work on Insulin Analogue Therapy Topic

Key research questions on this topic area included:

  • Are insulin analogues justified for all patients with diabetes?
  • Do insulin analogues improve long-term health outcomes or patient quality of life?

CADTH conducted this project under its former COMPUS program. Insulin analogue therapy is one of a number of topics that CADTH has taken on in conjunction with our diabetes priority theme area.

Key Messages

CADTH’s work on this project has resulted in the following key messages:

Bolus insulin therapy:

  • In patients with type 1 diabetes, either regular human insulin or rapid-acting insulin analogues can be considered as first-line therapy (except in adolescent patients).
  • In adolescent patients with type 1 diabetes, rapid-acting insulin analogues may be considered as first-line therapy.
  • In patients with type 2 diabetes requiring bolus insulin, regular human insulin may be considered first. Although the evidence is limited and inconsistent, patients who are experiencing significant hypoglycemia while taking human insulin may benefit from rapid-acting insulin analogues.

Basal insulin therapy:

  • In patients with type 1 or type 2 diabetes requiring basal insulin, insulin NPH should be considered first. Although the evidence is limited and inconsistent, patients who are experiencing significant hypoglycemia while taking insulin NPH may benefit from long-acting insulin analogues.

Refer to our Project Status web page to find out what stage we are at in this project.

Related Information

Find all CADTH reports and tools related to diabetes in the Diabetes Virtual Library.