Diabetes Treatment Review
GLP-1 and insulin analogs
Nicole Meinel of the Diabetic Hypoglycemia Editorial Team
Diabetic Hypoglycemia January 2010, Volume 2, Issue 3: page 22-25
Insulin analogs are produced by synthetically modifying the human insulin molecule, retaining the glucose regulatory function of native insulin with different absorption and activity characteristics. Glucagon-like peptide-1 (GLP-1) analogs mimic the action of the peptide hormone GLP-1, and have a glucose-dependent action on the insulin/glucagon balance.
This treatment review focuses on five recent publications that compare both GLP-1 and insulin analogs with established treatment regimens. Two publications compared once-daily liraglutide with twice-daily exenatide and investigated a switch from basal neutral protamine Hagedorn (NPH)-insulin to glargine or detemir in type 1 diabetes patients. A meta-analysis assessed differences in glycemic control, hypoglycemia, and weight gain between treatment with NPH-insulin and insulin detemir or glargine in type 1 diabetes patients. Two further studies investigated whether hormonal and symptomatic responses during hypoglycemia were altered with detemir in comparison with human or NPH insulin.
The review concludes that switching to long-acting insulin analogs from NPH or human insulin appears to be associated with an improvement in glycemic control, and a lower risk of nocturnal and severe hypoglycemia. The switch does not appear to alter counter-regulatory hormonal responses during hypoglycemia in the studies reviewed, although it remains unclear whether symptoms of hypoglycemia differ between insulin types.
Keywords: Glucagon-like peptide-1 analogs, insulin analogs, human insulin, neutral protamine Hagedorn-insulin