Insulin analogues. A critical review.
Multiple and important technological innovations in the field of insulin therapy have appeared in the last decade. Insulin analogues with novel pharmacokinetics have been developed. The first of these analogues to appear in the market was insulin lispro. We believe that the most part of the stu-dies carried out with this molecule in comparison with regular insulin were unfair as long as its short duration of action was ignored, since in many of these studies it was administered with meals and with only one dose of intermediate insulin given at night. Several studies done mainly by Italian investigators have proven this concept being true in studies with adequate baseline insulin coverage. Insulin aspart has appeared recently in the market in the United States with very similar effects to lispro. The FDA has recently approved a new ultralong acting analogue. The main advantages are its long, peakless action with better effects during down hours and a lower incidence of hypoglycaemia. We also review other approaches with novel insulin molecules attached to thyroxin or fatty acids in order to create a bridge for binding to plasmatic proteins. These molecules have longer effects and some of them more selective sites of action. Finally we included a brief review of other routes of insulin administration.