Insulin analogs versus human insulins for the management of diabetes: An evidence-based review

Insulin analogs are preferred by many physicians over human insulins in the management of Type 1 diabetes and in patients with Type 2 diabetes who require insulin. Insulin analogs have a pharmacological profile that is close to the normal physiological action of insulin. There is a notion among some clinicians that insulin analogs offer advantages over human insulins, including better glucose control, less hypoglycemia, and flexibility. A large number of clinical studies, along with systematic reviews, have compared insulin analogs to human insulins in regard to glucose control, rates of hypoglycemia, quality of life, and cost-effectiveness. For Type 1 diabetes, rapid-acting insulin analogs offer better glucose control and less rates of hypoglycemia compared to regular human insulin. Long-acting basal insulins result in less nocturnal hypoglycemia compared to neutral protamine Hagedorn (NPH) insulin but no difference in glucose control in patients with Type 1 diabetes. For patients with Type 2 diabetes, rapid-acting insulins offer no advantage for glucose control or rates of hypoglycemia when compared to regular insulin. There was only a reduction in rates of nocturnal hypoglycemia with no difference in glucose control with the use of basal insulin analogs compared to NPH insulin in Type 2 diabetes. The cost of insulin analogs is considerably higher than human insulins and favorable cost-effectiveness was only demonstrated with rapid-acting insulin analogs in Type 1 diabetes. The available evidence does not support the routine use of insulin analogs over human insulins. There are only few situations where insulin analogs have shown clear benefit over human insulin. In a large percentage of patients cost consideration and lack of better glucose control would favor the use of human insulins.