Service d’Endocrinologie, Diabète et Maladies Métaboliques, « Pavillon Leriche », Hôpital Civil, 67091 Strasbourg, Faculté de Médecine, Université Louis Pasteur, Centre National de la Recherche Scientifique, Unité Mixte de recherche 7004, Institut de Physique Biologique, Strasbourg
- Key words: type 2 diabetes, insulin analogues, postprandial hyperglycemy
- DOI : 10.1684/stv.2007.0136
- Page(s) : 240-7
- Published in: 2007
Since the 90s, the insulintherapy has largely benefitted from the progress of genetic engineering. The modifications of its primary structure have allowed the development of insulins imitating the physiological secretion of insulin after subcutaneous absorption.These modified insulins, called insulin analogues, allow patients with type 1 diabetes to have a more flexible treatment and to adapt the insulintherapy to their way of life. Thus, patients with type 1 diabetes can appropriate their treatment more easily, the best example being functional insulintherapy. Moreover, the risk of hypoglycemia, combined with the optimisation of the insulintherapy, is noticeably reduced when compared to the use of regular and NPH insulins. Compared to NPH insulins, the long-acting analogues allow a better control of fasting glycemia and a decreased frequency of hypoglycemia (including during the night) regardless of the time of injection. For patients with type 2 diabetes, long-acting analogues can help instauration a bed time treatment combining a real basal insulin with oral antidiabetics. It is more and more acknowledged that postprandial hyperglycemia plays a negative role in the occurrence of vascular complications for type 2 diabetes. Even if, in terms of HbA1c, the superiority of rapidly acting analogues is moderate, their impact on the control of postprandial hyperglycemia can not be questioned. Studies of cardiovascular morbi-mortality comparing rapidly acting analogues with regular insulin in prandial insulintherapy for type 2 diabetes are required.