Insulin Glargine: A Long-Acting Insulin Analog for Better Diabetes Management
Insulin is a key hormone required by our body for maintaining normal blood glucose levels. However, for people with diabetes, their body either does not produce enough insulin or cannot use the insulin properly. These people require insulin injections to control their blood glucose. While regular human insulin has been used for decades, it has limitations in mimicicking the body’s natural basal insulin profile. Insulin glargine was developed to overcome these limitations and provide a more effective treatment option.
What is Insulin Glargine?
Insulin glargine, sold under the brand names Lantus among others, is a long-acting, “basal” insulin analog developed for once-daily administration to diabetics. It was designed to have a relatively flat glucose-lowering action of about 24 hours’ duration after administration in contrast to regular human insulin which typically has a peak effect within 4–6 hours and a duration of action of 8–12 hours.
Insulin glargine differs from regular human insulin in its amino acid composition, resulting in slower absorption from subcutaneous tissue and slower interaction with insulin receptors. Specifically, two arginine residues are added to the molecule and Aspartate at position B3 is substituted with glycine. These modifications prolong the time course of absorption and action, giving it a peakless and extended duration of action compared to regular insulin.
Effectiveness in Glycemic Control
Numerous clinical trials have demonstrated the effectiveness and safety of insulin glargine in achieving glycemic control compared to Neutral Protamine Hagedorn NPH insulin. A meta-analysis of 35 randomized controlled trials involving over 12,000 participants with type 1 and type 2 diabetes found that glargine was associated with significantly lower rates of hypoglycemia and no difference in A1C levels when compared to NPH insulin.
Specifically, insulin glargine was found to reduce the risk of nocturnal hypoglycemia by 41% and the risk of severe hypoglycemia by 25%. The results were consistent regardless of diabetes type, baseline A1C level, or concomitant diabetes medication use. These findings established insulin glargine as the new standard basal insulin, significantly improving patients’ quality of life by reducing the fear of hypoglycemia.
Subsequent studies have evaluated insulin glargine’s efficacy in new populations like geriatric patients with type 2 diabetes. A study published in Diabetes Care found that switching elderly patients (age 65+) from NPH or premixed insulins to glargine significantly reduced the risk of hypoglycemia by 43% along with an improvement in glycemic control. This demonstrated insulin glargine’s safety and benefits in managing diabetes among the elderly.
Ease of Administration
Beyond its clinical efficacy, insulin glargine has practical advantages over other basal insulins that improve treatment adherence and convenience. Unlike NPH insulin which requires refrigeration before use, insulin glargine remains stable at room temperature for up to 28 days after opening. This “room temperature stability” eliminates the need for refrigeration during travel or storage and allows for flexibility in dosing schedules.
Insulin glargine also requires only one injection every day compared to the twice-daily regimen of NPH insulin. The easy, once-daily dosing promotes better adherence to treatment. Additionally, glargine’s peakless action profile means there is very little risk of hypoglycemia if the dose is taken later than usual in the day. This makes missed or delayed doses less problematic compared to regular human insulin.
Overall, these practical benefits of insulin glargine translate to improved quality of life for patients through simplified diabetes management. Many patients find the convenience of an effective “long-acting” insulin that is stable at room temperature and requires only one daily dose an attractive treatment option.
Adverse Effects and Safety Considerations
Insulin glargine is generally well tolerated with a good safety profile. Hypoglycemia remains the most common adverse event but as discussed earlier, clinical trials have consistently shown insulin glargine carries a lower risk compared to NPH insulin, premixed insulins and human insulin. Local injection site reactions like redness, soreness or itching occur in less than 5% of patients.
Importantly, no difference in cancer risk has been demonstrated between insulin glargine and human insulin based on long-term follow-up studies and meta-analyses of randomized trials. However, as with all insulin therapies, clinicians need to be vigilant about potential weight gain in patients switching to or intensifying glargine treatment. Careful diabetes education focusing on diet, exercise and lifestyle can help mitigate against unintended weight gain with insulin therapy.
Insulin glargine represents a significant advancement in diabetes care offering clinicians an effective and convenient basal insulin option. Its pharmacokinetic profile, clinical efficacy, safety and practical characteristics have established it as the preferred long-acting basal insulin analog for type 1 and type 2 diabetes patients requiring insulin therapy. Future research will further optimize insulin delivery and expand the use of insulin analogs like glargine to improve glucose control while minimizing hypoglycemia in more populations with diabetes.
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it