Insulin analogues: new agents for improving glycemic control.

For years, it has been recognized that "reasonable" control of blood glucose levels reduces the acute complications of diabetes mellitus. Recent studies have conclusively shown that strict glycemic control reduces the appearance and progression of chronic complications. Thus, strict glycemic control is the most salient goal of insulin therapy. Insulin regimens that closely mimic physiologic insulin secretory patterns have been inadequate because of limitations imposed by the pharmacokinetic profiles of commercially available preparations. The newer insulin analogues, both rapid-acting and long-acting, have more appropriate pharmacokinetic profiles. Lispro (Humalog) is the first human insulin analogue to be approved in the United States. Its pharmacokinetic and pharmacodynamic profile makes it amenable for use before meals. The search for long-acting and hepatospecific analogues continues.