Human Insulin Versus Insulin Analogues: A True Companion Forgotten

Insulin, as the oldest therapeutic agent in the management of diabetes mellitus (DM), has always ranked high among different pharmacologic products in all clinical practice guidelines on standard care of DM. Insulin is the most effective agent for glycemic control and glycated hemoglobin (HbA1c) reduction that can be used in all stages of type 2 DM as monotherapy or combined with other glucose-lowering agents (1, 2). Nowadays, in addition to old human insulin products, several rapidand long-acting insulin analogues as pens are available. Arguments, however, continue about the cost-effectiveness of using these new products with pharmacologic profiles closer to normal physiology (3, 4). Based on the American Diabetes Association algorithm for use of glucoselowering medications in type 2 DM, where cost is a major concern, insulin with the lowest cost would be considered (5). According to the World Health Organization guidelines, in low-resource settings, human insulin products, both short-acting regular insulin and intermediate-acting NPH insulin, are strongly recommended as the insulin of choice in adults with type 1 DM and as the third-line treatment for individuals with type 2 DM; long-acting insulin analogues is suggested for patients with frequent severe hypoglycemia with human insulin (6).