CME Review Article #29Variability of Insulin Action and Clinical EffectsAsamoah, Ernest MD, FACE, FACP, FRCP (London) Author Information Clinical Practitioner, Diabetes & Endocrinology Consultants, Indianapolis, Indiana and Voluntary Clinical Assistant Professor of Medicine, Indiana University School of Medicine, Indianapolis, Indiana. The author has disclosed that he has no significant relationships with or financial interests in any commercial company that pertains to this educational activity. Dr. Asamoah is/was a consultant for Novo Nordisk, and is/was on speakers bureau for Amylin, Eli Lilly, GlaxoSmithKline, Novo Nordisk, AstraZeneca, and Sanofi-Aventis. Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity. Reprints: Ernest Asamoah, MD, FACE, FACP, FRCP (London), Diabetes & Endocrinology Consultants, 7440 N Shadeland Avenue, Suite 200, Indianapolis, IN 46250. E-mail: [email protected]. Chief Editor's Note:This article is the 29th of 36 that will be published in 2007 for which a total of up to 36 AMA PRA Category 1 Credits™ can be earned. Instructions for how credits can be earned precede the CME Examination at the back of this issue. The Endocrinologist 17(5):p 282-290, September 2007. | DOI: 10.1097/TEN.0b013e318156355f Buy CME Test Metrics Abstract It is now generally accepted that insulin treatment regimens matching normal physiologic insulin secretion are the optimal approach to management of patients with diabetes whose glycemia cannot be controlled with lifestyle changes or oral drugs. However, many patients do not receive the full benefits of such therapy because of variability in the action of older insulin formulations. Within-patient variability in the pharmacodynamic and pharmacokinetic profiles of older insulin preparations makes it difficult to achieve glycemic control, increases the risk of hypoglycemia, and contributes to day-to-day variability in blood glucose, which is now recognized as an independent risk factor for long-term complications of diabetes. The newer insulin analogs have been engineered to provide more consistent and predictable pharmacodynamic and pharmacokinetic profiles and have been shown to result in significantly decreased within-patient variability in plasma glucose. These newer insulin analogs can also be titrated more aggressively, with less risk of hypoglycemia, and they facilitate the development of insulin regimens that more effectively mimic physiological insulin secretion. In the effort to achieve good glycemic control and lower glycosylated hemoglobin levels, it is imperative that clinicians fully understand the pharmacodynamic and pharmacokinetic actions of insulin analogs to use them effectively. © 2007 Lippincott Williams & Wilkins, Inc.