Insulin is a lifesaving drug for patients with type 1 diabetes mellitus. Many type 2 diabetes
mellitus patients will eventually require insulin. The rapid-acting and long-acting insulin analogues
(RAIAs and LAIAs) have a pharmacological profile that closely mimics normal human physiology
when compared to Neutral Protamine Hagedorn (NPH) insulin and regular human insulin,
respectively. Glucagon-like peptide 1 receptor agonists (GLP-1RAs) were found to have a proven
cardiovascular safety. They are preferred over insulin in many recent guidelines. Fixed-ratio combinations
of GLP-1RAs and insulin are also recommended when either of these molecules fail to
achieve glycaemic control. Despite decades of experience in using insulin, there is a debate among
the scientific community over the safety of exogenous insulin, especially regarding their cardiovascular
safety and the risk of cancer. There is also an ongoing debate regarding the safety, even
though two long-acting insulin analogues (glargine and degludec) have proven their cardiovascular
non-inferiority. Drugs with proven safety are often preferred in patients with pre-existing cardiovascular
disease or at high risk of cardiovascular disease. In this review we will critically analyse efficacy
and safety issues related to insulin molecules to help in clinical decision making.
Keywords: Insulin, insulin analogue, diabetes mellitus, cardiovascular safety, efficacy, cancer.
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