The silver jubilee (2025) of insulin glargine: Introducing the era of long‐acting insulin analogues for diabetes mellitus

Bolli, Geremia B., Home, Philip D., Lepore, Mauro, Riddle, Matthew C., Porcellati, Francesca, Fanelli, Carmine G., Lucidi, Paola, Yki‐Järvinen, Hannele, Becker, Reinhard H. and Owens, David R. 2026. The silver jubilee (2025) of insulin glargine: Introducing the era of long‐acting insulin analogues for diabetes mellitus. Diabetes, Obesity and Metabolism: A Journal of Pharmacology and Therapeutics 28 (7) , pp. 5527-5541. 10.1111/dom.70751

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Abstract

In the year 2000 the first once daily long‐acting bioengineered insulin analogue (LAIA), insulin glargine (‘glargine’), a true basal insulin (BI), became available for clinical use. This led to the decline in the 50‐year‐old era and prominence of the intermediate‐acting insulins, neutral protamine Hagedorn (NPH) and lente, requiring twice daily administration to control the basal metabolism of people with type 1 diabetes (T1DM) and type 2 diabetes (T2DM). This milestone bridged the gap between regimens involving unmodified human insulins of the previous century to those referred to as using ‘designer insulins’, with the introduction 4 years previously of the meal‐time analogue, insulin lispro. The rapid gain in popularity of glargine is explained by its clinical benefits (once‐daily dosing, titration to achieve improved pre‐breakfast plasma glucose, with a lower risk of nocturnal hypoglycaemia compared to NPH, and less frequent blood glucose monitoring). These benefits correlate with the pharmacokinetic/pharmacodynamic characteristics of insulin glargine being closer to physiological BI supply. In T2DM glargine changed the paradigm of insulin substitution by embedding the concept of ‘treating‐to‐target’, by starting BI ‘early’, with focus on near‐normal fasting plasma glucose prior to the introduction of prandial insulin, and more recently in combination with GLP‐1 receptor agonists. These practices/principles have continued with the introduction of additional innovative LAIAs for once‐daily or indeed weekly use. Today glargine remains in widespread worldwide use in people with T1DM and T2DM, is often the initial BI used, while it serves as a reference against which other LAIAs are tested in clinical trials.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Additional Information:	License information from Publisher: LICENSE 1: URL: http://creativecommons.org/licenses/by/4.0/
Publisher:	Wiley
ISSN:	1462-8902
Date of First Compliant Deposit:	5 May 2026
Date of Acceptance:	2 April 2026
Last Modified:	02 Jul 2026 15:46
URI:	https://orca.cardiff.ac.uk/id/eprint/186769

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