Diabetes rates will double worldwide by 2030, to 366 million people with the disease, even if the obesity rate remains stable, an international team of researchers reported. This is a global threat now-a-days. As per WHO diabetes are the silent killer of this century and the prevalence of diabetes in South East Asia is increasing rapidly. Usually diabetic patients are suffering from numerous complications like retinopathy (defect in vision linked to diabetes), peripheral neuropathy (disease involving destruction of the tissues of the nervous system), kidney diseases, some heart diseases, stroke.

Recent evidences have proven that strict control of diabetes can reduce its complication significantly. The landmark diabetes trial UKPDS (United Kingdom Prospective Diabetes Study) has shown that every 1 per cent reduction of HbA1c can reduce 35 per cent incidences of diabetes complication like eye and kidney diseases.

Within two years of global launching “LANTUS” becomes the most popular Insulin in America, UK, Germany, France and most part of Europe due to its unique efficacy and safety.

LANTUS has several data in using both Type I and Type II diabetes providing better control and superior safety. That is why LANTUS is considered as the most modern physiological treatment approach for diabetic patients.

LANTUS (insulin glargine) the first long acting insulin analogue has been developed to mimic the physiological basal insulin secretion. It is designed to improve glycemic control and reduce the risk of hypoglycemia offering improved long-term outcomes for people living with diabetes.

This new molecule is going to be launched in Bangladesh by the reputed Multinational Company sanofi-aventis Bangladesh limited.

What is insulin glargine (LANTUS)
Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-hour duration of action), parenteral blood-glucose-lowering agent.

Mechanism of drug action
The primary activity of insulin, is regulation of glucose metabolism.

After injection into the subcutaneous tissue, small amounts of insulin glargine are slowly released, resulting in a relatively constant concentration/time profile over 24 hours with no pronounced peak. This profile allows once-daily dosing as a patient's basal insulin.

The longer duration of action (up to 24 hours) of LANTUS is directly related to its slower rate of absorption and supports once-daily subcutaneous administration. It has more prolonged absorption and a relatively constant concentration/time profile over 24 hours with no pronounced peak in comparison to NPH human insulin. Serum insulin concentrations were thus consistent with the time profile of the pharmacodynamic activity of insulin glargine.

LANTUS had similar effectiveness as either once- or twice-daily NPH human insulin in reducing glycohemoglobin and fasting glucose with a similar incidence of hypoglycemia. This is how it is more patient compliant.

Indication and usage
LANTUS is indicated for once-daily subcutaneous administration for the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia.

Benefit
LANTUS is a recombinant human insulin analog. Its potency is approximately the same as human insulin. It exhibits a relatively constant glucose-lowering profile over 24 hours that permits once-daily dosing.

LANTUS may be administered at any time during the day. LANTUS should be administered subcutaneously once a day at the same time every day. Blood glucose monitoring is recommended for all patients with diabetes.

It possesses the following beneficial factors --

*The unique, peakless Lantus profile helps reduce hypoglycaemia (reduced level of blood glucose level). As it works on basal glucose level, there is the least chance of hypoglucaemic shock that diabetic patients face frequently as a hazard of hypoglycaemic agents.

* Continued insulin release helps patients get to A1C goal (recommended level is less than 7).

* From different studies it was observed that Lantus provides 1% greater A1C reduction than NPH.

Precautions:
LANTUS must only be used if the solution is clear and colorless with no particles visible. The syringes must not contain any other medicinal product or residue. Mixing and diluting. LANTUS must NOT be diluted or mixed with any other insulin or solution.

Storage:
Unopened LANTUS vials should be stored in a refrigerator, 36°F - 46°F (2°C - 8°C). LANTUS should not be stored in the freezer and it should not be allowed to freeze. Discard vial if frozen.

Opened vials, whether or not refrigerated, must be used within 28 days. They must be discarded if not used within 28 days.

Insulin glargine in Bangladesh
Patients have been using insulin glargine in the western world for about two years. But in our country it has been introduced recently by the pharmaceutical company Sanofi Aventis in the trade name "LANTUS".