Where now for insulin glargine - a time for pragmatic medicine?

July 2009 saw the publication of results from a German health insurance database, which suggested that when compared with human insulin, the basal insulin analogue glargine is associated with a dose-dependent increase in cancer (1). When the data were submitted for publication, it was decided to defer their release until a special advisory group of the European Association for the Study of Diabetes (EASD) was convened. This group recommended that the data should be replicated by other studies before the original was published. Evaluation of these studies has proven controversial (2), but it is now clear that cancer must be listed amongst the many other complications of diabetes. Prevention of many, if not all, of these non-neoplastic complications mandates intensive glycaemic control. Data are currently insufficient to draw final conclusions regarding the carcinogenicity of glargine and other insulin analogues, and long-term randomised control trials may not be available for many years. However, the main benefit of glargine over human insulin is reduced symptomatic overnight hypoglycaemia, and in striving for good glucose control, there are safe and effective alternatives. © 2009 Blackwell Publishing Ltd.