All subjects with type 1 diabetes need insulin and, given the current lack of disease-modifying drugs, all patients with type 2 diabetes will eventually need insulin if they live long lives. The data supporting the use of the new ‘ultra-long’ acting insulin analogue degludec which are currently being considered by the regulatory authorities show a continued improvement in duration and variability of action but the well-known downsides of weight-gain and hypoglycaemia (albeit diminished) remain.

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