The New Era of Insulin Therapy: Ultra-Long Acting, Smart Delivery, and Beyond

Jia-Hong LinTaiwan Speaker The New Era of Insulin Therapy: Ultra-Long Acting, Smart Delivery, and BeyondInsulin therapy is entering a transformative era driven by innovations in pharmacology, delivery systems, and data integration, fundamentally reshaping diabetes management. The development of ultra-long-acting basal insulin analogues has markedly improved glycemic stability by providing flatter, more predictable pharmacokinetic and pharmacodynamic profiles with extended duration of action. These agents reduce glycemic variability, lower the risk of nocturnal and overall hypoglycemia, and allow greater dosing flexibility, thereby improving treatment adherence and quality of life for people with diabetes. Beyond molecular advances, smart insulin delivery technologies are redefining how insulin is administered and titrated. Continuous subcutaneous insulin infusion (CSII) systems integrated with continuous glucose monitoring (CGM) have evolved into automated insulin delivery (AID) or hybrid closed-loop systems that dynamically adjust basal insulin and deliver correction boluses based on real-time glucose data. These systems consistently demonstrate superior time-in-range, reduced hypoglycemia, and decreased patient burden compared with conventional multiple daily injections or sensor-augmented pump therapy. Increasingly, algorithm refinement, interoperability, and personalization are enabling broader clinical applicability across age groups and diabetes phenotypes. Collectively, these advances signal a paradigm shift from reactive glucose control toward proactive, personalized, and technology-enabled insulin therapy. The integration of ultra-long-acting insulins, smart delivery systems, and digital innovations promises to further improve glycemic outcomes, safety, and patient-centered care in the management of diabetes.