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Attri B, Nagendra L, Dutta D, Shetty S, Shaikh S, Kalra S, Bhattacharya S. Prandial Insulins: A Person-Centered Choice. Curr Diab Rep 2024; 24:131-145. [PMID: 38568467 DOI: 10.1007/s11892-024-01540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE OF REVIEW Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management. RECENT FINDINGS Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods. The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.
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Affiliation(s)
- Bhawna Attri
- Department of Endocrinology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Deep Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis and Rheumatism (CEDAR) Super-Speciality Healthcare, Dwarka, Delhi, India
| | - Sahana Shetty
- Department of Endocrinology, Kasturba Medical College, Manipal, Karnataka, India
| | - Shehla Shaikh
- Department of Endocrinology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Saptarshi Bhattacharya
- Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, Delhi, 110076, India.
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Wang Y, Song M, Qi BR. Effects of insulin aspart and metformin on gestational diabetes mellitus and inflammatory markers. World J Diabetes 2023; 14:1532-1540. [PMID: 37970132 PMCID: PMC10642422 DOI: 10.4239/wjd.v14.i10.1532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/15/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) refers to hyperglycemia caused by insulin resistance or insufficient insulin secretion during pregnancy. Patients with GDM have a high risk of pregnancy complications, which can adversely affect both maternal and fetal health. Therefore, early diagnosis, treatment and monitoring of GDM are essential. In recent years, a new treatment scheme represented by insulin aspart combined with metformin has received increasing attention. AIM To explore the effects of insulin aspart combined with metformin on patients with GDM and inflammatory markers. METHODS From April 2020 to September 2022, 124 patients with GDM in Sanya Women and Children's Hospital Managed by Shanghai Children's Medical Center were collected and analyzed retrospectively. The control group (CG) comprised 62 patients treated with insulin aspart alone, and 62 patients treated with insulin aspart and metformin formed the observation group (OG). Before and after treatment, improvement of blood-glucose-related indexes [fasting blood glucose (FBG), 2-h postprandial glucose (2h PG) and hemoglobin A1c (HbA1c)], serum related factor [serum homocysteine (Hcy)], serum inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-6 and C-reactive protein (CRP)] were compared between the two groups. The clinical efficacy, adverse pregnancy outcomes and incidence of pregnancy complications were compared between the two groups. RESULTS After treatment, the levels of FBG, 2h PG, HbA1c, Hcy, TNF-α, IL-6 and CRP in both groups were significantly decreased (P < 0.05), and the levels of FBG, 2h PG, HbA1c, Hcy, TNF-α, IL-6 and CRP in the OG were lower than in the CG (P < 0.05). The total clinical effectiveness in the OG was higher than that in the CG (P < 0.05). The total incidence of adverse pregnancy outcomes and complications in the OG was significantly lower than in the CG (P < 0.05). CONCLUSION Insulin aspart combined with metformin are effective for treatment of GDM, which can reduce blood-glucose-related indexes, Hcy and serum inflammatory cytokines, and risk of adverse pregnancy outcomes and complications.
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Affiliation(s)
- Yan Wang
- Department of Obstetrics and Gynecology, Sanya Women and Children’s Hospital Managed by Shanghai Children’s Medical Center, Sanya 572099, Hainan Province, China
| | - Min Song
- Department of Obstetrics and Gynecology, Sanya Women and Children’s Hospital Managed by Shanghai Children’s Medical Center, Sanya 572099, Hainan Province, China
| | - Bang-Ruo Qi
- Department of Obstetrics and Gynecology, Sanya Women and Children’s Hospital Managed by Shanghai Children’s Medical Center, Sanya 572099, Hainan Province, China
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Lechleitner M, Roden M, Weitgasser R, Ludvik B, Fasching P, Hoppichler F, Kautzky-Willer A, Schernthaner G, Prager R, Kaser S, Wascher TC. [Injection therapy of diabetes]. Wien Klin Wochenschr 2023; 135:45-52. [PMID: 37101024 PMCID: PMC10133050 DOI: 10.1007/s00508-023-02171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The present article is a recommendation of the Austrian Diabetes Association for the practical use of injection therapy (GLP1-receptor agonists and insulin) in type 2 diabetes.
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Affiliation(s)
- Monika Lechleitner
- Avomed-Arbeitskreis für Vorsorgemedizin und Gesundheitsförderung in Tirol, Innsbruck, Österreich
| | - Michael Roden
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetesforschung, Düsseldorf, Deutschland
- Deutsches Zentrum für Diabetesforschung (DZD e. V.), München-Neuherberg, Deutschland
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
- Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Bernhard Ludvik
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Peter Fasching
- Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
| | - Guntram Schernthaner
- Department of Internal Medicine II, Medizinische Universität Wien, Wien, Österreich
| | - Rudolf Prager
- Stoffwechselzentrum im Rudolfinerhaus, Rudolfinerhaus Privatklinik, Wien, Österreich
| | - Susanne Kaser
- Department für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - T C Wascher
- Medizinische Abteilung, Hanusch-Krankenhaus, Wien, Österreich
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Rosinha P, Teixeira S, Vilaverde J, Cardoso MH. Faster Insulin Aspart for Continuous Subcutaneous Insulin Infusion: Is It Worth It? Cureus 2022; 14:e28422. [PMID: 36176818 PMCID: PMC9509526 DOI: 10.7759/cureus.28422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Faster insulin aspart (fASP) is the new formulation of insulin aspart (ASP) with a left-shifted pharmacokinetic profile, allowing better control of early postprandial hyperglycemia and a reduction in the risk of late post-meal hypoglycemia. However, it can be associated with more frequent infusion set changes. The purpose of this study is to evaluate efficacy and safety one, three, and six months after starting fASP in continuous subcutaneous insulin infusion (CSII) systems. Methods This is a retrospective study that included adults with type 1 diabetes mellitus, users of CSII ≥3 months, who started fASP. Exclusion criteria included less than one month of follow-up after the intervention, concomitant initiation of pharmacological therapy, pre-conception period, and non-use of continuous glucose monitoring. Results A total of 77 individuals were included, of which 52 (67.5%) were female, aged 39.87 ± 13.10 years, with a mean time under CSII of 7.30 ± 3.58 years and a median follow-up time after transition to fASP of six months. There was a trend to a global glycemic control improvement at six months after starting fASP: numeric increase in time in range (56.40 ± 12.62% vs 60.15 ± 13.53%, p=0.148), reduction in time above range (37.76 ± 13.05% vs 34.67 ± 14.94%, p=0.557), time below range (6.00 (5.00)% vs 4.50 (5.25)%, p=0.122), and mean glucose (174.29 ± 25.14 mg/dL vs 167.00 ± 25.30 mg/dL, p=0.207). There was a reduction in body mass index (BMI) at six months after switching to fASP (25.08 (4.59) kg/m2 vs 24.45 (3.05) kg/m2, p=0.010), despite the absence of a significant variation in total daily insulin. Adverse event and discontinuation rates were 7.8% and 6.5%, respectively, with no documented episodes of diabetic ketoacidosis or severe hypoglycemia. Conclusions fASP proved to be a safe and effective therapeutic option in CSII systems associated with a significant BMI reduction, aspects that might justify its preference.
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Insulin Aspart Combined with Exercise Therapy in Spleen Deficiency Type Gestational Diabetes Mellitus: The Effect on Disease Control and Pregnancy Outcomes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3084522. [PMID: 35600942 PMCID: PMC9117034 DOI: 10.1155/2022/3084522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022]
Abstract
Objective. To investigate the effect of insulin aspart combined with exercise therapy on the disease control and pregnancy outcomes of spleen deficiency type gestational diabetes mellitus patients. Methods. In this prospective study, a total of 102 patients with spleen deficiency type gestational diabetes mellitus admitted to our hospital from January 2019 to December 2019 were selected and assigned at a ratio of 1 : 1 via the random number table method to receive insulin aspart (control group) or insulin aspart plus exercise therapy (observation group). Outcome measures include blood sugar, clinical efficacy, adverse pregnancy outcomes, and complications. Results. Insulin aspart plus exercise therapy was associated with significantly lower blood glucose and glycosylated hemoglobin levels versus insulin aspart alone (
). Insulin aspart plus exercise therapy resulted in significantly higher total efficacy (96.08%) versus insulin aspart (74.51%) (
). Patients receiving insulin aspart plus exercise therapy showed a significantly lower incidence of adverse pregnancy outcomes (3.92%) versus those given insulin aspart alone (37.25%) (
). Insulin aspart plus exercise therapy resulted in a lower incidence of complications (5.88%) versus insulin aspart (41.17%) (
). Conclusion. Exercise therapy plus insulin aspart might offer a viable treatment alternative for patients with spleen deficiency-type gestational diabetes mellitus given its promising effects in disease control and pregnancy outcomes, with good efficacy and safety profiles.
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Costa C, Linhares MI, Bastos F, Cardoso R, Dinis I, Santos AP, Mirante A, Serra-Caetano J. Effect of ultra-rapid insulin aspart on glycemic control in children with type 1 diabetes: the experience of a Portuguese tertiary centre. Diabetol Int 2022; 13:531-537. [PMID: 35036267 PMCID: PMC8740860 DOI: 10.1007/s13340-021-00565-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 12/01/2022]
Abstract
Background Postprandial hyperglycemia is one of the biggest challenges in children with type 1 diabetes (T1D). Ultra-fast-acting aspartic insulin (faster aspart) has a quicker onset of action and an earlier maximum activity. The aim of this study is to analyze the impact of faster aspart in metabolic control of pediatric patients with T1D in a “real-world” setting. Methods Retrospective analysis of 60 pediatric patients with T1D who changed their insulin analogue to faster aspart. Anthropometric data, insulin doses, capillary and interstitial glucose recordings and average glycated hemoglobin before and after insulin analogue’s switch were obtained. After all population analyses, patients were analyzed separately according to the type of treatment, multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and according to age group. Results Faster aspart significantly improved metabolic control, increasing time in range (TIR) (42 vs.54%, respectively; P = 0.007) and decreasing time above range (TAR) (52 vs.40%, respectively; P = 0.009), without an increased time in hypoglycemia (7% before and after faster aspart’s introduction; P = 0.933). This was reassured in the adolescent years (n = 45), with an increase in TIR (37 vs. 47%, respectively; P = 0.034) and decrease in TAR (51 vs. 45%, respectively; P = 0.022). Patients on CSII (n = 47), also demonstrated an increase in TIR (38 vs. 50%, respectively; P = 0.010). The reduction of A1c was not statistically significant. Conclusion Although the advantage of faster aspart had already been demonstrated in pediatric patients under MDI, “real-world” studies, including patients under CSII, are still lacking. This study highlights the important impact of faster aspart on metabolic control in children with T1D, particularly among adolescents under CSII.
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Affiliation(s)
- Cláudia Costa
- Serviço de Endocrinologia, Instituto Português de Oncologia do Porto Francisco Gentil, Rua Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal
| | | | - Filipa Bastos
- Serviço de Endocrinologia, Hospital Garcia de Orta, Almada, Portugal
| | - Rita Cardoso
- Unidade de Endocrinologia Pediátrica de Endocrinologia, Hospital Pediátrico de Coimbra-CHUC, Coimbra, Portugal
| | - Isabel Dinis
- Unidade de Endocrinologia Pediátrica de Endocrinologia, Hospital Pediátrico de Coimbra-CHUC, Coimbra, Portugal
| | - Ana Paula Santos
- Serviço de Endocrinologia, Instituto Português de Oncologia do Porto Francisco Gentil, Rua Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal
| | - Alice Mirante
- Unidade de Endocrinologia Pediátrica de Endocrinologia, Hospital Pediátrico de Coimbra-CHUC, Coimbra, Portugal
| | - Joana Serra-Caetano
- Unidade de Endocrinologia Pediátrica de Endocrinologia, Hospital Pediátrico de Coimbra-CHUC, Coimbra, Portugal
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Benioudakis E, Karlafti E, Kalaitzaki A, Kaiafa G, Savopoulos C, Didangelos T. Technological Developments and Quality of Life in Type 1 Diabetes Mellitus Patients: A Review of the Modern Insulin Analogues, Continuous Glucose Monitoring and Insulin Pump Therapy. Curr Diabetes Rev 2022; 18:e031121197657. [PMID: 34732118 DOI: 10.2174/1573399818666211103163208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/15/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disease, which is characterized by an increased prevalence worldwide, which, in fact, tends to take extensive dimensions. The recent rapid development of science and technology has significantly contributed to the improvement of the management of type 1 diabetes mellitus, both in achieving the required euglycaemic regulation and reducing the psychological burden associated with the disease, consequently improving the quality of life of the patients with type 1 diabetes mellitus. METHODS A literature review from 2010, related to the contribution of the modern insulin analogues, continuous glucose monitoring and the insulin pump, was performed using Scopus, ScienceDirect and PubMed databases. RESULTS Studies included in the review support a direct and indirect association of technological innovations with the quality of life. The use of type 1 diabetes mellitus technology was negatively associated with the frequency of the hypoglycaemias and the value of the glycosylated hemoglobin, while at the same time, the development and use of the related technology were highly associated with an improvement in the quality of life. CONCLUSION Patients' quality of life is an indicator of the management of type 1 diabetes mellitus, and it is just as important as glycaemic regulation. Through this review, it was concluded that a better quality of life of T1DM patients was associated with the improvement of glycosylated hemoglobin and hypoglycemic episodes.
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Affiliation(s)
- Emmanouil Benioudakis
- Psychiatric Clinic of the General Hospital of Chania, Chania, Greece
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyroula Kalaitzaki
- Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life, Social Work Department, Health Sciences Faculty, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Georgia Kaiafa
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Savopoulos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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8
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Piro S, Purrello F. Acute diabetes complications. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Daly A, Hartnell S, Boughton CK, Evans M. Hybrid Closed-loop to Manage Gastroparesis in People With Type 1 Diabetes: a Case Series. J Diabetes Sci Technol 2021; 15:1216-1223. [PMID: 34378426 PMCID: PMC8564229 DOI: 10.1177/19322968211035447] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastroparesis is associated with unpredictable gastric emptying and can lead to erratic glucose profiles and negative impacts on quality-of-life. Many people with gastroparesis are unable to meet glycemic targets and there is a need for new approaches for this population. Hybrid closed-loop systems improve glucose control and quality-of-life but evidence for their use in people with diabetic gastroparesis is limited. METHODS We present a narrative review of the challenges associated with type 1 diabetes management for people with gastroparesis and present a case series of 7 people with type 1 diabetes and gastroparesis. We compare glycemic control before and during the first 12 months of hybrid closed-loop therapy. Data were analyzed using electronic patient records and glucose management platforms. We also discuss future advancements for closed-loop systems that may benefit this population. RESULTS Five of 7 patients had data available for time in range before and during hybrid closed-loop therapy, and all had an improvement in percentage time in target glucose range, with the overall mean time in range increasing from 26.0% ± 15.7% to 58.4% ± 8.6% during HCL use, (P = .004). There were significant reductions in HbA1c (83 ± 9 mmol/mol to 71 ± 14 mmol/mol) and mean glucose from 13.0 ± 1.7 mmol/L (234 ± 31 mg/dL) to 10.0 ± 0.7 mmol/L (180 ± 13 mg/dL) with use of a hybrid closed-loop system. Importantly, this was achieved without an increase in time in hypoglycemia (P = .50). CONCLUSION Hybrid closed-loop systems may represent a valuable approach to improve glycemic control for people with type 1 diabetes and gastroparesis. Prospective studies are required to confirm these findings.
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Affiliation(s)
- Aideen Daly
- Wellcome Trust-MRC Institute of
Metabolic Science, University of Cambridge, Cambridge, UK
- Aideen Daly, MB BCh, Wellcome Trust-MRC
Institute of Metabolic Science, University of Cambridge, Level 4, Addenbrookes
Hospital, Cambridge, CB2 0QQ, UK.
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic,
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charlotte K. Boughton
- Wellcome Trust-MRC Institute of
Metabolic Science, University of Cambridge, Cambridge, UK
- Wolfson Diabetes and Endocrine Clinic,
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mark Evans
- Wellcome Trust-MRC Institute of
Metabolic Science, University of Cambridge, Cambridge, UK
- Wolfson Diabetes and Endocrine Clinic,
Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Phyo P, Zhao X, Templeton AC, Xu W, Cheung JK, Su Y. Understanding molecular mechanisms of biologics drug delivery and stability from NMR spectroscopy. Adv Drug Deliv Rev 2021; 174:1-29. [PMID: 33609600 DOI: 10.1016/j.addr.2021.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 02/07/2021] [Indexed: 02/06/2023]
Abstract
Protein therapeutics carry inherent limitations of membrane impermeability and structural instability, despite their predominant role in the modern pharmaceutical market. Effective formulations are needed to overcome physiological and physicochemical barriers, respectively, for improving bioavailability and stability. Knowledge of membrane affinity, cellular internalization, encapsulation, and release of drug-loaded carrier vehicles uncover the structural basis for designing and optimizing biopharmaceuticals with enhanced delivery efficiency and therapeutic efficacy. Understanding stabilizing and destabilizing interactions between protein drugs and formulation excipients provide fundamental mechanisms for ensuring the stability and quality of biological products. This article reviews the molecular studies of biologics using solution and solid-state NMR spectroscopy on structural attributes pivotal to drug delivery and stability. In-depth investigation of the structure-function relationship of drug delivery systems based on cell-penetrating peptides, lipid nanoparticles and polymeric colloidal, and biophysical and biochemical stability of peptide, protein, monoclonal antibody, and vaccine, as the integrative efforts on drug product design, will be elaborated.
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Affiliation(s)
- Pyae Phyo
- Pharmaceutical Sciences, Merck & Co., Inc., Kenilworth, NJ 07033, United States
| | - Xi Zhao
- Pharmaceutical Sciences, Merck & Co., Inc., Kenilworth, NJ 07033, United States
| | - Allen C Templeton
- Pharmaceutical Sciences, Merck & Co., Inc., Kenilworth, NJ 07033, United States
| | - Wei Xu
- Pharmaceutical Sciences, Merck & Co., Inc., Kenilworth, NJ 07033, United States
| | - Jason K Cheung
- Pharmaceutical Sciences, Merck & Co., Inc., Kenilworth, NJ 07033, United States
| | - Yongchao Su
- Pharmaceutical Sciences, Merck & Co., Inc., Kenilworth, NJ 07033, United States.
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Chawla R, Mukherjee JJ, Chawla M, Kanungo A, Shunmugavelu MS, Das AK. Expert Group Recommendations on the Effective Use of Bolus Insulin in the Management of Type 2 Diabetes Mellitus. Med Sci (Basel) 2021; 9:38. [PMID: 34071359 PMCID: PMC8162981 DOI: 10.3390/medsci9020038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/22/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
Evidence suggests a major contribution of postprandial glucose (PPG) excursions to the increased risk of micro- and macro-vascular complications in individuals with type 2 diabetes mellitus (T2DM). Administration of bolus insulin remains a very effective therapeutic option for PPG control. The aim of this expert group recommendation document was to provide practical and easy-to-execute guidelines for physicians on the appropriate use of bolus insulin in the management of T2DM. A panel of key opinion leaders from India reviewed and discussed the available clinical evidence and guideline recommendations on the following topics: (1) optimum control of PPG; (2) choice of bolus insulin; and (3) special situations and practical considerations. The expert panel critically analyzed the current literature and clinical practice guidelines and factored their rich clinical experience to develop a set of nine expert group recommendations for the effective use of bolus insulin. These recommendations will not only result in a more evidence-based application of bolus insulin in the clinical setting but also trigger further research and provide a valuable base for the development of future guidelines on the use of bolus insulin in the management of individuals with T2DM.
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Affiliation(s)
- Rajeev Chawla
- Department of Diabetology, North Delhi Diabetes Centre, 180, Jai Apartments, Sec 9, Rohini 110085, India;
| | - Jagat Jyoti Mukherjee
- Division of Endocrinology, Department of Medicine, Apollo Gleneagles Hospitals, 58, Canal Circular Road, Kolkata 700054, India
| | - Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, 704, Cosmos Plaza, Opp. Indian Oil Nagar, J.P. Road, Andheri (W), Mumbai 400053, India;
| | - Alok Kanungo
- Department of Diabetology, Kanungo Institute of Diabetes Specialities Pvt. Ltd., 1120, Dumduma, Bhubaneswar 751019, India;
| | - Meenakshi Sundaram Shunmugavelu
- Department of Diabetology, Trichy Diabetes Speciality Centre (P) Ltd. B-37, Sasthri Road, VII Cross East, Thillai Nagar, Trichy 620018, India;
| | - Ashok Kumar Das
- Department of Internal Medicine, Pondicherry Institute of Medical Sciences, Kalathumettupathai, Ganapathichettikulam Village, No 20, Kalapet, Puducherry 6050146, India;
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Berget C, Lange S, Messer L, Forlenza GP. A clinical review of the t:slim X2 insulin pump. Expert Opin Drug Deliv 2020; 17:1675-1687. [PMID: 32842794 DOI: 10.1080/17425247.2020.1814734] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Insulin pumps are commonly used for intensive insulin therapy to treat type 1 diabetes in adults and youth. Insulin pump technologies have advanced dramatically in the last several years to integrate with continuous glucose monitors (CGM) and incorporate control algorithms. These control algorithms automate some insulin delivery in response to the glucose information received from the CGM to reduce the occurrence of hypoglycemia and hyperglycemia and improve overall glycemic control. The t:slim X2 insulin pump system became commercially available in 2016. It is an innovative insulin pump technology that can be updated remotely by the user to install new software onto the pump device as new technologies become available. Currently, the t:slim X2 pairs with the Dexcom G6 CGM and there are two advanced software options available: Basal-IQ, which is a predictive low glucose suspend (PLGS) technology, and Control-IQ, which is a Hybrid Closed Loop (HCL) technology. This paper will describe the different types of advanced insulin pump technologies, review how the t:slim X2 insulin pump works, and summarize the clinical studies leading to FDA approval and commercialization of the Basal-IQ and Control-IQ technologies.
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Affiliation(s)
- Cari Berget
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
| | - Samantha Lange
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
| | - Laurel Messer
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
| | - Gregory P Forlenza
- School of Medicine, Barbara Davis Center for Childhood Diabetes, University of Colorado Anschutz Campus , Aurora, CO, USA
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13
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Garg SK. Reflections on Diabetes Care at the End of the Second Decade of the 21st Century. Diabetes Technol Ther 2020; 22:63-65. [PMID: 31916843 DOI: 10.1089/dia.2020.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Satish K Garg
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, Colorado
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14
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Falk BT, Liang Y, McCoy MA. Profiling Insulin Oligomeric States by 1H NMR Spectroscopy for Formulation Development of Ultra-Rapid-Acting Insulin. J Pharm Sci 2019; 109:922-926. [PMID: 31449814 DOI: 10.1016/j.xphs.2019.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/16/2019] [Accepted: 07/30/2019] [Indexed: 11/15/2022]
Abstract
Formulations that can increase the dissociation of insulin oligomers into monomers/dimers are important considerations in the development of ultra-rapid-acting insulins with faster onset and shorter duration of actions. Here we present a novel strategy to characterize the oligomeric states of insulin in solution that leverages the ability of nuclear magnetic resonance spectroscopy to assess higher-order structure of proteins in solution. The oligomeric structures and solution behaviors of 2 fast-acting insulins, aspart and lispro, with varying excipient concentrations were studied using 1D and diffusion profiling methods. These methods can provide insight on the structural differences and distributions of the molecular association states in different insulin formulations, which is consistent with other orthogonal biophysical characterization tools. In addition, these methods also highlight their sensitivity to subtle changes in solution behaviors in response to excipient that are difficult to monitor with other tools. This work introduces the utility of 1D and diffusion profiling methods to characterize the oligomeric assembly of fast-acting insulins, suggesting promising applications in compound screening, excipient selection, and formulation development of fast-acting insulins as well as other peptide or protein therapeutics.
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Affiliation(s)
- Bradley T Falk
- Mass Spectrometry and Biophysics, Merck & Co., Inc., Kenilworth, New Jersey 07033
| | - Yingkai Liang
- Discovery Pharmaceutical Sciences, Merck & Co., Inc., West Point, Pennsylvania 19486
| | - Mark A McCoy
- Mass Spectrometry and Biophysics, Merck & Co., Inc., Kenilworth, New Jersey 07033.
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15
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Zhang R, Zhang N, Mohri M, Wu L, Eckert T, Krylov VB, Antosova A, Ponikova S, Bednarikova Z, Markart P, Günther A, Norden B, Billeter M, Schauer R, Scheidig AJ, Ratha BN, Bhunia A, Hesse K, Enani MA, Steinmeyer J, Petridis AK, Kozar T, Gazova Z, Nifantiev NE, Siebert HC. Nanomedical Relevance of the Intermolecular Interaction Dynamics-Examples from Lysozymes and Insulins. ACS OMEGA 2019; 4:4206-4220. [PMID: 30847433 PMCID: PMC6398350 DOI: 10.1021/acsomega.8b02471] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/28/2018] [Indexed: 06/01/2023]
Abstract
Insulin and lysozyme share the common features of being prone to aggregate and having biomedical importance. Encapsulating lysozyme and insulin in micellar nanoparticles probably would prevent aggregation and facilitate oral drug delivery. Despite the vivid structural knowledge of lysozyme and insulin, the environment-dependent oligomerization (dimer, trimer, and multimer) and associated structural dynamics remain elusive. The knowledge of the intra- and intermolecular interaction profiles has cardinal importance for the design of encapsulation protocols. We have employed various biophysical methods such as NMR spectroscopy, X-ray crystallography, Thioflavin T fluorescence, and atomic force microscopy in conjugation with molecular modeling to improve the understanding of interaction dynamics during homo-oligomerization of lysozyme (human and hen egg) and insulin (porcine, human, and glargine). The results obtained depict the atomistic intra- and intermolecular interaction details of the homo-oligomerization and confirm the propensity to form fibrils. Taken together, the data accumulated and knowledge gained will further facilitate nanoparticle design and production with insulin or lysozyme-related protein encapsulation.
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Affiliation(s)
- Ruiyan Zhang
- Institute
of Biopharmaceutical Research, Liaocheng
University, Liaocheng 252059, P. R. China
- RI-B-NT
Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148 Kiel, Germany
- Institute
of Zoology, Department of Structural Biology, Christian-Albrechts-University, Am Botanischen Garten 1-9, 24118 Kiel, Germany
| | - Ning Zhang
- Institute
of Biopharmaceutical Research, Liaocheng
University, Liaocheng 252059, P. R. China
| | - Marzieh Mohri
- RI-B-NT
Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148 Kiel, Germany
| | - Lisha Wu
- Department
of Chemical and Biological Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Thomas Eckert
- Department
of Chemistry and Biology, University of
Applied Sciences Fresenius, Limburger Str. 2, 65510 Idstein, Germany
- Institut
für Veterinärphysiolgie und Biochemie, Fachbereich Veterinärmedizin, Justus-Liebig-Universität Gießen, Frankfurter Str. 100, 35392 Gießen, Germany
| | - Vadim B. Krylov
- Laboratory
of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky prospect 47, 119991 Moscow, Russian Federation
| | - Andrea Antosova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Slavomira Ponikova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Zuzana Bednarikova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Philipp Markart
- Medical
Clinic II, Justus-Liebig-University, Klinikstraße 33, 35392 Giessen, Germany
- Pneumology,
Heart-Thorax-Center Fulda, Pacelliallee 4, 36043 Fulda, Germany
| | - Andreas Günther
- Medical
Clinic II, Justus-Liebig-University, Klinikstraße 33, 35392 Giessen, Germany
| | - Bengt Norden
- Department
of Chemical and Biological Engineering, Chalmers University of Technology, 41296 Gothenburg, Sweden
| | - Martin Billeter
- Department
of Chemistry and Molecular Biology, University
of Gothenburg, 40530 Gothenburg, Sweden
| | - Roland Schauer
- Institute
of Biochemistry, Christian-Albrechts-University, Olshausenstrasse 40, 24098 Kiel, Germany
| | - Axel J. Scheidig
- Institute
of Zoology, Department of Structural Biology, Christian-Albrechts-University, Am Botanischen Garten 1-9, 24118 Kiel, Germany
| | - Bhisma N. Ratha
- Biomolecular
NMR and Drug Design Laboratory, Department of Biophysics, Bose Institute, P-1/12 CIT Scheme VII (M), 700054 Kolkata, India
| | - Anirban Bhunia
- Biomolecular
NMR and Drug Design Laboratory, Department of Biophysics, Bose Institute, P-1/12 CIT Scheme VII (M), 700054 Kolkata, India
| | - Karsten Hesse
- Tierarztpraxis
Dr. Karsten Hesse, Rathausstraße
16, 35460 Stauffenberg, Germany
| | - Mushira Abdelaziz Enani
- Infectious
Diseases Division, Department of Medicine, King Fahad Medical City, P.O. Box 59046, 11525 Riyadh, Kingdom of Saudi
Arabia
| | - Jürgen Steinmeyer
- Laboratory
for Experimental Orthopaedics, Department of Orthopaedics, Justus-Liebig-University, Paul-Meimberg-Str. 3, D-35392 Giessen, Germany
| | - Athanasios K. Petridis
- Neurochirurgische
Klinik, Universität Düsseldorf, Geb. 11.54, Moorenstraße 5, 40255 Düsseldorf, Germany
| | - Tibor Kozar
- Center
for Interdisciplinary Biosciences, TIP-UPJS, Jesenna 5, 04001 Kosice, Slovakia
| | - Zuzana Gazova
- Department
of Biophysics Institute of Experimental Physics, Slovak Academy of Sciences, Watsonova 47, 04001 Kosice, Slovakia
| | - Nikolay E. Nifantiev
- Laboratory
of Glycoconjugate Chemistry, N.D. Zelinsky Institute of Organic Chemistry, Russian Academy of Sciences, Leninsky prospect 47, 119991 Moscow, Russian Federation
| | - Hans-Christian Siebert
- RI-B-NT
Research Institute of Bioinformatics and Nanotechnology, Franziusallee 177, 24148 Kiel, Germany
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