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Russell-Jones D, Bawlchhim Z. Discovery of insulin 100 years on. Postgrad Med J 2023; 99:661-668. [PMID: 37389580 DOI: 10.1136/postgradmedj-2022-141651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
The discovery of insulin 100 years ago ranks among the greatest medical achievements ever. This sparked a revolution of scientific discovery and therapeutic intervention to treat people suffering with diabetes. A light was shone for other areas of medicine to illuminate what was possible with detailed scientific endeavour. There followed a range of firsts leading to the current time in which we now know more about this peptide hormone than almost any other protein in existence. This has allowed therapeutic advancement from a positon of knowledge leading to stunning innovation. This innovation is likely to lead to more physiological insulin replacement reducing the disease burden to individuals and society as whole.
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Affiliation(s)
- David Russell-Jones
- CEDAR, Royal Surrey County Hospital, Guildford, UK
- Diabetes & Endocrinology, University of Surrey, Guildford, UK
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2
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Steyn LV, Drew D, Vlachos D, Huey B, Cocchi K, Price ND, Johnson R, Putnam CW, Papas KK. Accelerated absorption of regular insulin administered via a vascularizing permeable microchamber implanted subcutaneously in diabetic Rattus norvegicus. PLoS One 2023; 18:e0278794. [PMID: 37384782 PMCID: PMC10310011 DOI: 10.1371/journal.pone.0278794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/13/2023] [Indexed: 07/01/2023] Open
Abstract
In Type 1 diabetes patients, even ultra-rapid acting insulins injected subcutaneously reach peak concentrations in 45 minutes or longer. The lag time between dosing and peak concentration, as well as intra- and inter-subject variability, render prandial glucose control and dose consistency difficult. We postulated that insulin absorption from subcutaneously implantable vascularizing microchambers would be significantly faster than conventional subcutaneous injection. Male athymic nude R. norvegicus rendered diabetic with streptozotocin were implanted with vascularizing microchambers (single chamber; 1.5 cm2 surface area per side; nominal volume, 22.5 μl). Plasma insulin was assayed after a single dose (1.5 U/kg) of diluted insulin human (Humulin®R U-100), injected subcutaneously or via microchamber. Microchambers were also implanted in additional animals and retrieved at intervals for histologic assessment of vascularity. Following conventional subcutaneous injection, the mean peak insulin concentration was 22.7 (SD 14.2) minutes. By contrast, when identical doses of insulin were injected via subcutaneous microchamber 28 days after implantation, the mean peak insulin time was shortened to 7.50 (SD 4.52) minutes. Peak insulin concentrations were similar by either route; however, inter-subject variability was reduced when insulin was administered via microchamber. Histologic examination of tissue surrounding microchambers showed mature vascularization on days 21 and 40 post-implantation. Implantable vascularizing microchambers of similar design may prove clinically useful for insulin dosing, either intermittently by needle, or continuously by pump including in "closed loop" systems, such as the artificial pancreas.
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Affiliation(s)
- Leah V. Steyn
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
| | - Delaney Drew
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
| | - Demetri Vlachos
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
| | - Barry Huey
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
| | - Katie Cocchi
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
| | - Nicholas D. Price
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
| | - Robert Johnson
- Procyon Technologies, LLC., Medical Research Building (Room 121), University of Arizona, Tucson, AZ, United States of America
| | - Charles W. Putnam
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
| | - Klearchos K. Papas
- Institute for Cellular Transplantation, Department of Surgery, University of Arizona College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States of America
- Procyon Technologies, LLC., Medical Research Building (Room 121), University of Arizona, Tucson, AZ, United States of America
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3
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Fleeman L, Gilor C. Insulin Therapy in Small Animals, Part 1: General Principles. Vet Clin North Am Small Anim Pract 2023; 53:615-633. [PMID: 36906469 DOI: 10.1016/j.cvsm.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Understanding the pharmacology of insulin and how it relates to the pathophysiology of diabetes can lead to better clinical outcomes. No insulin formulation should be considered "best" by default. Insulin suspensions (NPH, NPH/regular mixes, lente, and PZI) as well as insulin glargine U100 and detemir are intermediate-acting formulations that are administered twice daily. For a formulation to be an effective and safe basal insulin, its action should be roughly the same every hour of the day. Currently, only insulin glargine U300 and insulin degludec meet this standard in dogs, whereas in cats, insulin glargine U300 is the closest option.
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Affiliation(s)
- Linda Fleeman
- Animal Diabetes Australia, Melbourne, Victoria, Australia.
| | - Chen Gilor
- Small Animal Internal Medicine, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA
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Egan AM, Galior KD, Maus AD, Fatica E, Simha V, Shah P, Singh RJ, Vella A. Pitfalls in Diagnosing Hypoglycemia Due to Exogenous Insulin: Validation and Utility of an Insulin Analog Assay. Mayo Clin Proc 2022; 97:1994-2004. [PMID: 36210202 PMCID: PMC9996747 DOI: 10.1016/j.mayocp.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To overcome the limitations of commercially available insulin immunoassays which have variable detection of analog insulin and can lead to clinically discordant results and misdiagnosis in the workup of factitious hypoglycemia. PATIENTS AND METHODS We performed analytical validation of a liquid chromatography high resolution accurate mass (LC-HRAM) immunoassay to detect insulin analogs. We completed clinical assessment using a large cohort of human serum samples from 78 unique individuals, and subsequently used the assay in the evaluation of eight individuals with high diagnostic suspicion for factitious hypoglycemia. RESULTS The performance characteristics show that the LC-HRAM immunoassay can be applied to detect five commonly used synthetic insulin analogs (lispro, glulisine, aspart, glargine metabolite, and detemir) in human serum. Our clinical cases show that this assay could be used in the diagnosis of factitious hypoglycemia by identifying the analog insulin(s) in question. CONCLUSION The LC-HRAM immunoassay reported here overcomes a gap in our diagnostic pathway for hypoglycemia. The results obtained from our studies suggest that this method is appropriate for use in clinical laboratories when factitious hypoglycemia is considered as a differential diagnosis.
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Affiliation(s)
- Aoife M Egan
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Kornelia D Galior
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA
| | - Anthony D Maus
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Erica Fatica
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA; Department of Pathology and Laboratory Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Vinaya Simha
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Pankaj Shah
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, MN, USA.
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5
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Gilor C, Fleeman LM. One hundred years of insulin: Is it time for smart? J Small Anim Pract 2022; 63:645-660. [PMID: 35560042 DOI: 10.1111/jsap.13507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 10/10/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022]
Abstract
Smarter understanding of diabetes pathophysiology and pharmacology of insulin therapy can lead to better clinical outcomes. Rather than looking for an insulin formulation that is considered "best" for a general population, it could be appropriate to seek the "smart" insulin choice, tailored to the specific clinical situation. Different treatment goals should be considered, with pros and cons to each. Ideally, insulin therapy in most diabetic dogs should mimic a "basal-bolus" pattern. The "intermediate"-acting insulin formulations might provide better "bolus" treatment in dogs than the rapid-acting formulations used in people. In patients with some residual beta cell function such as many diabetic cats, administering only a "basal" insulin might lead to complete normalisation of blood glucose concentrations. Insulin suspensions (neutral protamine Hagedorn, neutral protamine Hagedorn/regular mixes, lente and protamine zinc insulin) as well as insulin glargine U100 and detemir are "intermediate"-acting formulations that are administered twice daily. For a formulation to be an effective and safe "basal" insulin, its action should be roughly the same every hour of the day. Currently, only insulin glargine U300 and insulin degludec meet this standard in dogs, whereas in cats, insulin glargine U300 is the closest option.
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Affiliation(s)
- C Gilor
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - L M Fleeman
- Animal Diabetes Australia, Melbourne, Victoria, Australia
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Kesavadev J, Gowda A, Kumar H, Yalamanchi SR, Lodha S, Singh KP, Basu D, Asirvatham A, Shah N, Pathan MK, Revanna M, Mukherjee JJ. Safety of Insulin Degludec/Insulin Aspart in Patients with Diabetes Mellitus over a Period of 1 Year during Routine Clinical Care in India: SMART (Study of Management of Diabetes with Ryzodeg™ Treatment). Med Sci (Basel) 2021; 10:1. [PMID: 35076540 PMCID: PMC8788540 DOI: 10.3390/medsci10010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
This post-authorization study was conducted to evaluate the safety of insulin degludec/insulin aspart (IDegAsp) in adult patients with diabetes mellitus (DM) during routine clinical care under a real-world setting in India. Eligible patients received IDegAsp for a minimum of 12 months during routine clinical management. Data were collected at 0, 3, 6, and 12 months. In total, 1029 adult patients with DM were included; 65.2% (n = 671) were men; mean age was 55.0 ± 12.2 years, and the mean duration of diabetes mellitus was 10.8 ± 7.4 years. Thirty adverse events were reported in 23 patients (2.2%) during the follow-up: two adverse events in two patients were serious with fatal outcomes, which were unrelated to IDegAsp use. At baseline, there were 176 confirmed hypoglycemic events in 67 (6.7%) patients while they were on their previous treatment options. At 12 months of treatment with IDegAsp, 11 confirmed hypoglycemic events were reported in 11 (1.1%) patients since the previous visit; there were no reported episodes of severe hypoglycemia. Mean glycosylated hemoglobin value reduced from 9.5% ± 1.8% at baseline to 7.7% ± 1.1% at 12 months. This study showed the safety of IDegAsp in patients with diabetes mellitus over a period of 1 year during routine clinical care.
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Affiliation(s)
| | - Ambanna Gowda
- Fortis Hospital, Cunningham Road, Bengaluru 560052, India;
| | - Harish Kumar
- Amrita Institute of Medical Sciences, Kochi 682041, India;
| | | | | | | | - Debasis Basu
- Apollo Gleneagles Hospital, Kolkata 700067, India; (D.B.); (J.J.M.)
| | | | | | | | - Manjunatha Revanna
- Novo Nordisk India Private Limited, Bengaluru 560066, India; (M.K.P.); (M.R.)
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González-Beltrán M, Gómez-Alegría C. Molecular Modeling and Bioinformatics Analysis of Drug-Receptor Interactions in the System Formed by Glargine, Its Metabolite M1, the Insulin Receptor, and the IGF1 Receptor. Bioinform Biol Insights 2021; 15:11779322211046403. [PMID: 34594103 PMCID: PMC8477355 DOI: 10.1177/11779322211046403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Insulin and insulin-like growth factor type 1 (IGF1) regulate multiple physiological functions by acting on the insulin receptor (IR) and insulin-like growth factor type 1 receptor (IGF1R). The insulin analog glargine differs from insulin in three residues (GlyA21, ArgB31, ArgB32), and it is converted to metabolite M1 (lacks residues ArgB31 and ArgB32) by in vivo processing. It is known that activation of these receptors modulates pathways related to metabolism, cell division, and growth. Though, the structures and structural basis of the glargine interaction with these receptors are not known. Aim To generate predictive structural models, and to analyze the drug/receptor interactions in the system formed by glargine, its metabolite M1, IR, and IGF1R by using bioinformatics tools. Methods Ligand/receptor models were built by homology modeling using SWISSMODEL, and surface interactions were analyzed using Discovery Studio® Visualizer. Target and hetero target sequences and appropriate template structures were used for modeling. Results Our glargine/IR and metabolite M1/IR models showed an overall symmetric T-shaped conformation and full occupancy with four ligand molecules. The glargine/IR model revealed that the glargine residues ArgB31 and ArgB32 fit in a hydrophilic region formed by the α-chain C-terminal helix (αCT) and the cysteine-rich region (CR) domain of this receptor, close to the CR residues Arg270-Arg271-Gln272 and αCT residue Arg717. Regarding IGF1R, homologous ligand/receptor models were further built assuming that the receptor is in a symmetrical T-shaped conformation and is fully occupied with four ligand molecules, similar to what we described for IR. Our glargine/IGF1R model showed the interaction of the glargine residues ArgB31 and ArgB32 with Glu264 and Glu305 in the CR domain of IGF1R. Conclusion Using bioinformatics tools and predictive modeling, our study provides a better understanding of the glargine/receptor interactions.
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Affiliation(s)
| | - Claudio Gómez-Alegría
- Grupo de investigación UNIMOL, Departamento de Farmacia, Facultad de Ciencias, Universidad Nacional de Colombia-Sede Bogotá, Bogotá, Colombia
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Fast-Acting Insulin Aspart: A Review of its Pharmacokinetic and Pharmacodynamic Properties and the Clinical Consequences. Clin Pharmacokinet 2021; 59:155-172. [PMID: 31667789 PMCID: PMC7007438 DOI: 10.1007/s40262-019-00834-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Fast-acting insulin aspart (faster aspart) is insulin aspart (IAsp) with two added excipients, l-arginine and niacinamide, to ensure formulation stability with accelerated initial absorption after subcutaneous administration compared with previously developed rapid-acting insulins. The pharmacokinetic/pharmacodynamic properties of faster aspart have been characterised in clinical pharmacology trials with comparable overall methodology. In subjects with type 1 (T1D) or type 2 (T2D) diabetes, the serum IAsp concentration–time and glucose-lowering effect profiles are left-shifted for faster aspart compared with IAsp. In addition, faster aspart provides earlier onset, doubling of initial exposure, and an up to 2.5-fold increase in initial glucose-lowering effect within 30 min of subcutaneous injection, as well as earlier offset of exposure and effect. Similar results have been shown using continuous subcutaneous insulin infusion (CSII). The improved pharmacological properties of faster aspart versus IAsp are consistent across populations, i.e. in the elderly, children, adolescents and the Japanese. Thus, the faster aspart pharmacological characteristics more closely resemble the mealtime insulin secretion in healthy individuals, giving faster aspart the potential to further improve postprandial glucose control in subjects with diabetes. Indeed, change from baseline in 1-h postprandial glucose increment is in favour of faster aspart versus IAsp when used as basal-bolus or CSII treatment in phase III trials in subjects with T1D or T2D. This review summarises the currently published results from clinical pharmacology trials with faster aspart and discusses the potential clinical benefits of faster aspart compared with previous rapid-acting insulin products.
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9
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Radenković S, Velojić-Golubović M, Radojković D, Ćirić V, Kocić R. Treatment satisfaction in patients with diabetes mellitus type 1 treated with intensified insulin therapy with insulin analogues. ACTA FACULTATIS MEDICAE NAISSENSIS 2021. [DOI: 10.5937/afmnai38-32875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The outcome of diabetes treatments can and should be evaluated through the patients' treatment satisfaction. The aim of this study was to examine the patients' satisfaction with the therapy with human insulin analogues compared with previous treatment with human insulin. We evaluated patient satisfaction in patients with T1DM in our institution who were currently on IIT with human insulins. We performed testing with standard World Health Organization Diabetes Treatment Satisfaction Questionnaire (WHO DTSQ) before and after the therapy with insulin analogs. The overall DTSQ score in forty-nine patients after the third month of therapy and after the sixth month of therapy is higher than before the initiation of therapy (p < 0.001). The results of the responses on the perception of hyperglycaemia were lower after three months of therapy (p < 0.05) and after the six months of treatment than before the onset of therapy (p < 0.01). There were no differences in the perception of hypoglycaemia after three months; however, perception of hypoglycaemia after the sixth month of treatment was lower than before the onset of therapy (p < 0.001) and compared to the score after the third month of therapy (p < 0.01). Therapy of T1DM patients with insulin analogue aspart over three months led to an increase in satisfaction with therapy and a reduction of the perception of hyperglycaemia. Therapy of T1DM patients with insulin analogues (aspart and glargine) over three months led to an increase in satisfaction with therapy and a reduction of the perception of both hyperglycaemia and hypoglycamia.
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10
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Glucose-responsive insulin by molecular and physical design. Nat Chem 2019; 9:937-943. [PMID: 28937662 DOI: 10.1038/nchem.2857] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/11/2017] [Indexed: 12/15/2022]
Abstract
The concept of a glucose-responsive insulin (GRI) has been a recent objective of diabetes technology. The idea behind the GRI is to create a therapeutic that modulates its potency, concentration or dosing relative to a patient's dynamic glucose concentration, thereby approximating aspects of a normally functioning pancreas. From the perspective of the medicinal chemist, the GRI is also important as a generalized model of a potentially new generation of therapeutics that adjust potency in response to a critical therapeutic marker. The aim of this Perspective is to highlight emerging concepts, including mathematical modelling and the molecular engineering of insulin itself and its potency, towards a viable GRI. We briefly outline some of the most important recent progress toward this goal and also provide a forward-looking viewpoint, which asks if there are new approaches that could spur innovation in this area as well as to encourage synthetic chemists and chemical engineers to address the challenges and promises offered by this therapeutic approach.
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Cost-Effectiveness of the Interventions to Avoid Complications and Management in Diabetes Mellitus: A Narrative Review from South-East Asian Perspective. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and Aims: Asians accounts 60% of the world’s diabetic population with a different burden on young and middle-aged. The objective is to critically evaluate the published literature relevant to cost-effectiveness analysis of interventions to avoid complications followed by the management of diabetes mellitus in South-east Asia. Methods: PubMed, ScienceDirect International Pharmaceutical Abstracts (IPA), Proquest and Google Scholar thoroughly searched within the period of November- December 2015. Only research and reviews published in the English language within the period of January 2000-November 2015 considered. The extracted details and particulars from the included studies account for interventions, outcomes, and modeling methods. Results: A total of seven studies from Japan, Singapore, Cambodia and two each from India and Thailand were included. Incremental cost-effectiveness ratios (ICERs) per quality-adjusted-life-year (QALY) accounted as an outcome in more than half of the reviewed studies. Most of the economic evaluations of DM management and preventive interventions in each country focused on different interventions and alternatives for comparison. However, type 1 DM patients showed better outcome when using specific insulin regimens utilized in the southeastern Asian countries followed by the implementation of Thai DM-self management support program (DM-SMS) via healthcare professionals. Conclusion: Alternatives to pharmacologic approaches such as insulin regimen and oral anti-diabetic agents showed a significant difference
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12
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Yang RS, Tang W, Sheng H, Meng F. Rapid Characterization of Insulin Modifications and Sequence Variations by Proteinase K Digestion and UHPLC-ESI-MS. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2018; 29:853-858. [PMID: 29380268 DOI: 10.1007/s13361-017-1887-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/06/2017] [Accepted: 12/16/2017] [Indexed: 06/07/2023]
Abstract
Discovery of novel insulin analogs as therapeutics has remained an active area of research. Compared with native human insulin, insulin analog molecules normally incorporate either covalent modifications or amino acid sequence variations. From the drug discovery and development perspective, methods for efficient and detailed characterization of these primary structural changes are very important. In this report, we demonstrate that proteinase K digestion coupled with UPLC-ESI-MS analysis provides a simple and rapid approach to characterize the modifications and sequence variations of insulin molecules. A commercially available proteinase K digestion kit was used to process recombinant human insulin (RHI), insulin glargine, and fluorescein isothiocynate-labeled recombinant human insulin (FITC-RHI) samples. The LC-MS data clearly showed that RHI and insulin glargine samples can be differentiated, and the FITC modifications in all three amine sites of the RHI molecule are well characterized. The end-to-end experiment and data interpretation was achieved within 60 min. This approach is fast and simple, and can be easily implemented in early drug discovery laboratories to facilitate research on more advanced insulin therapeutics. Graphical Abstract ᅟ.
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Affiliation(s)
- Rong-Sheng Yang
- Analytical Research and Development, Merck and Co., Inc., Rahway, NJ, 07065, USA.
| | - Weijuan Tang
- Analytical Research and Development, Merck and Co., Inc., Rahway, NJ, 07065, USA
| | - Huaming Sheng
- Analytical Research and Development, Merck and Co., Inc., Rahway, NJ, 07065, USA
| | - Fanyu Meng
- Analytical Research and Development, Merck and Co., Inc., Rahway, NJ, 07065, USA.
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Heise T, Stender-Petersen K, Hövelmann U, Jacobsen JB, Nosek L, Zijlstra E, Haahr H. Pharmacokinetic and Pharmacodynamic Properties of Faster-Acting Insulin Aspart versus Insulin Aspart Across a Clinically Relevant Dose Range in Subjects with Type 1 Diabetes Mellitus. Clin Pharmacokinet 2018; 56:649-660. [PMID: 27878566 PMCID: PMC5425492 DOI: 10.1007/s40262-016-0473-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Absorption of current rapid-acting insulins is too slow for patients with diabetes mellitus to achieve optimal postprandial glucose control. Faster-acting insulin aspart (faster aspart) is insulin aspart in a new formulation with faster early absorption. We compared the pharmacokinetic/pharmacodynamic properties of faster aspart and insulin aspart across a clinically relevant dose range. Methods In this randomised, double-blind, crossover trial, 46 subjects with type 1 diabetes mellitus received single subcutaneous doses of faster aspart and insulin aspart at 0.1, 0.2 (repeated three times to estimate within-subject variability) and 0.4 U/kg in a euglycaemic clamp setting (target 5.5 mmol/L). Results Consistently for the three doses, faster aspart demonstrated faster onset and greater early absorption and glucose-lowering effect versus insulin aspart. Across all three doses, onset of appearance occurred approximately twice as fast (approximately 5 min earlier) and early insulin exposure (AUCIAsp,0–30min) was approximately 1.5- to 2-fold greater for faster aspart versus insulin aspart. Likewise, onset of action occurred approximately 5 min faster and early glucose-lowering effect (AUCGIR,0–30min) was approximately 1.5- to 2-fold larger for faster aspart versus insulin aspart. Relative bioavailability was approximately 100% and total glucose-lowering effect was similar for faster aspart versus insulin aspart. Dose–concentration and dose–response relationships were comparable between faster aspart and insulin aspart. Within-subject variability in glucose-lowering effect was low for faster aspart (coefficient of variation approximately 20%) and not significantly different from insulin aspart. Conclusion The faster onset and greater early insulin exposure and glucose-lowering effect with faster aspart versus insulin aspart are preserved across a broad range of doses and consistently observed from day to day. ClinicalTrials.gov identifier NCT02033239. Electronic supplementary material The online version of this article (doi:10.1007/s40262-016-0473-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim Heise
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstrasse 9, 41460, Neuss, Germany.
| | | | - Ulrike Hövelmann
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstrasse 9, 41460, Neuss, Germany
| | | | - Leszek Nosek
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstrasse 9, 41460, Neuss, Germany
| | - Eric Zijlstra
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergstrasse 9, 41460, Neuss, Germany
| | - Hanne Haahr
- Novo Nordisk A/S, Vandtårnsvej 114, 2860, Søborg, Denmark
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14
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Qu Y, Luo J, Garhyan P, Antalis CJ, Chang AM, Jacober SJ. Dose Unit Establishment for a New Basal Insulin Using Joint Modeling of Insulin Dose and Glycemic Response. J Diabetes Sci Technol 2018; 12:155-162. [PMID: 28466661 PMCID: PMC5761965 DOI: 10.1177/1932296817707542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND For new insulin analogs with properties that vary from human insulin, defining activity in units of human insulin based on glycemic lowering efficacy may be challenging. Here we present a new method that can be used to quantify a unit dose of an experimental insulin when the traditional euglycemic clamp method is not adequate. METHODS Joint modeling of insulin dose and the glycemic outcome variable hemoglobin A1c (HbA1c), where both were response variables, was used to evaluate insulin unit potency for basal insulin peglispro (BIL). The data were from the Phase 3 program for BIL, which included greater than 5500 patients with type 1 or type 2 diabetes who were treated for 26 or 52 weeks with BIL or a comparator insulin. Both basal-bolus and basal insulin only studies were included, and some type 2 diabetes patients were insulin-naïve. RESULTS The analysis showed that 1 unit of BIL, composed of 9 nmol of active ingredient, had similar or slightly greater potency compared to 1 unit insulin glargine or NPH insulin for all populations. CONCLUSIONS Despite some limitations, the joint modeling of HbA1c and insulin dose provides a reasonable approach to estimate the relative potency of a new basal insulin versus an established basal insulin.
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Affiliation(s)
- Yongming Qu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | - Scott J. Jacober
- Eli Lilly and Company, Indianapolis, IN, USA
- Scott J. Jacober, DO, Eli Lilly and Company, Lilly Corporate Center, Drop Code 2232, Indianapolis, IN 46285, USA.
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Nagai Y, Nishine A, Hashimoto E, Nakayama T, Sasaki Y, Murakami M, Ishii S, Kato H, Tanaka Y. Efficacy and safety of switching from basal insulin to once-daily insulin degludec/insulin aspart in Japanese patients with inadequately controlled type 2 diabetes: A 4-week, randomized, open-label, treat-to-target study. J Diabetes Investig 2017; 9:567-572. [PMID: 28921900 PMCID: PMC5934257 DOI: 10.1111/jdi.12748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/21/2017] [Accepted: 09/13/2017] [Indexed: 11/27/2022] Open
Abstract
AIMS/INTRODUCTION A prospective, 4-week, single-center, randomized, open-label, parallel-group, treat-to-target study was carried out to develop an algorithm for safe and effective switching from basal insulin to once-daily insulin degludec/insulin aspart (IDegAsp) in patients with inadequately controlled type 2 diabetes. MATERIALS AND METHODS Patients were randomly assigned to continue their current basal insulin therapy (n = 10) or to switch to IDegAsp on a 1:1 unit basis (n = 10). The insulin dose could be titrated once weekly, targeting a self-measured blood glucose of 80-100 mg/dL before breakfast. A mixed meal test was carried out at baseline and after 4 weeks. RESULTS After 4 weeks, the mean daily dose of insulin was similarly increased by 60% in both groups, and there was a significant decrease of mean plasma glucose and glucose area under the glucose concentration vs time curve for 2 h in the meal test. The mean estimated treatment difference (IDegAsp group - basal insulin group) of the mean plasma glucose level was -28 mg/dL (95% confidence interval -47 to -8, P = 0.008) after 4 weeks and that of the area under the glucose concentration vs time curve for 2 h was -2,800 mg/min/dL (95% confidence interval -5,300 to -350, P = 0.028), confirming the superiority of IDegAsp to basal insulin. In the IDegAsp group, the 2-h postprandial plasma glucose level was significantly decreased to the fasting plasma glucose range. There were no confirmed hypoglycemic episodes in either group during the 4-week study period. CONCLUSIONS After switching from basal insulin, the IDegAsp dose can be uptitrated by 60% based on fasting plasma glucose data. However, monitoring of postprandial glucose should be considered before further uptitration of IDegAsp.
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Affiliation(s)
- Yoshio Nagai
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Ami Nishine
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Eriko Hashimoto
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Taiga Nakayama
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Yosuke Sasaki
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Mariko Murakami
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Satoshi Ishii
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Hiroyuki Kato
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Yasushi Tanaka
- Division of Metabolism and EndocrinologyDepartment of Internal MedicineSt. Marianna University School of MedicineKawasakiJapan
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Pechenov S, Bhattacharjee H, Yin D, Mittal S, Subramony JA. Improving drug-like properties of insulin and GLP-1 via molecule design and formulation and improving diabetes management with device & drug delivery. Adv Drug Deliv Rev 2017; 112:106-122. [PMID: 28153578 DOI: 10.1016/j.addr.2017.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/25/2022]
Abstract
There is an increased incidence of diabetes worldwide. The discovery of insulin revolutionized the management of diabetes, the revelation of glucagon-like peptide-1 (GLP-1) and introduction of GLP-1 receptor agonists to clinical practice was another breakthrough. Continued translational research resulted in better understanding of diabetes, which, in combination with cutting-edge biology, chemistry, and pharmaceutical tools, have allowed for the development of safer, more effective and convenient insulins and GLP-1. Advances in self-administration of insulin and GLP-1 receptor agonist therapies with use of drug-device combination products have further improved the outcomes of diabetes management and quality of life for diabetic patients. The synergies of insulin and GLP-1 receptor agonist actions have led to development of devices that can deliver both molecules simultaneously. New chimeric GLP-1-incretins and insulin-GLP-1-incretin molecules are also being developed. The objective of this review is to summarize molecular designs to improve the drug-like properties of insulin and GLP-1 and to highlight the continued advancement of drug-device combination products to improve diabetes management.
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Affiliation(s)
| | - Himanshu Bhattacharjee
- Merck Research Laboratories, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Daniel Yin
- Merck Research Laboratories, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Sachin Mittal
- Merck Research Laboratories, Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
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Siegmund T, Pfohl M, Forst T, Pscherer S, Bramlage P, Foersch J, Borck A, Seufert J. Titration of basal insulin or immediate addition of rapid acting insulin in patients not at target using basal insulin supported oral antidiabetic treatment - A prospective observational study in 2202 patients. Diabetes Metab Syndr 2017; 11:51-57. [PMID: 27578616 DOI: 10.1016/j.dsx.2016.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022]
Abstract
AIM Optimal treatment intensification strategies in patients with type-2 diabetes mellitus (T2DM) receiving basal insulin supported oral antidiabetic therapy (BOT) remain controversial. The objective of the present study was to compare outcomes of BOT-intensification by either the uptitration of long-acting insulin glargine or by the immediate addition of a rapid acting insulin analogue (RAIA). METHODS This was a prospective, observational, 24-week study in T2DM patients with BOT using insulin glargine and baseline glycated hemoglobin (HbA1c) between 7.0 and 8.5%. Patients were stratified by their physicians to one of the following treatment intensification strategies: Basal insulin titration to target with discretionary subsequent addition of RAIA at weeks 12 or 24 (GLAR), or immediate addition of RAIA at baseline (GLARplus). RESULTS A total of 3266 patients were prescreened of whom 2202 fulfilled the selection criteria. Of these, 1684 patients were documented in the GLAR group and 518 in the GLARplus group. In the GLAR group, in 91 (5.5%) and 21 patients (1.3%) RAIA was added at weeks 12 and 24, respectively. The groups displayed similar baseline characteristics; except, mean diabetes duration was slightly shorter in the GLAR group (8.7 vs. 9.4 years). During the study, insulin glargine dose was increased from 18.7 to 26.4U (plus 7.7U) in GLAR and from 24.9 to 27.3U (plus 2.4U) in GLARplus patients. Mean RAIA dose was 9.6±4.7U at the final visit. After 24 weeks, HbA1c was reduced by 0.8 and 0.9% in the GLAR and GLARplus groups, respectively (both p<0.001). An HbA1c of ≤7.0% was achieved in 49.2% of GLAR and 48.5% of GLARplus patients. In both groups, we observed improvements in cardiovascular risk factors such as lipids and blood pressure. The rates of symptomatic (1.6 vs. 1.7%) and severe (0.18 vs. 0.19%) hypoglycemic episodes were low and comparable in both groups. CONCLUSION These findings provide evidence that treatment intensification in patients with type 2 diabetes not at glycemic target on BOT with insulin glargine is equally safe and effective using either long-acting insulin titration alone or the addition of a rapid-acting insulin analogue.
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Affiliation(s)
- Thorsten Siegmund
- Department for Endocrinology, Diabetes and Metabolism, Isar Klinikum München GmbH, Sonnen Str. 24-26, 80331 Munich, Germany.
| | - Martin Pfohl
- Evang. Krankenhaus BETHESDA GmbH, Heerstraße 219, 47053 Duisburg, Germany.
| | - Thomas Forst
- Profil Institut für Stoffwechselforschung GmbH, Hellersbergerstraße 9, 41460 Neuss, Germany.
| | - Stefan Pscherer
- Klinik für Innere Medizin III, Sophien- und Hufeland-Klinikum, Henry-van-de-Velde-Straße 2, 99425 Weimar, Germany.
| | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Menzelstraße 21, 15831 Mahlow, Germany.
| | - Johannes Foersch
- Medical Department, Sanofi, Potsdamer Straße 8, 10785 Berlin, Germany.
| | - Anja Borck
- Medical Department, Sanofi, Potsdamer Straße 8, 10785 Berlin, Germany.
| | - Jochen Seufert
- Universitätsklinikum Freiburg, Hugstetter Straße 55, 79106 Germany.
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Labay LM, Bitting CP, Legg KM, Logan BK. The Determination of Insulin Overdose in Postmortem Investigations. Acad Forensic Pathol 2016; 6:174-183. [PMID: 31239889 DOI: 10.23907/2016.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/19/2016] [Accepted: 05/24/2016] [Indexed: 01/17/2023]
Abstract
The analysis of biological specimens for the presence of exogenous insulin is of special interest in select postmortem investigations. Insulin analogues are primarily used to mediate the regulation of blood glucose concentrations; however, their use has also been implicated or suspected as a cause of death in suicides, accidents, and homicides. Toxicological analysis for these compounds is challenging due to the large molecular weight, the limited stability of insulin in whole blood, and complexities associated with sample preparation and instrumental testing. As a consequence, determination of insulin in postmortem specimens is not routinely offered by most forensic toxicology laboratories. Forensic death investigation is further complicated by interpretative difficulties such as the frequent absence of anatomical findings, concentration interpretation in known insulin users, and addressing the impact of chemical instability and postmortem redistribution. There are ongoing efforts, however, to develop and validate robust methods that may be used for this analysis on these challenging samples and that are capable of withstanding scientific and legal scrutiny for forensic use. In this regard, in recent years, methods for the detection of exogenous insulin in postmortem samples have been reported and results of this testing has been published in a handful of cases. The purpose of this article is to review the primary functions of insulin, the disease states associated with the therapeutic use of exogenous insulin, the current state of laboratory testing, and to provide case summaries that summarize the timeline of advancements and underscore the importance of this work.
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Affiliation(s)
| | | | - Kevin M Legg
- Center for Forensic Science Research and Education
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19
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Bohn B, Kerner W, Seufert J, Kempe HP, Jehle PM, Best F, Füchtenbusch M, Knauerhase A, Hofer M, Rosenbauer J, Holl RW. Trend of antihyperglycaemic therapy and glycaemic control in 184,864 adults with type 1 or 2 diabetes between 2002 and 2014: Analysis of real-life data from the DPV registry from Germany and Austria. Diabetes Res Clin Pract 2016; 115:31-8. [PMID: 27242120 DOI: 10.1016/j.diabres.2016.03.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 01/29/2016] [Accepted: 03/04/2016] [Indexed: 11/17/2022]
Abstract
AIMS To analyse time trends of antihyperglycaemic therapy and glycaemic control in adult subjects with type 1, or type 2 diabetes between 2002 and 2014 in Germany/Austria. METHODS 184,864 adults with diabetes (35,144 type 1 diabetes (T1D), 149,720 type 2 diabetes (T2D)) from the DPV-database documented between 2002 and 2014 were included. Regression models were applied for antihyperglycaemic therapy in T2D (non-pharmacological, OADs only, insulin±OADs), insulin therapy in T1D (CT, ICT, CSII) and T2D (BOT, SIT, CT, ICT, CSII), for the use of insulin analogues, and for glycaemic control (HbA1C, severe hypoglycaemia), adjusting for confounders sex, age, and diabetes duration. RESULTS In T1D, CT (2002:19.7%; 2014:16.0%) and ICT (2002:66.8%; 2014:52.4%) decreased, while CSII increased from 13.5% to 31.5%. In T2D, non-pharmacological treatment became less frequent (2002:36.0%, 2014:21.8%), the use of OADs (2002:19.3%, 2014:28.9%) and insulin±OADs (2002:44.6%, 2014:49.4%) increased. BOT increased from 7.9% to 18.9%, SIT decreased from 12.0% to 8.3%. ICT slightly increased (2002:44.0%, 2014:45.3%), CT decreased (2002:35.8%, 2014:27.2%). Insulin analogues were used more frequently in T1D (rapid-acting:2002:46.8%, 2014:84.8%; long-acting:2002:26.0%, 2014:54.8%) and in T2D (rapid-acting:2002:26.0%, 2014:43.5%; long-acting:2002:13.7%, 2014:53.6%). Until 2011, HbA1C increased in T1D and T2D, but then decreased again. High variability in the rate of hypoglycaemia was observed. CONCLUSIONS This observational study indicates an increased use of insulin pumps in T1D. In T2D, non-pharmacological therapy decreased, and insulin therapy, particular as BOT, rose. An increase in the use of rapid- and long-acting insulin analogues was present in both patient-groups. Time trend was less clear in glycaemic control.
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Affiliation(s)
- Barbara Bohn
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany; German Center for Diabetes Research (DZD) , München-Neuherberg, Germany.
| | - Wolfgang Kerner
- Centre of Diabetes and Metabolic Disorders, Karlsburg, Germany
| | - Jochen Seufert
- University Hospital of Freiburg, Division of Endocrinology & Diabetology, Department of Medicine II, Freiburg, Germany
| | - Hans-Peter Kempe
- Centre for Diabetes and Nutrition Ludwigshafen, Ludwigshafen, Germany
| | - Peter M Jehle
- Academic Hospital Paul Gerhardt Stift, Lutherstadt Wittenberg, Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, Germany
| | - Frank Best
- Diabetes-Practice Dr. Best, Essen, Germany
| | | | - Andreas Knauerhase
- University Hospital of Rostock, Clinic for Internal Medicine, Department of Endocrinology and Metabolic Diseases, Rostock, Germany
| | - Martin Hofer
- University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Department of Internal Medicine I, St. Poelten, Austria
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany; German Center for Diabetes Research (DZD) , München-Neuherberg, Germany
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany; German Center for Diabetes Research (DZD) , München-Neuherberg, Germany
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20
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Cengiz E, Bode B, Van Name M, Tamborlane WV. Moving toward the ideal insulin for insulin pumps. Expert Rev Med Devices 2015; 13:57-69. [DOI: 10.1586/17434440.2016.1109442] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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22
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Leite EB, Pedrosa HC, Casulari LA. Results of glycated hemoglobin during treatment with insulin analogues dispensed in the public health system of Federal District in Brazil. Diabetol Metab Syndr 2015; 7:66. [PMID: 26288660 PMCID: PMC4539715 DOI: 10.1186/s13098-015-0061-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/03/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Diabetes treatment requires specialized multi-professional teams, supplies for blood glucose monitoring and training for self-injections of human insulin or insulin analogues. The State Health Secretariat of the Federal District (SHS-FD) has dispensed insulin analogues by means of clinical validated protocols since 2004. However, data on outcomes of follow-up are still unknown. OBJECTIVE To evaluate the results of glycated hemoglobin (HbA1c) among diabetic patients treated with insulin analogues. METHODS It is a retrospective cohort study involving data of type 1(DM1) and type 2 diabetes (DM2) patients 18 years old and above who were registered to participate at the insulin analogues dispense program of the SHS-FD. Evaluation of criteria of insulin treatment continuity was based on HbA1c values achieved in the follow-up period: in the target, <7 %, patients between 18 and 65 years old; <8 % for those above 65 years old; out of target, when values were superior these cut off points for both age groups; and minimum 0.5 % reduction of two HbA1c values during follow-up. RESULTS Two hundred and fifteen formularies were analyzed: Type 2 patients (63.7 %) and female sex were the most prevalent (63.7 %), (p < 0.05). Mean age and SD were 41.5 ± 23.5 years among DM1 and 60.5 ± 28.5 in those with DM2. HbA1c in the target was found in 26 %, 48 % were out of target and 26 % achieved 0.5 % minimum reduction in HbA1c value (p < 0.05). The main clinical characteristics associated with HbA1c found to be in the target were older age (>65 years), more than three medical appointments in the follow-up and lower mean HbA1c in the patient selection for inclusion criteria in the dispense program (p < 0.05). CONCLUSION The low number of patients using insulin analogues in the target group, considered to be in good control, implies the need to reevaluate both level of patients self-care knowledge and glucose monitoring prior their inclusion in the insulin analogue dispense program. Reinforcement and training of health professional teams in enrollment procedures should be on mandatory basis to avoid protocol failure or deviations.
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Affiliation(s)
- Eliziane Brandão Leite
- />Diabetes Central Coordination, State Health Secretariat of Federal District, SQS 304 Bloco F Apto 403, Brasília, DF 70337-060 Brazil
| | - Hermelinda Cordeiro Pedrosa
- />Research Centre, Foundation of Teaching and Research on Health Sciences, Brasília, DF Brazil
- />Unit of Endocrinology, Taguatinga Regional Hospital-HRT, Brasília, DF Brazil
| | - Luiz Augusto Casulari
- />Endocrinology Service, University Hospital (HUB) and University of Brasília (UnB), Brasília, DF Brazil
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Kitagawa K, Misumi Y, Ueda M, Hayashi Y, Tasaki M, Obayashi K, Yamashita T, Jono H, Arima H, Ando Y. Inhibition of insulin amyloid fibril formation by cyclodextrins. Amyloid 2015. [PMID: 26204452 DOI: 10.3109/13506129.2015.1064818] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Localized insulin-derived amyloid masses occasionally form at the site of repeated insulin injections in patients with insulin-dependent diabetes and cause subcutaneous insulin resistance. Various kinds of insulin including porcine insulin, human insulin, and insulin analogues reportedly formed amyloid fibrils in vitro and in vivo, but the impact of the amino acid replacement in insulin molecules on amyloidogenicity is largely unknown. In the present study, we demonstrated the difference in amyloid fibril formation kinetics of human insulin and insulin analogues, which suggests an important role of the C-terminal domain of the insulin B chain in nuclear formation of amyloid fibrils. Furthermore, we determined that cyclodextrins, which are widely used as drug carriers in the pharmaceutical field, had an inhibitory effect on the nuclear formation of insulin amyloid fibrils. These findings have significant implications for the mechanism underlying insulin amyloid fibril formation and for developing optimal additives to prevent this subcutaneous adverse effect.
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Affiliation(s)
- Keisuke Kitagawa
- a Department of Neurology , Graduate School of Medical Sciences, Kumamoto University , Kumamoto , Japan
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Bilotta F, Badenes R, Lolli S, Belda FJ, Einav S, Rosa G. Insulin infusion therapy in critical care patients: regular insulin vs short-acting insulin. A prospective, crossover, randomized, multicenter blind study. J Crit Care 2014; 30:437.e1-6. [PMID: 25466315 DOI: 10.1016/j.jcrc.2014.10.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/15/2014] [Accepted: 10/20/2014] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The aim of this multicenter, prospective, randomized, crossover trial is to compare, in critical care patients receiving insulin infusion therapy (IIT), the pharmacodynamic of Humulin insulin (Hlin), currently used as "standard of care," and Humalog insulin (Hlog), a shorter acting insulin formulation. This was measured as extent and duration of the carryover effect of insulin treatment, with the latter calculated as ratio between blood glucose concentration (BGC) reduction during and after IIT. MATERIALS AND METHODS Twenty-eight patients treated in an intensive care unit and receiving full nutritional support were randomly assigned to Hlin or Hlog as first treatment. Insulin was infused at a constant rate in patients presenting with BGC greater than or equal to 180 mg/dL (0.04 U/kg per hour) and was discontinued when BGC was less than or equal to 140 mg/dL (therapeutic BGC drop). Further reductions in BGC after discontinuation of insulin infusion were recorded (postinfusional BGC drop). During the study period, whole blood BGC was measured every 30 minutes. A minimal 6-hour washout interval was maintained between treatments with the 2 types of insulin. The primary end point was the extent (calculated as ratio between the therapeutic BGC drop and the postinfusional BGC drop) and duration of the carryover effect. RESULTS Treatment with Hlog, as compared with Hlin, was associated with a less profound carryover effect as well as a briefer duration of carryover (median, 0.40 vs 0.62; P < .001; median, 1 vs 1.5 hours; P < .001). CONCLUSIONS The use of constant Hlog infusion for IIT, when compared with Hlin at the same dose, is associated with a less profound carryover effect on BGC after discontinuation of IIT, a briefer duration of carryover, a faster BGC drop during infusion, and a quicker BGC rise after discontinuation. These characteristics suggest that Hlog IIT may be preferable for use in critically ill patients.
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Affiliation(s)
- Federico Bilotta
- Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy.
| | - Rafael Badenes
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari Valencia, Valencia, Spain
| | - Simona Lolli
- Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy
| | - Francisco Javier Belda
- Department of Anesthesiology and Surgical Intensive Care, Hospital Clinic Universitari Valencia, Valencia, Spain
| | - Sharon Einav
- Department of Anesthesiology and General Intensive Care Unit, Shaare Zedek Medical Centre, Jerusalem, Israel
| | - Giovanni Rosa
- Department of Anesthesiology, Critical Care and Pain Medicine, Neuroanesthesia and Neurocritical Care, "Sapienza" University of Rome, Rome, Italy
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Abstract
AIM: To assess the efficacy of glargine in the management of hepatogenic diabetes.
METHODS: Eighty-two patients with hepatogenic diabetes treated with glargine were included in the study. The insulin dose was adjusted according to fasting blood glucose (FBG) till discharge. FBG, 2 h postprandial blood glucose (2 h PBG) and glycosylated hemoglobin (HbAlc) were monitored for 24 wk. HbAlc and blood glucose levels were compared before and after treatment.
RESULTS: The FBG, 2 h PBG and HbAlc were significantly decreased after treatment (FBG: 6.35 mmol/L ± 1.47 mmol/L vs 10.52 mmol/L ± 3.13 mmol/L, P < 0.05; 2 h PBG: 9.81 mmol/L ± 3.14 mmol/L vs 17.51 mmol/L ± 4.33 mmol/L, P < 0.05; HbA1c: 7.54% ± 1.31% vs 10.65% ± 1.43%, P < 0.05). There were no significant differences in the above parameters between 12 and 24 wk after treatment (FBG: 6.47 mmol/L ± 1.25 mmol/L vs 6.35 mmol/L ± 1.47 mmol/L, P > 0.05; 2 h PBG: 8.91 mmol/L ± 2.76 mmol/L vs 9.81 mmol/L ± 3.14 mmol/L, P > 0.05; HbA1c: 7.28% ± 1.12% vs 7.54% ± 1.31%, P > 0.05). The incidence of hypoglycemia was low, which occurred only once.
CONCLUSION: Glargine therapy is effective and safe for hepatogenic diabetes.
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Haahr H, Heise T. A review of the pharmacological properties of insulin degludec and their clinical relevance. Clin Pharmacokinet 2014; 53:787-800. [PMID: 25179915 PMCID: PMC4156782 DOI: 10.1007/s40262-014-0165-y] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Insulin degludec (IDeg) is a new-generation basal insulin with an ultra-long duration of action. To date, a large number of studies have been conducted to investigate the pharmacokinetic and pharmacodynamic properties of IDeg. Standardised methods for collection and analysis of blood samples (for pharmacokinetic endpoints) and euglycaemic clamp procedures (for pharmacodynamic endpoints) were applied across studies to enable cross-study evaluation of important pharmacokinetic and pharmacodynamic parameters. Data show that IDeg has a half-life of >25 h [compared with ~12 h for insulin glargine (IGlar)] and reaches steady state within 3 days of administration in all patient populations investigated. The pharmacokinetic profile of IDeg demonstrates an even distribution of exposure across one dosing interval. The pharmacodynamic profile of IDeg is flat and stable, demonstrated by an even distribution of glucose-lowering effect across all four 6-h intervals in a 24-h period (one dosing day). These properties were consistently demonstrated across different type 1 and type 2 diabetes mellitus patient populations, including those from different ethnic origins (both males and females with type 2 diabetes), the elderly, and patients with hepatic or renal impairment. IDeg has an ultra-long duration of action exceeding 42 h and demonstrates four times lower day-to-day within-subject variability in glucose-lowering effect than IGlar. This review discusses the pharmacokinetic and pharmacodynamic data accumulated thus far, and the relevance of these results from a clinical perspective.
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Affiliation(s)
- Hanne Haahr
- Novo Nordisk A/S, Vandtårnsvej 108, 2860, Søborg, Denmark,
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Olausson EA, Grundin H, Isaksson M, Brock C, Drewes AM, Attvall S, Simrén M. Postprandial plasma glucose response and gastrointestinal symptom severity in patients with diabetic gastroparesis. J Diabetes Sci Technol 2014; 8:881-8. [PMID: 24876417 PMCID: PMC4764220 DOI: 10.1177/1932296814531098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Gastroparesis is a well-known diabetic complication. The pathogenesis is not fully understood. However, it is important to early diagnose these patients. This study evaluated the plasma glucose response after a test meal, and gastrointestinal (GI) symptom severity in patients with clinical suspicion of diabetic gastroparesis, and assessed its usefulness to predict gastroparesis. In all, 83 subjects with insulin-treated diabetes mellitus (DM) type 1 and 2 were included; 53 subjects had gastroparesis and 30 had normal gastric emptying determined by gastric scintigraphy. GI symptom severity during the preceding 2 weeks was evaluated with a validated questionnaire. The test meal consisted of 100 g meat, 40 g pasta, 150 g carrot, and 5 g oil. The subjects ingested the meal under fasting conditions, and plasma glucose was followed during 180 minutes. Patients with gastroparesis demonstrated a blunted plasma glucose response after a test meal versus patients with normal gastric emptying (P < .005), reflected by lower maximum increase in plasma glucose response and incremental area under the curve of the plasma glucose, but a similar time to the maximum plasma glucose level. All GI symptoms were more severe in patients with gastroparesis. GI symptom severity had the best discriminative value to identify patients with gastroparesis with an area under the receiver operating curve of 0.83 (optimal cutoff: sensitivity 87%, specificity 80%). Patients with diabetic gastroparesis have a blunted postprandial plasma glucose response. Combining this information with the presence of GI symptoms can help clinicians identify diabetic patients with gastroparesis.
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Affiliation(s)
- Eva A Olausson
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Håkan Grundin
- Department of Radiation Physics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mats Isaksson
- Department of Radiation Physics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Brock
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Asbjørn M Drewes
- Department of Gastroenterology and Hepatology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
| | - Stig Attvall
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Simrén
- Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bilotta F, Guerra C, Badenes R, Lolli S, Rosa G. Short acting insulin analogues in intensive care unit patients. World J Diabetes 2014; 5:230-234. [PMID: 24936244 PMCID: PMC4058727 DOI: 10.4239/wjd.v5.i3.230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 01/18/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023] Open
Abstract
Blood glucose control in intensive care unit (ICU) patients, addressed to actively maintain blood glucose concentration within defined thresholds, is based on two major therapeutic interventions: to supply an adequate calories load and, when necessary, to continuously infuse insulin titrated to patients needs: intensive insulin therapy (IIT). Short acting insulin analogues (SAIA) have been synthesized to improve the chronic treatment of patients with diabetes but, because of the pharmacokinetic characteristics that include shorter on-set and off-set, they can be effectively used also in ICU patients and have the potential to be associated with a more limited risk of inducing episodes of iatrogenic hypoglycemia. Medical therapies carry an intrinsic risk for collateral effects; this can be more harmful in patients with unstable clinical conditions like ICU patients. To minimize these risks, the use of short acting drugs in ICU patients have gained a progressively larger room in ICU and now pharmaceutical companies and researchers design drugs dedicated to this subset of medical practice. In this article we report the rationale of using short acting drugs in ICU patients (i.e., sedation and treatment of arterial hypertension) and we also describe SAIA and their therapeutic use in ICU with the potential to minimize iatrogenic hypoglycemia related to IIT. The pharmacodynamic and pharmachokinetic characteristics of SAIA will be also discussed.
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30
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Systemic delivery of biotherapeutics through the lung: opportunities and challenges for improved lung absorption. Ther Deliv 2014; 4:1511-25. [PMID: 24304249 DOI: 10.4155/tde.13.119] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The development of Exubera(®) (inhaled insulin) has paved the way for consideration of future inhaled biotherapeutic products for systemic delivery. This route of drug delivery favors highly potent small peptides without self-association and large proteins resistant to enzymatic degradation for high bioavailability, while likely resulting in transient therapeutic effects. Improved therapeutic benefits with a needle-free delivery, such as inhaled insulin, are also rational pursuits. Molecules and their formulations must be carefully chosen and designed to optimize the rates of lung absorption and nonabsorptive loss. Novel molecular or formulation approaches, for example, Technosphere(®), Fc-/scFv-fusion protein, PEGylation, polymeric or lipid-based micro/nanoparticles and liposomes, offer opportunities to improve lung absorption and therapeutic duration of some biotherapeutics. Critical assessments are now essential as to their therapeutic benefits, safety, patient acceptance and market competition, as carried out for Exubera.
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31
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Building better drugs: developing and regulating engineered therapeutic proteins. Trends Pharmacol Sci 2013; 34:534-48. [PMID: 24060103 DOI: 10.1016/j.tips.2013.08.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 08/08/2013] [Accepted: 08/13/2013] [Indexed: 11/22/2022]
Abstract
Most native proteins do not make optimal drugs and thus a second- and third-generation of therapeutic proteins, which have been engineered to improve product attributes or to enhance process characteristics, are rapidly becoming the norm. There has been unprecedented progress, during the past decade, in the development of platform technologies that further these ends. Although the advantages of engineered therapeutic proteins are considerable, the alterations can affect the safety and efficacy of the drugs. We discuss both the key technological innovations with respect to engineered therapeutic proteins and advancements in the underlying basic science. The latter would permit the design of science-based criteria for the prediction and assessment of potential risks and the development of appropriate risk management plans. This in turn holds promise for more predictable criteria for the licensure of a class of products that are extremely challenging to develop but represent an increasingly important component of modern medical practice.
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Abstract
Basal insulin have been developed over the years. In recent times newer analogues have been added to the armanentarium for diabetes therapy. This review specifically reviews the current status of different basal insulins.
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Affiliation(s)
- S. V. Madhu
- Department of Medicine, Division of Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - M. Velmurugan
- Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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33
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Heteronuclear NMR provides an accurate assessment of therapeutic insulin's quality. J Pharm Biomed Anal 2013; 78-79:252-4. [PMID: 23499919 DOI: 10.1016/j.jpba.2013.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 02/10/2013] [Accepted: 02/13/2013] [Indexed: 11/24/2022]
Abstract
New generations of drugs are using more and more often therapeutic proteins as the active ingredient, prompting the regulation agencies to adapt their analytical methods. Fast and unambiguous information on the secondary, tertiary and quaternary structure of the protein should be provided to assess the quality of these biodrugs. Recent developments of heteronuclear NMR methods, enabling their use on pharmaceutical formulated unlabeled proteins, provide an efficient way to perform such analysis, a feature that is illustrated here using various commercial formulations of insulins.
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Goldman-Levine JD, Patel DK, Schnee DM. Insulin Degludec: A Novel Basal Insulin Analogue. Ann Pharmacother 2013; 47:269-77. [DOI: 10.1345/aph.1r351] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical trial data, adverse effects, and potential role in therapy of insulin degludec. DATA SOURCES: Articles were identified using the MEDLINE database (January 1996-December 2012). Abstracts and posters were identified from respective congressional websites and published supplements of the American Diabetes Association, the European Association for the Study of Diabetes, and the American Association of Clinical Endocrinologists (January 2008-December 2012). Clinicaltrials.gov was used to identify any ongoing clinical trials or completed trials whose results had not been presented or published. STUDY SELECTION AND DATA EXTRACTION: All available studies were reviewed for inclusion; pharmacokinetic studies were limited to those reporting human data. DATA SYNTHESIS: Insulin degludec is a novel, ultra-long-acting basal insulin analogue that has a similar safety and efficacy profile when compared with insulin glargine in patients with type 1 or type 2 diabetes. Clinical trials have indicated that there is less hypoglycemia, particularly nocturnal hypoglycemia, associated with this agent. CONCLUSIONS: If insulin degludec is approved, it may offer an alternative basal insulin for patients needing more flexible dosing, having a history of nocturnal hypoglycemia, or those with severe insulin resistance needing a higher concentration of basal insulin.
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Affiliation(s)
- Jennifer D Goldman-Levine
- Jennifer D Goldman-Levine PharmD CDE BC-ADM FCCP, Professor of Pharmacy Practice, School of Pharmacy—Boston, MCPHS University, Boston
| | - Dhiren K Patel
- Dhiren K Patel PharmD CDE, BC-ADM, BCACP Assistant Professor of Pharmacy Practice, School of Pharmacy—Boston, MCPHS University
| | - David M Schnee
- David M Schnee PharmD BCACP, Associate Professor of Pharmacy Practice, School of Pharmacy—Boston, MCPHS University
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Lv WS, Li L, Wen JP, Pan RF, Sun RX, Wang J, Xian YX, Cao CX, Gao YY. Comparison of a multiple daily insulin injection regimen (glargine or detemir once daily plus prandial insulin aspart) and continuous subcutaneous insulin infusion (aspart) in short-term intensive insulin therapy for poorly controlled type 2 diabetes patients. Int J Endocrinol 2013; 2013:614242. [PMID: 23737776 PMCID: PMC3662171 DOI: 10.1155/2013/614242] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 03/27/2013] [Accepted: 04/13/2013] [Indexed: 11/18/2022] Open
Abstract
Aims. To examine the potential differences between multiple daily injection (MDI) regimens based on new long-acting insulin analogues (glargine or detemir) plus prandial insulin aspart and continuous subcutaneous insulin aspart infusion (CSII) in patients with poorly controlled type 2 diabetes. Methods. Patients (n = 119) with poorly controlled type 2 diabetes of a duration exceeding five years were randomly assigned into three groups: Group A treated with CSII using insulin aspart; Group B treated with glargine-based MDI and Group C treated with detemir-based MDI. Results. Good glycemic control was achieved by patients in Group A in a significantly shorter duration than patients in Groups B and C. Total daily insulin, basal insulin dose and dose per kg body weight in Group A were significantly less than those in Groups B and C. Daily blood glucose fluctuation in Group A was significantly less than that in Groups B and C. There were no differences between Groups B and C. Conclusions. Aspart-based CSII may achieve good blood glucose control with less insulin doses over a shorter period compared with glargine or detemir-based MDI. No differences between glargine- and detemir-based MDI were detected in poorly controlled subjects with type 2 diabetes.
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Affiliation(s)
- Wen-shan Lv
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Li Li
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Jun-ping Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Fujian Medical University, North Branch of Fujian Provincial Hospital, Fujian Provincial Geriatric Hospital, Fuzhou 350001, China
- *Jun-ping Wen: and
| | - Rong-fang Pan
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Rui-xia Sun
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Jing Wang
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Yu-xin Xian
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Cai-xia Cao
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
| | - Yan-yan Gao
- The Department of Internal Medicine, The Affiliated Hospital of Medical College, Qingdao University, Qingdao 266100, China
- *Yan-yan Gao:
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Winkelman L, Overton T. The effects of increasing doses of 2 preparations of long-acting insulin on short-term plasma profiles of glucose and insulin in lactating dairy cows. J Dairy Sci 2012; 95:6974-82. [DOI: 10.3168/jds.2011-5045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 08/17/2012] [Indexed: 11/19/2022]
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Moser EG, Morris AA, Garg SK. Emerging diabetes therapies and technologies. Diabetes Res Clin Pract 2012; 97:16-26. [PMID: 22381908 DOI: 10.1016/j.diabres.2012.01.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 01/23/2012] [Indexed: 11/20/2022]
Abstract
The prevalence of diabetes is increasing globally and is expected to increase to 439 million people by the year 2030. Several studies have shown that improved glycemic control measured by glycosylated hemoglobin (A1c) in patients with type 1 and type 2 diabetes results in a reduction of both the micro- and macrovascular complications associated with the disease. The recent introduction of new oral medications, insulin analogs (long and rapid acting), insulin pens and pumps, better SMBG meters and continuous glucose monitoring (CGM) have all resulted in improvement of glycemic control. Closed-loop devices currently in development aim to integrate the CGM and pump system in order to more closely mimic the human pancreas. The other upcoming new basal insulin (Degludec), prandial insulin, other new technologies and improved oral therapies will significantly improve patient acceptance of intensive therapy, glycemic control and quality of life in patients with diabetes.
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Affiliation(s)
- Emily G Moser
- School of Medicine, University of Colorado Denver, Aurora, CO 80045, United States
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38
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Evans M, Schumm-Draeger PM, Vora J, King AB. A review of modern insulin analogue pharmacokinetic and pharmacodynamic profiles in type 2 diabetes: improvements and limitations. Diabetes Obes Metab 2011; 13:677-84. [PMID: 21410860 PMCID: PMC3380549 DOI: 10.1111/j.1463-1326.2011.01395.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Insulin analogues have been engineered to enhance desired molecular properties without altering immunogenicity. The majority of insulin pharmacology studies are conducted in healthy volunteers and patients with type 1 diabetes. At present, there are more patients with type 2 than type 1 diabetes receiving insulin treatment. As the responsibility for initiating insulin therapy in these patients continues to shift to primary care, it will be important for general practitioners to understand the different pharmacological properties of insulin preparations in patients with type 2 diabetes, so that treatment can be adapted to meet patients' physiological and lifestyle requirements. The purpose of this review is to summarize pharmacological studies of insulin analogues in patients with type 2 diabetes. Faster onset of action of rapid acting insulin analogues has improved postprandial glycaemic control. Biphasic insulin analogues are associated with a lower incidence of nocturnal hypoglycaemia compared with human biphasic preparations and allow for intensification from once to twice or thrice daily dosing. More predictable glycaemic-lowering profiles of the insulin analogues have also led to reductions in nocturnal hypoglycaemia, particularly comparing long-acting insulin analogues with protaminated human insulin. Enhancing insulin self-association and reversible binding with albumin has led to further reductions in variability. However, improvements can still be made. Effective once daily clinical dosing of long-acting insulin analogues is not possible in all patients. In addition, the protaminated component of biphasic insulin analogues do not provide the duration of action or profile for physiological basal insulin replacement and neither insulin glargine nor insulin detemir are suitable for mixing with other insulin analogues as this would substantially alter their pharmacokinetic properties. Enhancing the pharmacological predictability and extending the duration of action could simplify insulin titration and further reduce the incidence of hypoglycaemia.
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Affiliation(s)
- M Evans
- Department of Medicine, University Hospital of Wales, Cardiff, UK.
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39
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Rys P, Pankiewicz O, Łach K, Kwaskowski A, Skrzekowska-Baran I, Malecki MT. Efficacy and safety comparison of rapid-acting insulin aspart and regular human insulin in the treatment of type 1 and type 2 diabetes mellitus: a systematic review. DIABETES & METABOLISM 2011; 37:190-200. [PMID: 21333580 DOI: 10.1016/j.diabet.2010.12.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 12/27/2010] [Accepted: 12/31/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND Insulin aspart (IAsp) is one of the three rapid-acting insulin analogues (RAAs) registered for the treatment of diabetes. However, there is an ongoing debate concerning the efficacy and safety of RAAs. For this reason, a systematic review-based study was performed to compare clinical outcomes of treatment with IAsp and regular human insulin (RHI) as well as biphasic insulin aspart and premixed human insulin in type 1 and type 2 diabetes (T1DM, T2DM) patients. METHODS Relevant articles were identified by a systematic search through the electronic medical databases (MEDLINE, EMBASE, CENTRAL) up to July 2009. RESULTS A total of 28 trials fulfilled the inclusion criteria, including 17 studies of T1DM, 10 of T2DM and one study of both. For T1DM, pooled data for HbA(1c) (13 studies) demonstrated lower levels with IAsp than with RHI (WMD=-0.11%; 95% CI: -0.16 to -0.06). In addition, meta-analysis revealed statistically significant differences in favour of IAsp for postprandial glucose (PPG) after breakfast, lunch and dinner, but not for fasting glucose (FG). The Diabetes Treatment Satisfaction Questionnaire evaluating treatment flexibility showed IAsp benefits compared with RHI (WMD=0.31; 95% CI: 0.15 to 0.47). Safety analyses (three studies) showed a significant reduction in nocturnal hypoglycaemia risk with IAsp (RR=0.67; 95% CI: 0.54 to 0.83), and no difference in severe hypoglycaemias and a slight increase in any hypoglycaemic episodes with RAAs (RR=1.06; 95% CI: 1.01 to 1.10). For T2DM, a meta-analysis of nine studies revealed no significant differences between IAsp and RHI in HbA(1c) (WMD=-0.04%; 95% CI: -0.10 to 0.03), whereas PPG was significantly lower in the IAsp group (WMD=-1.18 mmol/L; 95% CI: -1.88 to -0.47). No studies of treatment satisfaction or quality of life were identified. CONCLUSION Analyses based on a systematic review showed that treatment with IAsp in T1DM patients resulted in moderately better metabolic control and treatment satisfaction than RHI. In T2DM patients, meta-analysis showed improvement in PPG, but not in any other outcomes.
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Affiliation(s)
- P Rys
- HTA Consulting, Krakow, Poland
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40
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Arnolds S, Kuglin B, Kapitza C, Heise T. How pharmacokinetic and pharmacodynamic principles pave the way for optimal basal insulin therapy in type 2 diabetes. Int J Clin Pract 2010; 64:1415-24. [PMID: 20618882 PMCID: PMC2984539 DOI: 10.1111/j.1742-1241.2010.02470.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This pedagogical review illustrates the differences between pharmacokinetic (PK) and pharmacodynamic (PD) measures, using insulin therapy as the primary example. The main conclusion is that PD parameters are of greater clinical significance for insulin therapy than PK parameters. The glucose-clamp technique, the optimal method for determining insulin PD, is explained so that the reader can understand the important studies in the literature. Key glucose-clamp studies that compare two basal insulin analogues - insulin glargine and insulin detemir - to Neutral Protamine Hagedorn insulin and to each other are then presented. The review further explains how PD parameters have been translated into useful clinical concepts and simple titration algorithms for everyday clinical practice. Finally, the necessity of overcoming patient and/or physician barriers to insulin therapy and providing continuing education and training is emphasised.
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Affiliation(s)
- S Arnolds
- PROFIL Institut für Stoffwechselforschung GmbH, Neuss, Germany.
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41
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Verrotti A, Chiuri RM, Blasetti A, Mohn A, Chiarelli F. Treatment options for paediatric diabetes. Expert Opin Pharmacother 2010; 11:2483-95. [DOI: 10.1517/14656566.2010.506479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Le Floch JP. Critical appraisal of the safety and efficacy of insulin detemir in glycemic control and cardiovascular risk management in diabetics. Diabetes Metab Syndr Obes 2010; 3:197-213. [PMID: 21437089 PMCID: PMC3047990 DOI: 10.2147/dmsott.s7315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Insulin detemir is an analog of human insulin designed to provide a long duration of basal insulin action. This is achieved by protracted absorption from the injection depot, which results in part from increased self-association of insulin detemir molecules and in part from reversible albumin binding. Subsequent albumin binding in the circulation is thought to buffer changes in the effects at target tissues that could otherwise arise from variability in absorption rate. In consequence, insulin detemir has shown a less variable pharmacodynamic profile than alternative basal insulins; this manifests as more consistent temporal glucose reduction profiles in repeat-clamp studies. In clinical trials, insulin detemir has been characterized by consistent risk reductions in hypoglycemia, as well as reduced weight gain in comparison with other basal insulins. Given some recent associations that have been made in prospective and epidemiologic studies between glucose variability and/or hypoglycemia and increased cardiovascular risk, and the long-known association between excess weight and cardiovascular risk, it is possible that the clinical profile of insulin detemir may carry prognostic value with regard to cardiovascular safety, although this is yet to be substantiated. There have also been some concerns raised recently over the use of insulin analogs and cancer risk, but available clinical data and the receptor interaction profile of insulin detemir suggest no excess in risk in comparison with human insulin therapy. Optimal approaches for the clinical use of insulin detemir have been emerging through an increasing clinical study base, and the analog is becoming established as a potentially valuable therapy option.
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Affiliation(s)
- Jean-Pierre Le Floch
- Correspondence: Jean-Pierre Le Floch, Department of Diabetology, Medical Clinic, 8 Boulevard Richerand, 94440 Villecresnes, France, Tel +33 145 955 757, Fax +33 145 697 584, Email
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Therapeutics of diabetes mellitus: focus on insulin analogues and insulin pumps. EXPERIMENTAL DIABETES RESEARCH 2010; 2010:178372. [PMID: 20589066 PMCID: PMC2877202 DOI: 10.1155/2010/178372] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Accepted: 02/01/2010] [Indexed: 11/29/2022]
Abstract
Aim. Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas. Results. Intensive insulin therapy with multiple daily injections (MDI) allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM) systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial “closed-loop” systems mimicking the pancreatic activity have been also developed. Conclusions. Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients.
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Abstract
The first manufactured insulin pump was introduced in the 1970s and the first insulin pens in 1985; since then, many improvements have been made to both devices. The advantages of pens over syringes have been confirmed in numerous studies and include greater accuracy, ease of use, patient satisfaction, quality of life, and adherence. United States claims database analyses indicate that the improved adherence made possible by use of an insulin pen has the potential to reduce diabetes care costs when compared with using a vial and syringe. Features of certain advanced pump models include the ability to connect wirelessly to a blood glucose meter or to a subcutaneous interstitial glucose sensor for semicontinuous glucose-driven insulin rate adjustment. A new trend in the design of insulin pumps is the tubing-free patch pump that adheres directly to the skin. The low rate of insulin pen usage in the United States compared with European countries and the fact that many patients report that they are not offered the option of an insulin pen by their physician suggest that there is a need to increase patient and provider awareness of the currently available devices for insulin administration.
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45
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Gilor C, Graves TK. Synthetic Insulin Analogs and Their Use in Dogs and Cats. Vet Clin North Am Small Anim Pract 2010; 40:297-307. [DOI: 10.1016/j.cvsm.2009.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Yatuv R, Robinson M, Dayan I, Baru M. Enhancement of the efficacy of therapeutic proteins by formulation with PEGylated liposomes; a case of FVIII, FVIIa and G-CSF. Expert Opin Drug Deliv 2010; 7:187-201. [DOI: 10.1517/17425240903463846] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hossain MA, Belgi A, Lin F, Zhang S, Shabanpoor F, Chan L, Belyea C, Truong HT, Blair AR, Andrikopoulos S, Tregear GW, Wade JD. Use of a Temporary “Solubilizing” Peptide Tag for the Fmoc Solid-Phase Synthesis of Human Insulin Glargine via Use of Regioselective Disulfide Bond Formation. Bioconjug Chem 2009; 20:1390-6. [DOI: 10.1021/bc900181a] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mohammed Akhter Hossain
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Alessia Belgi
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Feng Lin
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Suode Zhang
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Fazel Shabanpoor
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Linda Chan
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Chris Belyea
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Hue-Trung Truong
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Amy R. Blair
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Sof Andrikopoulos
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - Geoffrey W. Tregear
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
| | - John D. Wade
- Howard Florey Institute, Department of Biochemistry and Molecular Biology, School of Chemistry, Department of Medicine (AH/NH), The University of Melbourne, Victoria 3010, Australia, and Metabolic Pharmaceuticals Ltd, 2/320 Lorimer Street, Port Melbourne, Victoria 3207, Australia
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Dündar BN, Dündar N, Eren E. Comparison of the efficacy and safety of insulin glargine and insulin detemir with NPH insulin in children and adolescents with type 1 diabetes mellitus receiving intensive insulin therapy. J Clin Res Pediatr Endocrinol 2009; 1:181-7. [PMID: 21274293 PMCID: PMC3005656 DOI: 10.4274/jcrpe.v1i4.56] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Accepted: 05/13/2009] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy and safety of insulin glargine and detemir with NPH insulin in children and adolescents with type 1 diabetes mellitus (DM). METHODS Thirty four children and adolescents with type 1 DM (mean age 12.7 ± 3.4 years, diabetes duration 5.4 ± 3.0 years) were included in the study. All patients had been receiving intensive insulin therapy with insulin aspart and NPH for at least 6 months before switching from NPH to insulin glargine (Group 1, n=19) or detemir (Group 2, n=15). The medical records obtained within 6 months before and after treatment with insulin glargine and detemir were retrospectively reviewed and the data were compared in each group. RESULTS The mean age and duration of DM were similar in two groups (p>0.05). In both groups, switching from NPH to insulin glargine or detemir, resulted in a reduction in HbA(1c) (p0.05, for both). Patients in the detemir treated group had less increment in body mass index (BMI) SDS at the end of 6 months of therapy compared to NPH and glargine treated patients (p>0.05, for both). No side effects were noted throughout the study. CONCLUSION Both insulin glargine and detemir improved HbA(1c) at short-term and proved to be safe and well tolerated in children and adolescents with type 1 DM.
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Affiliation(s)
- Bumin Nuri Dündar
- Department of Pediatric Endocrinology, Süleyman Demirel University, Faculty of Medicine, Isparta, Turkey.
| | - Nihal Dündar
- Department of Pediatrics, Süleyman Demirel University, Faculty of Medicine, Isparta
| | - Erdal Eren
- Department of Pediatric Endocrinology, Uludağ University, Faculty of Medicine, Bursa
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