Quantitative aspects of subcutaneous insulin absorption

A subcutaneous insulin pharmacokinetic model for computer simulation in a diabetes decision support role: model structure and parameter identification

OBJECTIVE

The goal of this study was to develop a unified physiological subcutaneous (SC) insulin absorption model for computer simulation in a clinical diabetes decision support role. The model must model the plasma insulin appearance of a wide range of current insulins, especially monomer insulin and insulin glargine, utilizing common chemical states and transport rates, where appropriate.

METHODS

A compartmental model was developed with 13 patient-specific model parameters covering six diverse insulin types [rapid-acting, regular, neutral protamine Hagedorn (NPH), lente, ultralente, and glargine insulin]. Model parameters were identified using 37 sets of mean plasma insulin time-course data from an extensive literature review via nonlinear optimization methods.

RESULTS

All fitted parameters have a coefficient of variation <100% (median 51.3%, 95th percentile 3.6-60.6%) and can be considered a posteriori identifiable.

CONCLUSION

A model is presented to describe SC injected insulin appearance in plasma in a diabetes decision support role. Clinically current insulin types (monomeric insulin, regular insulin, NPH, insulin, and glargine) and older insulin types (lente and ultralente) are included in a unified framework that accounts for nonlinear concentration and dose dependency. Future work requires clinical validation using published pharmacokinetic studies.

Insulin analogs with improved pharmacokinetic profiles

The aim of insulin replacement therapy is to normalize blood glucose in order to reduce the complications of diabetes. The pharmacokinetics of the traditional insulin preparations, however, do not match the profiles of physiological insulin secretion. The introduction of the rDNA technology 20 years ago opened new ways to create insulin analogs with altered properties. Fast-acting analogs are based on the idea that an insulin with less tendency to self-association than human insulin would be more readily absorbed into the systemic circulation. Protracted-acting analogs have been created to mimic the slow, steady rate of insulin secretion in the fasting state. The present paper provides a historical review of the efforts to change the physicochemical and pharmacological properties of insulin in order to improve insulin therapy. The available clinical studies of the new insulins are surveyed and show, together with modeling results, that new strategies for optimal basal-bolus treatment are required for utilization of the new fast-acting analogs.

Numerical approximation of mathematical model for absorption of subcutaneously injected insulin

A pharmacokinetic model is modified to enable quantitation of subcutaneous insulin absorption following insulin injections of soluble insulin and monomeric insulin analogues. The model for soluble insulin includes diffusion, equilibration between hexameric and dimeric insulin and absorption of dimeric insulin molecules. Numerical approximation is carried out by modelling the whole system as a capacitor-resistor network with lumped elements and discrete sources and sinks. By means of the analytical solution for monomeric-insulin absorption, it can be shown that the approximation scheme yields sufficiently accurate results. The modified model for soluble insulin demonstrates dose- and concentration-dependent insulin absorption within the range of therapeutic concentrations and volumes. Additionally, parameters are estimated from published glucose-clamp data. The results of the data fitting indicate that the model presented is adequate for pharmacological studies. The model is suitable for individual parameter estimation from the time course of plasma insulin or from the disappearance curves of radiolabelled injected insulin.

Pharmacokinetic model for the absorption of subcutaneously injected soluble insulin and monomeric insulin analogues

A subcutaneous insulin absorption model is presented for parameter estimation from the time course of plasma insulin. Modifications of a published model were made for the absorption of soluble insulin and monomeric insulin analogues in the range of therapeutic concentrations and volumes. The modified diffusion-dissociation model with distributed parameters was approximated by a multiple-compartment model. Subcutaneous absorption of soluble insulin and monomeric insulin analogues with various volumes, concentrations, and injection depths was simulated. The model for soluble insulin exhibits volume, concentration, and injection depth dependent absorption, as experimentally observed. It was found that binding of soluble insulin in the subcutaneous tissue is negligible for U-40 and U-100 strengths. The absorption of identical doses (10 U) of soluble U-40 insulin was markedly faster (T-50% = 159.4 min) than the absorption of U-100 (T-50% = 196.2 min). According to the simulation results, the absorption rate of monomeric analogues is not dependent on concentration. No significant chances of the absorption rate could also be observed by varying volume and injection depth of the monomeric analogues.

Subcutaneous absorption kinetics of two highly concentrated preparations of recombinant human growth hormone

OBJECTIVE

The relative bioavailability of two highly concentrated (12 IU/ml) formulations of biosynthetic human growth hormone (GH) administered subcutaneously was compared.

DESIGN

A randomized, crossover study. Conventional GH therapy was withdrawn 72 hours before each study period. There was a washout period of at least four weeks between the study periods.

SETTING

Participants were recruited from an outpatient clinic and were hospitalized during the two study periods.

PATIENTS

Fourteen GH-deficient patients (mean age 25.2 y, range 14-54). One patient was excluded from data analysis because of signs of endogenous GH secretion.

INTERVENTIONS

At the start of each study period, GH 3 IU/m2 was injected subcutaneously. The two formulations, PenFill and PenSet, differ in the buffers used and in the relative content of mannitol and glycine. Serum profiles of GH were monitored frequently for 24 hours. Samples were taken every 30 minutes for 6 hours and then hourly.

MAIN OUTCOME MEASURES

Bioavailability (F) and absorption dynamics of human GH were measured. The relative absorption fractions estimated from the areas under the individual serum concentration curves from 0 to 24 hours, and the observed time (Tmax) to reach the maximum concentration (Cmax) were determined. Short-term metabolic effects of GH on insulin-like growth factor (IGF-I), glucose, and insulin were determined.

RESULTS

The geometric mean (SD) of F was 0.910 (1,236). The 90 percent confidence interval was 0.819-1.010. Mean (+/- SD) of Cmax was 12.65 +/- 5.89 and 12.58 +/- 4.40 ng/mL for PenFill and PenSet, respectively. Corresponding values for Tmax were 5.49 +/- 1.55 and 5.89 +/- 1.79 hours for PenFill and PenSet, respectively. There was a considerable interindividual variation, but the relative absorption fraction did not significantly differ from 1 (p = 0.13). Neither Cmax (p = 0.74) nor Tmax (p = 0.58) of the two formulations was significantly different. Injection of the two formulations induced similar increments in serum IFG-I (p = 0.48). Serum insulin and blood glucose concentrations were not significantly different.

CONCLUSIONS

There is no significant difference between the absorption kinetics and short-term metabolic effects of these two highly concentrated formulations of biosynthetic GH. The two formulations are bioequivalent.