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Starlin Chellathurai M, Mahmood S, Mohamed Sofian Z, Wan Hee C, Sundarapandian R, Ahamed HN, Kandasamy CS, Hilles AR, Hashim NM, Janakiraman AK. Biodegradable polymeric insulin microneedles - a design and materials perspective review. Drug Deliv 2024; 31:2296350. [PMID: 38147499 PMCID: PMC10763835 DOI: 10.1080/10717544.2023.2296350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023] Open
Abstract
Microneedle (MN) delivery devices are more accepted by people than regular traditional needle injections (e.g. vaccination) due to their simplicity and adaptability. Thus, patients of chronic diseases like diabetes look for alternative pain-free treatment regimens circumventing regular subcutaneous injections. Insulin microneedles (INS-MNs) are a thoughtfully researched topic (1) to overcome needle phobia in patients, (2) for controlled delivery of the peptide, (3) decreasing the frequency of drug administration, (4) to ease the drug administration procedure, and (5) thus increasing patient adherence to the treatment dosage regimes. MNs physically disrupt the hard outer skin layer to create minuscule pores for insulin (INS) to pass through the dermal capillaries into the systemic circulation. Biodegradable polymeric MNs are of greater significance for INS and vaccine delivery than silicon, metal, glass, or non-biodegradable polymeric MNs due to their ease of fabrication, mass production, cost-effectiveness, and bioerodability. In recent years, INS-MNs have been researched to deliver INS through the transdermal implants, buccal mucosa, stomach wall, intestinal mucosal layers, and colonic mucosa apart from the usual transdermal delivery. This review focuses on the design characteristics and the applications of biodegradable/dissolvable polymeric INS-MNs in transdermal, intra-oral, gastrointestinal (GI), and implantable delivery. The prospective approaches to formulate safe, controlled-release INS-MNs were highlighted. Biodegradable/dissolvable polymers, their significance, their impact on MN morphology, and INS release characteristics were outlined. The developments in biodegradable polymeric INS-MN technology were briefly discussed. Bio-erodible polymer selection, MN fabrication and evaluation factors, and other design aspects were elaborated.
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Affiliation(s)
| | - Syed Mahmood
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
- Centre for Natural Products Research and Drug Discovery (CENAR), Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zarif Mohamed Sofian
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Cheng Wan Hee
- Faculty of Health and Life Sciences, INTI International University, Nilai, Malaysia
| | | | - Haja Nazeer Ahamed
- Crescent School of Pharmacy, B.S. Abdur Rahman Crescent Institute of Science and Technology, Vandalur, Chennai, India
| | - C. S. Kandasamy
- Department of Pharmacognosy, Karpagam College of Pharmacy, Coimbatore, India
| | - Ayah R. Hilles
- INHART, International Islamic University, Kuala Lumpur, Malaysia
| | - Najihah Mohd Hashim
- Centre for Natural Products Research and Drug Discovery (CENAR), Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ashok Kumar Janakiraman
- Department of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
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Rasmussen M, Hach M, Iwersen J, Anil G, Rosborg H, Larsen J, Hoffmann LC, Kurtzhals P. The Human Insulin Thermal Solution project-a private sector initiative to address the thermostability of insulin. Lancet Diabetes Endocrinol 2024; 12:292-294. [PMID: 38663943 DOI: 10.1016/s2213-8587(24)00094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/26/2024] [Accepted: 03/15/2024] [Indexed: 04/30/2024]
Affiliation(s)
| | | | | | - Gayathri Anil
- Novo Nordisk Service Centre India, Bangalore 560066, India.
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Surendran N, Durasiewicz CP, Hoffmann T, Wille A, Bussmann AB, Richter M. Microfluidic Delivery of High Viscosity Liquids Using Piezoelectric Micropumps for Subcutaneous Drug Infusion Applications. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2024; 5:21-31. [PMID: 38487095 PMCID: PMC10939327 DOI: 10.1109/ojemb.2024.3355692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 03/17/2024] Open
Abstract
Goal: Auto-injectors for self-administration of drugs are usually refrigerated. If not warmed up prior to the injection, ejection of the total drug volume is not guaranteed, as their spring and plunger mechanism cannot adjust for a change in viscosity of the drug. Here, we develop piezoelectric micro diaphragm pump that allows these modifications possible while investigating the effectiveness of this alternative dosing method. Methods: The dosing of highly viscous liquid of 25 mPa·s is made possible using application-specific micropump design. By comparing the analytical with experimental results, the practicality of the concept is verified. Results: Using a powerful piezoelectric stack actuator, the micropump achieves high fluid pressures of up to (368 ± 17) kPa. In order to assess the influence of viscosity, we characterize the fluidic performance of the designed micropump through 27G gauge needle for various water-glycerin mixtures. We find maximum flow rates of 2 mL/min for viscosities of up to 25 mPa·s. Conclusions: The developed micro diaphragm pump enables the development of smart auto-injectors with flow rate regulation to achieve drug delivery for high viscosity drugs through 27G needles.
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Affiliation(s)
- Nivedha Surendran
- Fraunhofer EMFT Institute for Electronic Microsystems and Solid-State Technologies80686MunichGermany
| | - Claudia Patricia Durasiewicz
- Fraunhofer EMFT Institute for Electronic Microsystems and Solid-State Technologies80686MunichGermany
- Fraunhofer IMTE Research Institute for Individualized and Cell-based Medical Engineering23562LübeckGermany
| | - Thalia Hoffmann
- Fraunhofer EMFT Institute for Electronic Microsystems and Solid-State Technologies80686MunichGermany
| | - Axel Wille
- Fraunhofer EMFT Institute for Electronic Microsystems and Solid-State Technologies80686MunichGermany
| | - Agnes Beate Bussmann
- Fraunhofer EMFT Institute for Electronic Microsystems and Solid-State Technologies80686MunichGermany
| | - Martin Richter
- Fraunhofer EMFT Institute for Electronic Microsystems and Solid-State Technologies80686MunichGermany
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Meraj L, Mehmood N, Majeed MI, Nawaz H, Rashid N, Fatima R, Habiba UE, Tahseen H, Naz M, Asghar M, Ghafoor N, Ahmad H. Characterization of structural changes occurring in insulin at different time intervals at room temperature by surface-enhanced Raman spectroscopy. Photodiagnosis Photodyn Ther 2023; 44:103796. [PMID: 37699467 DOI: 10.1016/j.pdpdt.2023.103796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Insulin storage above the temperature recommended by food and drug administration (FDA) causes decrease in its functional efficacy due to degradation and aggregation of its protein based active pharmaceutical ingredient (API) that results poor glycemic control in diabetic patients. The aggregation of protein causes serious neurodegenerative diseases such as type-2 diabetes, Huntington disease, Parkinson's disease, and Alzheimer's disease. Surface-enhanced Raman spectroscopy (SERS) has been employed for the denaturation study of many proteins at the temperature above the recommendations of food and drug administration (FDA) (above 30 °C) which indicates potential of technique for such studies. OBJECTIVE SERS along with multivariate discriminating analysis techniques-based analysis of degradation of liquid pharmaceutical insulin protein after regular intervals of time at room temperature to analyze the structural changes in this protein during the storage of insulin pharmaceutical at room temperature. METHODS Silver nanoparticles (Ag-NPs) prepared by chemical reduction method are used as SERS active substrate for the surface enhancement of the insulin spectral signal. SERS spectral measurements of insulin were collected from eight different samples of insulin in the time range of 7 pm to 7 am first at fridge temperature (5 °C), second after half hour and next six with the time difference of 2 h each time at room temperature. The acquired SERS spectral data was preprocessed and analyzed. SERS structural transformations detection and discrimination potential in insulin was further confirmed by applying multivariate discriminating analysis techniques including principal component analysis (PCA) and Partial least square regression analysis (PLSR). RESULTS SERS significantly detects the structural changes produced in insulin even after 2 h of insulin placement at room temperature. PCA successfully differentiates the insulin spectral data obtained after regular intervals of time according to PC-1 (77 %) explained variance. Application of PLSR model provides quantitative confirmation of SERS efficiency, by providing insulin data regression coefficients plot, efficient prediction of time with calibration data set having 0.77 mean square absolute error of calibration (RMSAEC), validation data set with 0.80 mean square absolute error of prediction (RMSAEP) and 0.98 coefficient of determination (R2) for both calibration and validation data set. CONCLUSION SERS is proved as a highly sensitive and discriminating technique to detect and discriminate insulin structural changes after regular intervals of time at room temperature.
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Affiliation(s)
- Lubna Meraj
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Nasir Mehmood
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Muhammad Irfan Majeed
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan.
| | - Haq Nawaz
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan.
| | - Nosheen Rashid
- Department of Chemistry, University of Education, Faisalabad Campus, Faisalabad 38000, Pakistan
| | - Rida Fatima
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Umm E Habiba
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Hira Tahseen
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Maira Naz
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Maria Asghar
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Nida Ghafoor
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
| | - Hafsa Ahmad
- Department of Chemistry, University of Agriculture Faisalabad, Faisalabad 38000, Pakistan
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Tay JH, Lim YH, Zheng M, Zhao Y, Tan WS, Xu C, Ramamurty U, Song J. Development of hyaluronic acid-silica composites via in situ precipitation for improved penetration efficiency in fast-dissolving microneedle systems. Acta Biomater 2023; 172:175-187. [PMID: 37865280 DOI: 10.1016/j.actbio.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/13/2023] [Accepted: 10/11/2023] [Indexed: 10/23/2023]
Abstract
Fast-dissolving microneedles (DMNs) hold significant promise for transdermal drug delivery, offering improved patient compliance, biocompatibility, and functional adaptability for various therapeutic purposes. However, the mechanical strength of the biodegradable polymers used in DMNs often proves insufficient for effective penetration into human skin, especially under high humidity conditions. While many composite strategies have been developed to reinforce polymer-based DMNs, simple mixing of the reinforcements with polymers often results in ineffective penetration due to inhomogeneous dispersion of the reinforcements and the formation of undesired micropores. In response to this challenge, this study aimed to enhance the mechanical performance of hyaluronic acid (HA)-based microneedles (MNs), one of the most commonly used DMN systems. We introduced in situ precipitation of silica nanoparticles (Si) into the HA matrix in conjunction with conventional micromolding. The precipitated silica nanoparticles were uniformly distributed, forming an interconnected network within the HA matrix. Experimental results demonstrated that the mechanical properties of the HA-Si composite MNs with up to 20 vol% Si significantly improved, leading to higher penetration efficiency compared to pure HA MNs, while maintaining structural integrity without any critical defects. The composite MNs also showed reduced degradation rates and preserved their drug delivery capabilities and biocompatibility. Thus, the developed HA-Si composite MNs present a promising solution for efficient transdermal drug delivery and address the mechanical limitations inherent in DMN systems. STATEMENT OF SIGNIFICANCE: HA-Si composite dissolving microneedle (DMN) systems were successfully fabricated through in situ precipitation and conventional micromolding processes. The precipitated silica nanoparticles formed an interconnected network within the HA matrix, ranging in size from 25 to 230 nm. The optimal silica content for HA-Si composite MN systems should be up to 20 % by volume to maintain structural integrity and mechanical properties. HA-Si composite MNs with up to 20 % Si showed improved penetration efficiency and reduced degradation rates compared to pure HA MNs, thereby expanding the operational window. The HA-Si composite MNs retained good drug delivery capabilities and biocompatibility.
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Affiliation(s)
- Jie Hao Tay
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 639798, Singapore
| | - Yu Han Lim
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 639798, Singapore
| | - Mengjia Zheng
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, China
| | - Yakai Zhao
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research, 138634, Singapore
| | - Wen See Tan
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 639798, Singapore; Singapore Centre for 3D Printing, Nanyang Technological University, Singapore, 639798, Singapore
| | - Chenjie Xu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong SAR, China
| | - Upadrasta Ramamurty
- Institute of Materials Research and Engineering, Agency for Science, Technology and Research, 138634, Singapore; Singapore Centre for 3D Printing, Nanyang Technological University, Singapore, 639798, Singapore; School of Mechanical and Aerospace Engineering, Nanyang Technological University, 639798, Singapore
| | - Juha Song
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, 639798, Singapore; Singapore Centre for 3D Printing, Nanyang Technological University, Singapore, 639798, Singapore.
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Richter B, Bongaerts B, Metzendorf MI. Thermal stability and storage of human insulin. Cochrane Database Syst Rev 2023; 11:CD015385. [PMID: 37930742 PMCID: PMC10627263 DOI: 10.1002/14651858.cd015385.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
BACKGROUND Health authorities stress the temperature sensitivity of human insulin, advising protection from heat and freezing, with manufacturers suggesting low-temperature storage for intact vials, and once opened, storage at room temperature for four to six weeks, though usage time and maximum temperature recommendations vary. For human insulin, the recommendations of current shelf life in use may range from 10 to 45 days, and the maximum temperature in use varies between 25 °C and 37 °C. Optimal cold-chain management of human insulin from manufacturing until the point of delivery to people with diabetes should always be maintained, and people with diabetes and access to reliable refrigeration should follow manufacturers' recommendations. However, a growing segment of the diabetes-affected global population resides in challenging environments, confronting prolonged exposure to extreme heat due to the climate crisis, all while grappling with limited access to refrigeration. OBJECTIVES To analyse the effects of storing human insulin above or below the manufacturers' recommended insulin temperature storage range or advised usage time, or both, after dispensing human insulin to people with diabetes. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 12 July 2023. SELECTION CRITERIA We included clinical and laboratory studies investigating the storage of human insulin above or below manufacturers' recommended temperature storage range, advised usage time, or both. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We used GRADE to assess the certainty of evidence for the clinical study. Most information emerged from in vitro studies, mainly from pharmaceutical companies. There is no validated risk of bias and certainty of evidence rating for in vitro studies. We thus presented a narrative summary of the results. MAIN RESULTS We included 17 eligible studies (22 articles) and additional information from pharmaceutical companies. Pilot clinical study One pilot clinical study investigated temperature conditions for insulin stored for six weeks in an unglazed clay pot with temperatures ranging between 25 °C and 27 °C. The mean fall in plasma glucose in eight healthy volunteers after clay pot-stored insulin injection was comparable to refrigerator-stored insulin injection (very low-certainty evidence). In-vitro studies Nine, three and four laboratory studies investigated storage conditions for insulin vials, insulin cartridges/pens and prefilled plastic syringes, respectively. The included studies reported numerous methods, laboratory measurements and storage conditions. Three studies on prefilled syringes investigating insulin potency at 4 °C up to 23 °C for up to 28 days showed no clinically relevant loss of insulin activity. Nine studies examined unopened vials and cartridges. In studies with no clinically relevant loss of insulin activity for human short-acting insulin (SAI), intermediate-acting insulin (IAI) and mixed insulin (MI) temperatures ranged between 28.9 °C and 37 °C for up to four months. Two studies reported up to 18% loss of insulin activity after one week to 28 days at 37 °C. Four studies examined opened vials and cartridges at up to 37 °C for up to 12 weeks, indicating no clinically relevant reduction in insulin activity. Two studies analysed storage conditions for oscillating temperatures ranging between 25 °C and 37 °C for up to 12 weeks and observed no loss of insulin activity for SAI, IAI and MI. Four studies, two on vials (including one on opened vials), and two on prefilled syringes, investigated sterility and reported no microbial contamination. Data from pharmaceutical companies Four manufacturers (BIOTON, Eli Lilly and Company, Novo Nordisk and Sanofi) provided previously unreleased human insulin thermostability data mostly referring to unopened containers (vials, cartridges). We could not include the data from Sanofi because the company announced the permanent discontinuation of the production of human insulins Insuman Rapid, Basal and Comb 25. BIOTON provided data on SAI after one, three and six months at 25 °C: all investigated parameters were within reference values, and, compared to baseline, loss of insulin activity was 1.1%, 1.0% and 1.7%, respectively. Eli Lilly and Company provided summary data: at below 25 °C or 30 °C SAI/IAI/MI could be stored for up to 25 days or 12 days, respectively. Thereafter, patient in-use was possible for up to 28 days. Novo Nordisk provided extensive data: compared to baseline, after three and six months at 25 °C, loss of SAI activity was 1.8% and 3.2% to 3.5%, respectively. Loss of IAI activity was 1.2% to 1.9% after three months and 2.0% to 2.3% after six months. Compared to baseline, after one, two and three months at 37 °C, loss of SAI activity was 2.2% to 2.8%, 5.7% and 8.3% to 8.6%, respectively. Loss IAI activity was 1.4% to 1.8%, 3.0% to 3.8% and 4.7% to 5.3%, respectively. There was no relevant increase in insulin degradation products observed. Up to six months at 25 °C and up to two months at 37 °C high molecular weight proteins were within specifications. Appearance, visible particles or macroscopy, particulate matter, zinc, pH, metacresol and phenol complied with specifications. There were no data for cold environmental conditions and insulin pumps. AUTHORS' CONCLUSIONS Under difficult living conditions, pharmaceutical companies' data indicate that it is possible to store unopened SAI and IAI vials and cartridges at up to 25 °C for a maximum of six months and at up to 37 °C for a maximum of two months without a clinically relevant loss of insulin potency. Also, oscillating temperatures between 25 °C and 37 °C for up to three months result in no loss of insulin activity for SAI, IAI and MI. In addition, ambient temperature can be lowered by use of simple cooling devices such as clay pots for insulin storage. Clinical studies on opened and unopened insulin containers should be performed to measure insulin potency and stability after varying storage conditions. Furthermore, more data are needed on MI, insulin pumps, sterility and cold climate conditions.
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Affiliation(s)
- Bernd Richter
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Brenda Bongaerts
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine-University, Düsseldorf, Germany
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Jia Y, Fernandez A, Sampath J. PEGylation of Insulin and Lysozyme To Stabilize against Thermal Denaturation: A Molecular Dynamics Simulation Study. J Phys Chem B 2023; 127:6856-6866. [PMID: 37498538 DOI: 10.1021/acs.jpcb.3c01289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Biologic drugs or "biologics" (proteins derived from living organisms) are one of the fastest-growing classes of FDA-approved therapeutics. These compounds are often fragile and require conjugation to polymers for stabilization, with many proteins too ephemeral for therapeutic use. During storage or administration, proteins tend to unravel and lose their secondary structure due to changes in solution temperature, pH, and other external stressors. To enhance their lifetime, protein drugs currently in the market are conjugated with polyethylene glycol (PEG), owing to its ability to increase the stability, solubility, and pharmacokinetics of protein drugs. Here, we perform all-atom molecular dynamics simulations to study the unfolding process of egg-white lysozyme and insulin at elevated temperatures. We test the validity of two force fields─CHARMM36 and Amber ff99SB-ILDN─in the unfolding process. By calculating global and local properties, we capture residues that deteriorate first─these are the "weak links" in the proteins. Next, we conjugate both proteins with PEG and find that PEG preserves the native structure of the proteins at elevated temperatures by blocking water molecules from entering the hydrophobic core, thereby causing the secondary structure to stabilize.
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Affiliation(s)
- Yinhao Jia
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, United States
| | - Adam Fernandez
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, United States
| | - Janani Sampath
- Department of Chemical Engineering, University of Florida, Gainesville, Florida 32611, United States
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Molina R, Enriquez M. Enhancing Diabetes Health Outcomes Among Haitian Migrants Living in Dominican Bateyes. Sci Diabetes Self Manag Care 2023; 49:281-290. [PMID: 37313730 DOI: 10.1177/26350106231178838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE The purpose of this study was to better understand the factors that influence the ability of batey adults to self-manage their type 2 diabetes mellitus (T2DM). METHODS A qualitative descriptive approach was used to conduct in-depth, individual interviews in Spanish. Participants (n = 12) were health care workers and members of a nongovernmental organization (NGO) that provides direct diabetes care to batey residents via free, pop-up, mobile medical clinics. Conventional content analysis was used to identify categories and common themes in the data. RESULTS Participants described daily existence in the bateyes as a constant "scarcity of resources." Additionally, four themes and one subtheme emerged that participants felt impacted diabetes health outcomes and the ability of NGO health care workers to provide diabetes care. CONCLUSIONS NGO members, while committed to serve and improve health outcomes for the batey population, often felt overwhelmed. Findings from this qualitative descriptive study may be used to inform novel interventions, which are needed, to enhance the diabetes outcomes of the batey residents who are living with T2DM. In addition, strategies are needed to build diabetes care infrastructure in the batey community.
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Affiliation(s)
- Rosalia Molina
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
| | - Maithe Enriquez
- Research College of Nursing, Kansas City, Missouri
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri
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9
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Weiss MA. Real-world insulin stability and global access. Lancet Diabetes Endocrinol 2023; 11:307-309. [PMID: 37003281 DOI: 10.1016/s2213-8587(23)00066-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Michael A Weiss
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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10
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Xu R, Bhangu SK, Sourris KC, Vanni D, Sani MA, Karas JA, Alt K, Niego B, Ale A, Besford QA, Dyett B, Patrick J, Carmichael I, Shaw JE, Caruso F, Cooper ME, Hagemeyer CE, Cavalieri F. An Engineered Nanosugar Enables Rapid and Sustained Glucose-Responsive Insulin Delivery in Diabetic Mice. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023; 35:e2210392. [PMID: 36908046 DOI: 10.1002/adma.202210392] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/11/2023] [Indexed: 05/26/2023]
Abstract
Glucose-responsive insulin-delivery platforms that are sensitive to dynamic glucose concentration fluctuations and provide both rapid and prolonged insulin release have great potential to control hyperglycemia and avoid hypoglycemia diabetes. Here, biodegradable and charge-switchable phytoglycogen nanoparticles capable of glucose-stimulated insulin release are engineered. The nanoparticles are "nanosugars" bearing glucose-sensitive phenylboronic acid groups and amine moieties that allow effective complexation with insulin (≈95% loading capacity) to form nanocomplexes. A single subcutaneous injection of nanocomplexes shows a rapid and efficient response to a glucose challenge in two distinct diabetic mouse models, resulting in optimal blood glucose levels (below 200 mg dL-1 ) for up to 13 h. The morphology of the nanocomplexes is found to be key to controlling rapid and extended glucose-regulated insulin delivery in vivo. These studies reveal that the injected nanocomplexes enabled efficient insulin release in the mouse, with optimal bioavailability, pharmacokinetics, and safety profiles. These results highlight a promising strategy for the development of a glucose-responsive insulin delivery system based on a natural and biodegradable nanosugar.
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Affiliation(s)
- Rong Xu
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Sukhvir Kaur Bhangu
- School of Science, RMIT University, Melbourne, Victoria, 3000, Australia
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, 3000, Australia
| | - Karly C Sourris
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Domitilla Vanni
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, 3000, Australia
- Dipartimento di Scienze e Tecnologie Chimiche Universita' di Roma "Tor Vergata", Via della Ricerca Scientifica 1, Rome, 00133, Italy
| | - Marc-Antoine Sani
- School of Chemistry, The Bio21 Institute, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - John A Karas
- School of Chemistry, The Bio21 Institute, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - Karen Alt
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Be'eri Niego
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Anukreity Ale
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Quinn A Besford
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, 3000, Australia
| | - Brendan Dyett
- School of Science, RMIT University, Melbourne, Victoria, 3000, Australia
| | - Joshua Patrick
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Irena Carmichael
- Monash Micro Imaging, Monash University, Melbourne, Victoria, 3004, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, 3004, Australia
| | - Frank Caruso
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria, 3000, Australia
| | - Mark E Cooper
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Christoph E Hagemeyer
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Victoria, 3004, Australia
| | - Francesca Cavalieri
- School of Science, RMIT University, Melbourne, Victoria, 3000, Australia
- Dipartimento di Scienze e Tecnologie Chimiche Universita' di Roma "Tor Vergata", Via della Ricerca Scientifica 1, Rome, 00133, Italy
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Pendsey S, James S, Garrett TJ, Nord AB, Pendsey S, Malmodin D, Karlsson G, Maniam J, Atkinson MA, Forsander G, Ogle GD. Insulin thermostability in a real-world setting. Lancet Diabetes Endocrinol 2023; 11:310-312. [PMID: 37003280 DOI: 10.1016/s2213-8587(23)00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 04/03/2023]
Affiliation(s)
- Sanket Pendsey
- Diabetes Research Education and Management Trust, Nagpur, India
| | - Steven James
- Life for a Child, Diabetes NSW & ACT, Sydney, NSW 2037, Australia; University of the Sunshine Coast, Petrie, QLD, Australia
| | | | | | - Sharad Pendsey
- Diabetes Research Education and Management Trust, Nagpur, India
| | | | - Göran Karlsson
- University of Gothenburg, Gothenburg, Sweden; Science for Life Laboratory, Gothenburg, Sweden
| | - Jayanthi Maniam
- Life for a Child, Diabetes NSW & ACT, Sydney, NSW 2037, Australia
| | | | - Gun Forsander
- University of Gothenburg, Gothenburg, Sweden; Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Graham D Ogle
- Life for a Child, Diabetes NSW & ACT, Sydney, NSW 2037, Australia.
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12
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Garige M, Ghosh S, Roelofs B, Rao VA, Sourbier C. Protocol to Assess the Biological Activity of Insulin Glargine, Insulin Lispro, and Insulin Aspart In Vitro. Methods Protoc 2023; 6:mps6020033. [PMID: 37104015 PMCID: PMC10144404 DOI: 10.3390/mps6020033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
Insulin is a hormone produced by β-cells of the pancreas and controls the amount of sugar in the blood. Since its discovery over 100 years ago, insulin has been used as a life-saving treatment for people with diabetes. Historically, the biological activity or bioidentity of insulin products has been assessed using an in vivo model. However, reduction in animal experiments is a goal for many worldwide, and there is a need to develop in vitro bioassays to reliably test the biological activity of insulin products. This article describes an in vitro cell-based method to assess the biological activity of insulin glargine, insulin aspart, and insulin lispro in a step-by-step manner.
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Affiliation(s)
- Mamatha Garige
- Office of Biotechnology Products, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Susmita Ghosh
- Office of Biotechnology Products, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Brian Roelofs
- Office of Biotechnology Products, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - V Ashutosh Rao
- Office of Biotechnology Products, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA
| | - Carole Sourbier
- Office of Biotechnology Products, Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD 20993, USA
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13
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Pande AK, Thakur AK, Kanchan A, Srivastava I. Addressing Challenges in Insulin Storage: An Ethical Dilemma among Physicians. Indian J Endocrinol Metab 2023; 27:140-144. [PMID: 37292065 PMCID: PMC10245316 DOI: 10.4103/ijem.ijem_437_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/21/2023] [Accepted: 01/27/2023] [Indexed: 06/10/2023] Open
Abstract
Background and Aims Insulin is a temperature-sensitive protein; hence, its potency is highly dependent on appropriate storage. Ideally, insulin should be stored in the refrigerator, but when in use it can be stored at room temperature for up to four weeks. However, room temperatures vary widely across regions and countries, and all rural areas of developing countries like India are not electrified. This study explored physicians' perception of alternative methods for appropriate storage of insulin, such as indigenous storage methods like clay pots. Methods A Study was conducted among 188 Indian physicians attending a diabetes conference in December 2018 to evaluate the feasibility of indigenous storage methods. Results It was observed that although the use of alternate indigenous methods like clay pots was recommended by them, the proportion was low. The awareness of literature on these methods for insulin storage validation was also less than 50%. Owing to the lack of validation studies on indigenous methods, nearly 80% of the physicians felt that they were not confident to recommend them. Besides, the study results highlighted the necessity of conducting an adequate number of validation studies on indigenous methods in the Indian setting, considering their scarcity. Conclusion This is the first time we highlight ethical dilemmas through a study among physicians when they advise non-refrigerator methods for insulin storage, in the event of a lack of electricity supply. It is hoped that results from these studies would highlight ethical dilemmas among physicians and would motivate researchers in this field to conduct studies to validate alternative methods of insulin storage.
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Affiliation(s)
- Arun K. Pande
- Department of Endocrinology, Lucknow Endocrine Diabetes and Thyroid Clinic, Lucknow, Uttar Pradesh, India
| | - Ashwani K. Thakur
- Biological Sciences and Bioengineering Department, Indian Institute of Technology, Kanpur, Uttar Pradesh, India
| | - Arvind Kanchan
- Department of Physiology, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Indu Srivastava
- Critical Care Consultant, Sahara Hospital, Lucknow, Uttar Pradesh, India
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14
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Kongmalai T, Orarachin P, Dechates B, Chanphibun P, Junnu S, Srisawat C, Sriwijitkamol A. The Effect of high temperature on the stability of basal insulin in a pen: a randomized controlled, crossover, equivalence trial. BMJ Open Diabetes Res Care 2022; 10:10/6/e003105. [PMID: 36585035 PMCID: PMC9809263 DOI: 10.1136/bmjdrc-2022-003105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Insulin is an essential medicine in the management of diabetes. When stored at high temperatures(HTs), its efficacy could rapidly decline. Therefore, appropriate storage of in-use insulin is necessary to achieve its maximum therapeutic effects. However, the ambient temperature in tropical countries is normally relatively high. This study aimed to compare the efficacies of basal insulin in a pen previously kept at 37°C for 21 days and basal insulin in a refrigerated pen (2°C-8°C). Continuous glucose monitoring (CGM) was used to evaluate daily mean glucose levels (MGLs). RESEARCH DESIGN AND METHODS This randomized controlled, crossover, equivalence trial recruited adults with type 2 diabetes mellitus and glycated hemoglobin levels <8% who had used insulin glargine for >3 months. Subjects were randomized for sequential use of refrigerated basal insulin followed by basal insulin kept at HT, with a 2-week washout between phases. The HT insulin pens were stored in a 37°C incubator for 21 days before use, while the refrigerated insulin pens were stored at 2°C-8°C. Study patients received 7-day CGM. The primary outcome was the difference in the groups' MGLs. The secondary outcome parameters were glucose variability represented by the standard deviation (SD), mean amplitude of glycemic excursion (MAGE), and percentage of time in range (TIR). The remaining quantity of insulin was evaluated by ultrahigh-performance liquid chromatography (UHPLC) assay. RESULTS Forty patients completed the study. The MGLwas 158.7±30.5 mg/dL and 157.0±40.9 mg/dL in the HT and refrigerated insulin pen groups, respectively (p=0.72). The groups had no significant differences in MAGE7day, SD, percentage of TIR, carryover period, or treatment effects (all p>0.05). There was also no significant difference in the remaining quantity of insulin evaluated by UHPLC (p=0.97). CONCLUSIONS HT basal insulin pens retain their potency and have biological activity comparable to that of refrigerated pens.Trial registration number TCTR20210611002.
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Affiliation(s)
- Tanawan Kongmalai
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patima Orarachin
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bothamai Dechates
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pornnapa Chanphibun
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarawut Junnu
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatchawan Srisawat
- Department of Biochemistry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Metabolomics and Phenomics Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Apiradee Sriwijitkamol
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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15
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Taerahkun S, Sriphrapradang C. Efficacy of alternative cooling devices used for insulin storage without refrigeration under hot-humid environment. Ann Med 2022; 54:1118-1125. [PMID: 35443846 PMCID: PMC9936990 DOI: 10.1080/07853890.2022.2067355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Insulin is temperature sensitive as high temperatures reduce its potency. Refrigeration for insulin storage is still needed but households in remote areas do not have refrigerators. Also, the electricity supply is usually affected by natural disasters. We aim to examine the temperature-reducing efficacy of cooling devices in hot-humid conditions. METHODS Five cooling devices, (1) earthen jar filled with water, (2) earthen jar filled with soil, (3) two clay pots, gap filled with wet soil, (4) two clay pots, gap filled with wet sand, and (5) commercial cooling wallet were used in this study. External and internal temperatures were monitored by the temperature logger between October 2019 and September 2020 in Narathiwat, Thailand. Cooling efficacy was assessed by average absolute temperature reduction and relative cooling effect. RESULTS Mean external temperature and humidity were 27.3 ± 1.5 °C and 78.2 ± 7.1%RH. The mean differences between the external and internal temperatures were; device (1) -0.1 ± 0.6 °C (p = NS), (2) 0.0 ± 0.8 °C (p = NS), (3) -1.7 ± 0.9 °C (p < .0001), (4) -2.0 ± 0.9 °C (p < .0001), and (5) -1.8 ± 0.9 °C (p < .0001). Device no. 3, 4, and 5 achieved a constant temperature reduction. The most efficacious device was device no. 4 with a relative cooling effect of 63.6% better than the cooling wallet (57.7%, p = .003). All devices were more efficacious at lower humidity levels. CONCLUSIONS Traditional low-cost devices, such as clay pots, reduce storage temperatures to or close to room temperature in hot-humid climates. This study provides some guidance for insulin storage in hot-humid environments.
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Affiliation(s)
- Supang Taerahkun
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Virmani A, Brink SJ, Middlehurst A, Mohsin F, Giraudo F, Sarda A, Ajmal S, von Oettingen JE, Pillay K, Likitmaskul S, Calliari LE, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Management of the child, adolescent, and young adult with diabetes in limited resource settings. Pediatr Diabetes 2022; 23:1529-1551. [PMID: 36537524 DOI: 10.1111/pedi.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Anju Virmani
- Department of Pediatrics, Max Super Specialty Hospital, New Delhi, India.,Department of Endocrinology, Madhukar Rainbow Children's Hospital, New Delhi, India
| | - Stuart J Brink
- New England Diabetes and Endocrinology Center, Boston, Massachusetts, USA.,New England Diabetes and Endocrinology Center, Newton, Massachusetts, USA.,Harvard School of Medicine, Tufts School of Medicine, Boston, Massachusetts, USA
| | - Angela Middlehurst
- ISPAD & International Volunteer Pediatric Diabetes Educator, Sydney, Australia
| | - Fauzia Mohsin
- Pediatric Endocrinology and Metabolism Unit, Dept of Pediatrics, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Franco Giraudo
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile.,San Borja Arriarán Clinical Hospital, Santiago, Chile
| | - Archana Sarda
- UDAAN, NGO for Persons with Diabetes, Aurangabad, India
| | - Sana Ajmal
- Meethi Zindagi, Not-for-Profit Community Organisation for Persons with Diabetes, Rawalpindi, Pakistan
| | - Julia E von Oettingen
- Dept of Pediatrics, Division of Endocrinology, Montreal Children's Hospital, Quebec, Canada
| | | | - Supawadee Likitmaskul
- Siriraj Diabetes Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Maria E Craig
- The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,The University of Sydney Children's Hospital, Westmead Clinical School, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of NSW, Sydney, New South Wales, Australia
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17
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Kehlenbrink S, Ansbro É, Besançon S, Hassan S, Roberts B, Jobanputra K. Strengthening Diabetes Care in Humanitarian Crises in Low- and Middle-income Settings. J Clin Endocrinol Metab 2022; 107:e3553-e3561. [PMID: 35639997 DOI: 10.1210/clinem/dgac331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Indexed: 11/19/2022]
Abstract
Amid the growing global diabetes epidemic, the scale of forced displacement resulting from armed conflict and humanitarian crises is at record-high levels. More than 80% of the displaced population lives in lower- and middle-income countries, which also host 81% of the global population living with diabetes. Most crises are protracted, often lasting decades, and humanitarian aid organizations are providing long-term primary care to both the local and displaced populations. Humanitarian crises are extremely varied in nature and occur in contexts that are diverse and dynamic. The scope of providing diabetes care varies depending on the phase of the crisis. This paper describes key challenges and possible solutions to improving diabetes care in crisis settings. It focuses on (1) ensuring a reliable supply of life preserving medications and diagnostics, (2) restoring and maintaining access to health care, and (3) adapting service design to the context. These challenges are illustrated through case studies in Ukraine, Mali, the Central African Republic, and Jordan.
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Affiliation(s)
- Sylvia Kehlenbrink
- Brigham and Women's Hospital, Boston, MA 02115, USA
- Harvard Humanitarian Initiative, Cambridge, MA 02138, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Éimhín Ansbro
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
| | | | - Saria Hassan
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322,USA
- Emory Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK
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18
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Silva-Jr H, Araújo TS, da Silva Almeida M, Scapin SMN, Lima LMTR. Formation of subvisible particles in commercial insulin formulations. Colloids Surf B Biointerfaces 2022; 216:112566. [PMID: 35623256 DOI: 10.1016/j.colsurfb.2022.112566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 12/01/2022]
Abstract
The conformation and assembly of insulin are sensitive to physical and chemical variables. Insulin can misfold and form both amorphous and amyloid aggregates. Localized cutaneous amyloidosis due to insulin usage has been reported, and question remains regarding its stability in the original flasks due to storage and handling. Here we report the evaluation of the formation of aggregates in insulin formulations upon once-weekly handling and storage of the in-use cartridges at 4 °C or 37 °C for 5 weeks. Electrospray ionization mass spectrometry showed no obvious chemical decomposition. No major changes in oligomeric distribution were observed by size-exclusion chromatography. Dynamic light scattering allowed the identification of particles with high hydrodynamic radius formed during storage at 4 °C and 37 °C. Transmission electron microscopy analysis revealed the formation of amorphous material, with no clear evidence for amyloid material up to 28 days of incubation. These data support evidences for the formation of subvisible and submicrometer amorphous particulate matter in insulin formulations shortly upon use.
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Affiliation(s)
- Hamilton Silva-Jr
- Laboratory for Pharmaceutical Biotechnology - pbiotech, Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil.
| | - Talita S Araújo
- Laboratory for Pharmaceutical Biotechnology - pbiotech, Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil; Protein Advanced Biochemistry - PAB, National Center for Structural Biology and Bioimaging - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil.
| | - Marcius da Silva Almeida
- Protein Advanced Biochemistry - PAB, National Center for Structural Biology and Bioimaging - CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil; Institute for Medical Biochemistry Leopoldo De Meis, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil.
| | - Sandra M N Scapin
- National Institute of Metrology, Quality and Technology - INMETRO, Duque de Caxias, RJ 25250-020, Brazil.
| | - Luís Maurício T R Lima
- Laboratory for Pharmaceutical Biotechnology - pbiotech, Faculty of Pharmacy, Federal University of Rio de Janeiro, Rio de Janeiro, RJ 21941-902, Brazil; National Institute of Metrology, Quality and Technology - INMETRO, Duque de Caxias, RJ 25250-020, Brazil.
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19
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Xu NY, Nguyen KT, DuBord AY, Pickup J, Sherr JL, Teymourian H, Cengiz E, Ginsberg BH, Cobelli C, Ahn D, Bellazzi R, Bequette BW, Gandrud Pickett L, Parks L, Spanakis EK, Masharani U, Akturk HK, Melish JS, Kim S, Kang GE, Klonoff DC. Diabetes Technology Meeting 2021. J Diabetes Sci Technol 2022; 16:1016-1056. [PMID: 35499170 PMCID: PMC9264449 DOI: 10.1177/19322968221090279] [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] [Indexed: 11/16/2022]
Abstract
Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 4 to November 6, 2021. This meeting brought together speakers to discuss various developments within the field of diabetes technology. Meeting topics included blood glucose monitoring, continuous glucose monitoring, novel sensors, direct-to-consumer telehealth, metrics for glycemia, software for diabetes, regulation of diabetes technology, diabetes data science, artificial pancreas, novel insulins, insulin delivery, skin trauma, metabesity, precision diabetes, diversity in diabetes technology, use of diabetes technology in pregnancy, and green diabetes. A live demonstration on a mobile app to monitor diabetic foot wounds was presented.
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Affiliation(s)
- Nicole Y. Xu
- Diabetes Technology Society,
Burlingame, CA, USA
| | | | | | | | | | | | - Eda Cengiz
- University of California, San
Francisco, San Francisco, CA, USA
| | | | | | - David Ahn
- Mary & Dick Allen Diabetes Center
at Hoag, Newport Beach, CA, USA
| | | | | | | | - Linda Parks
- University of California, San
Francisco, San Francisco, CA, USA
| | - Elias K. Spanakis
- Baltimore VA Medical Center,
Baltimore, MD, USA
- University of Maryland, Baltimore,
MD, USA
| | - Umesh Masharani
- University of California, San
Francisco, San Francisco, CA, USA
| | - Halis K. Akturk
- Barbara Davis Center for Diabetes,
University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Sarah Kim
- University of California, San
Francisco, San Francisco, CA, USA
| | - Gu Eon Kang
- The University of Texas at Dallas,
Richardson, TX, USA
| | - David C. Klonoff
- Diabetes Research Institute,
Mills-Peninsula Medical Center, San Mateo, CA, USA
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20
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Erzengin S, Guler E, Eser E, Polat EB, Gunduz O, Cam ME. In vitro and in vivo evaluation of 3D printed sodium alginate/polyethylene glycol scaffolds for sublingual delivery of insulin: Preparation, characterization, and pharmacokinetics. Int J Biol Macromol 2022; 204:429-440. [DOI: 10.1016/j.ijbiomac.2022.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022]
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21
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Ansbro É, Issa R, Willis R, Blanchet K, Perel P, Roberts B. Chronic NCD care in crises: a qualitative study of global experts’ perspectives on models of care for hypertension and diabetes in humanitarian settings. J Migr Health 2022; 5:100094. [PMID: 35434681 PMCID: PMC9010603 DOI: 10.1016/j.jmh.2022.100094] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 10/29/2022] Open
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22
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Abstract
This is a protocol for a Cochrane Review (prototype). The objectives are as follows: To analyse the effects of storing human insulin above or below the manufacturers' recommended insulin temperature storage range or advised usage time, or both, after dispensing human insulin to people with diabetes.
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23
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Reddy A. Diabetes and the WHO Model List of Essential Medicines. Lancet Diabetes Endocrinol 2022; 10:20-21. [PMID: 34919867 DOI: 10.1016/s2213-8587(21)00320-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022]
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24
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Amyloidogenicity of peptides targeting diabetes and obesity. Colloids Surf B Biointerfaces 2021; 209:112157. [PMID: 34715595 DOI: 10.1016/j.colsurfb.2021.112157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/20/2021] [Accepted: 10/09/2021] [Indexed: 12/15/2022]
Abstract
Since the discovery of insulin, a century ago, the repertoire of therapeutic polypeptides targeting diabetes - and now also obesity - have increased substantially. The focus on quality has shifted from impure and unstable preparations of animal insulin to highly pure, homologous recombinant insulin, along with other peptide-based hormones and analogs such as amylin analogs (pramlintide, davalintide, cagrilintide), glucagon and glucagon-like peptide-1 receptor agonists (GLP-1, liraglutide, exenatide, semaglutide). Proper formulation, storage, manipulation and usage by professionals and patients are required in order to avoid agglomeration into high molecular weight products (HMWP), either amorphous or amyloid, which could result in potential loss of biological activity and short- or long-term immune reaction and silent inactivation. In this narrative review, we present perspective of the aggregation of therapeutic polypeptides used in diabetes and other metabolic diseases, covering the nature and mechanisms, analytical techniques, physical and chemical stability, strategies aimed to hamper the formation of HMWP, and perspectives on future biopharmaceutical developments.
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