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Luo J, Khan NF, Manetti T, Rose J, Kaloghlian A, Gadhe B, Jain SH, Gagne JJ, Kesselheim AS. Implementation of a Health Plan Program for Switching From Analogue to Human Insulin and Glycemic Control Among Medicare Beneficiaries With Type 2 Diabetes. JAMA 2019; 321:374-384. [PMID: 30694321 PMCID: PMC6439763 DOI: 10.1001/jama.2018.21364] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Prices for newer analogue insulin products have increased. Lower-cost human insulin may be effective for many patients with type 2 diabetes. OBJECTIVE To evaluate the association between implementation of a health plan-based intervention of switching patients from analogue to human insulin and glycemic control. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study using population-level interrupted times series analysis of members participating in a Medicare Advantage and prescription drug plan operating in 4 US states. Participants were prescribed insulin between January 1, 2014, and December 31, 2016 (median follow-up, 729 days). The intervention began in February 2015 and was expanded to the entire health plan system by June 2015. EXPOSURES Implementation of a health plan program to switch patients from analogue to human insulin. MAIN OUTCOMES AND MEASURES The primary outcome was the change in mean hemoglobin A1c (HbA1c) levels estimated over three 12-month periods: preintervention (baseline) in 2014, intervention in 2015, and postintervention in 2016. Secondary outcomes included rates of serious hypoglycemia or hyperglycemia using ICD-9-CM and ICD-10-CM diagnostic codes. RESULTS Over 3 years, 14 635 members (mean [SD] age: 72.5 [9.8] years; 51% women; 93% with type 2 diabetes) filled 221 866 insulin prescriptions. The mean HbA1c was 8.46% (95% CI, 8.40%-8.52%) at baseline and decreased at a rate of -0.02% (95% CI, -0.03% to -0.01%; P <.001) per month before the intervention. There was an association between the start of the intervention and an overall HbA1c level increase of 0.14% (95% CI, 0.05%-0.23%; P = .003) and slope change of 0.02% (95% CI, 0.01%-0.03%; P < .001). After the completion of the intervention, there were no significant differences in changes in the level (0.08% [95% CI, -0.01% to 0.17%]) or slope (<0.001% [95% CI, -0.008% to 0.010%]) of mean HbA1c compared with the intervention period (P = .09 and P = 0.81, respectively). For serious hypoglycemic events, there was no significant association between the start of the intervention and a level (2.66/1000 person-years [95% CI, -3.82 to 9.13]; P = .41) or slope change (-0.66/1000 person-years [95% CI, -1.59 to 0.27]; P = .16). The level (1.64/1000 person-years [95% CI, -4.83 to 8.11]; P = .61) and slope (-0.23/1000 person-years [95% CI, -1.17 to 0.70]; P = .61) changes in the postintervention period were not significantly different compared with the intervention period. The baseline rate of serious hyperglycemia was 22.33 per 1000 person-years (95% CI, 12.70-31.97). For the rate of serious hyperglycemic events, there was no significant association between the start of the intervention and a level (4.23/1000 person-years [95% CI, -8.62 to 17.08]; P = .51) or slope (-0.51/1000 person-years [95% CI, -2.37 to 1.34]; P = .58) change. CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries with type 2 diabetes, implementation of a health plan program that involved switching patients from analogue to human insulin was associated with a small increase in population-level HbA1c.
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Affiliation(s)
- Jing Luo
- Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nazleen F. Khan
- Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Thomas Manetti
- Independent scholar, Torrance, California
- CareMore Health, Anthem Inc, Cerritos, California
| | - Jim Rose
- CareMore Health, Anthem Inc, Cerritos, California
| | | | - Balu Gadhe
- CareMore Health, Anthem Inc, Cerritos, California
| | | | - Joshua J. Gagne
- Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Aaron S. Kesselheim
- Program On Regulation, Therapeutics, And Law, Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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Moore MC, Kelley DE, Camacho RC, Zafian P, Ye T, Lin S, Kaarsholm NC, Nargund R, Kelly TM, Van Heek M, Previs SF, Moyes C, Smith MS, Farmer B, Williams P, Cherrington AD. Superior Glycemic Control With a Glucose-Responsive Insulin Analog: Hepatic and Nonhepatic Impacts. Diabetes 2018; 67:1173-1181. [PMID: 29540491 PMCID: PMC5961410 DOI: 10.2337/db18-0099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/03/2018] [Indexed: 12/18/2022]
Abstract
We evaluated the hepatic and nonhepatic responses to glucose-responsive insulin (GRI). Eight dogs received GRI or regular human insulin (HI) in random order. A primed, continuous intravenous infusion of [3-3H]glucose began at -120 min. Basal sampling (-30 to 0 min) was followed by two study periods (150 min each), clamp period 1 (P1) and clamp period 2 (P2). At 0 min, somatostatin and GRI (36 ± 3 pmol/kg/min) or HI (1.8 pmol/kg/min) were infused intravenously; basal glucagon was replaced intraportally. Glucose was infused intravenously to clamp plasma glucose at 80 mg/dL (P1) and 240 mg/dL (P2). Whole-body insulin clearance and insulin concentrations were not different in P1 versus P2 with HI, but whole-body insulin clearance was 23% higher and arterial insulin 16% lower in P1 versus P2 with GRI. Net hepatic glucose output was similar between treatments in P1. In P2, both treatments induced net hepatic glucose uptake (HGU) (HI mean ± SEM 2.1 ± 0.5 vs. 3.3 ± 0.4 GRI mg/kg/min). Nonhepatic glucose uptake in P1 and P2, respectively, differed between treatments (2.6 ± 0.3 and 7.4 ± 0.6 mg/kg/min with HI vs. 2.0 ± 0.2 and 8.1 ± 0.8 mg/kg/min with GRI). Thus, glycemia affected GRI but not HI clearance, with resultant differential effects on HGU and nonHGU. GRI holds promise for decreasing hypoglycemia risk while enhancing glucose uptake under hyperglycemic conditions.
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MESH Headings
- Absorption, Physiological/drug effects
- Animals
- Blood Glucose/analysis
- Blood Glucose/metabolism
- Dogs
- Dose-Response Relationship, Drug
- Drug Evaluation, Preclinical
- Drugs, Investigational/administration & dosage
- Drugs, Investigational/adverse effects
- Drugs, Investigational/pharmacokinetics
- Energy Metabolism/drug effects
- Gluconeogenesis/drug effects
- Glucose Clamp Technique
- Glycosylation
- Humans
- Hyperglycemia/metabolism
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/metabolism
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/blood
- Hypoglycemic Agents/pharmacokinetics
- Infusions, Intravenous
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/pharmacokinetics
- Liver/drug effects
- Liver/metabolism
- Male
- Metabolic Clearance Rate
- Random Allocation
- Somatostatin/administration & dosage
- Somatostatin/adverse effects
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Affiliation(s)
- Mary Courtney Moore
- Department of Molecular Biology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
| | - David E Kelley
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Raul C Camacho
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Peter Zafian
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Tian Ye
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Songnian Lin
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | - Ravi Nargund
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Terri M Kelly
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | | | | | - Marta S Smith
- Department of Molecular Biology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Ben Farmer
- Department of Molecular Biology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
| | - Phil Williams
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Alan D Cherrington
- Department of Molecular Biology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
- Diabetes Research and Training Center, Vanderbilt University School of Medicine, Nashville, TN
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3
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Kaarsholm NC, Lin S, Yan L, Kelly T, van Heek M, Mu J, Wu M, Dai G, Cui Y, Zhu Y, Carballo-Jane E, Reddy V, Zafian P, Huo P, Shi S, Antochshuk V, Ogawa A, Liu F, Souza SC, Seghezzi W, Duffy JL, Erion M, Nargund RP, Kelley DE. Engineering Glucose Responsiveness Into Insulin. Diabetes 2018; 67:299-308. [PMID: 29097375 DOI: 10.2337/db17-0577] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022]
Abstract
Insulin has a narrow therapeutic index, reflected in a small margin between a dose that achieves good glycemic control and one that causes hypoglycemia. Once injected, the clearance of exogenous insulin is invariant regardless of blood glucose, aggravating the potential to cause hypoglycemia. We sought to create a "smart" insulin, one that can alter insulin clearance and hence insulin action in response to blood glucose, mitigating risk for hypoglycemia. The approach added saccharide units to insulin to create insulin analogs with affinity for both the insulin receptor (IR) and mannose receptor C-type 1 (MR), which functions to clear endogenous mannosylated proteins, a principle used to endow insulin analogs with glucose responsivity. Iteration of these efforts culminated in the discovery of MK-2640, and its in vitro and in vivo preclinical properties are detailed in this report. In glucose clamp experiments conducted in healthy dogs, as plasma glucose was lowered stepwise from 280 mg/dL to 80 mg/dL, progressively more MK-2640 was cleared via MR, reducing by ∼30% its availability for binding to the IR. In dose escalations studies in diabetic minipigs, a higher therapeutic index for MK-2640 (threefold) was observed versus regular insulin (1.3-fold).
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MESH Headings
- Animals
- Animals, Inbred Strains
- Binding, Competitive
- CHO Cells
- Cricetulus
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Dogs
- Dose-Response Relationship, Drug
- Drug Design
- Drug Evaluation, Preclinical
- Half-Life
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/pharmacokinetics
- Hypoglycemic Agents/therapeutic use
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/pharmacokinetics
- Insulin, Regular, Human/therapeutic use
- Lectins, C-Type/agonists
- Lectins, C-Type/genetics
- Lectins, C-Type/metabolism
- Ligands
- Male
- Mannose Receptor
- Mannose-Binding Lectins/agonists
- Mannose-Binding Lectins/genetics
- Mannose-Binding Lectins/metabolism
- Metabolic Clearance Rate
- Receptor, Insulin/agonists
- Receptor, Insulin/genetics
- Receptor, Insulin/metabolism
- Receptors, Cell Surface/agonists
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Recombinant Proteins/adverse effects
- Recombinant Proteins/metabolism
- Recombinant Proteins/pharmacokinetics
- Recombinant Proteins/therapeutic use
- Swine
- Swine, Miniature
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Affiliation(s)
| | - Songnian Lin
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Lin Yan
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Theresa Kelly
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | - James Mu
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Margaret Wu
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Ge Dai
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Yan Cui
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Yonghua Zhu
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | - Vijay Reddy
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Peter Zafian
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Pei Huo
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Shuai Shi
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | - Aimie Ogawa
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Franklin Liu
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Sandra C Souza
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | | | - Joseph L Duffy
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Mark Erion
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - Ravi P Nargund
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
| | - David E Kelley
- Merck Research Laboratories, Merck & Co., Inc., Kenilworth, NJ
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4
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Ilag LL, Deeg MA, Costigan T, Hollander P, Blevins TC, Edelman SV, Konrad RJ, Ortmann RA, Pollom RK, Huster WJ, Zielonka JS, Prince MJ. Evaluation of immunogenicity of LY2963016 insulin glargine compared with Lantus® insulin glargine in patients with type 1 or type 2 diabetes mellitus. Diabetes Obes Metab 2016; 18:159-68. [PMID: 26434665 PMCID: PMC4737399 DOI: 10.1111/dom.12584] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/17/2015] [Accepted: 09/27/2015] [Indexed: 11/29/2022]
Abstract
AIMS To compare the immunogenicity profiles and the potential effects on clinical outcomes of LY2963016 insulin glargine (LY IGlar) and Lantus® insulin glargine (IGlar), products with identical primary amino acid sequences, in patients with type 1 or type 2 diabetes mellitus (T1DM or T2DM). METHODS To assess immunogenicity, anti-insulin glargine antibodies (measured as percent binding) were compared between treatments in 52-week (open-label) and 24-week (double-blind) randomized studies in total study populations of patients with T1DM (N = 535) and T2DM (N = 756), respectively, and two subgroups of patients with T2DM: insulin-naïve patients and those reporting prestudy IGlar treatment (prior IGlar). Relationships between insulin antibody levels and clinical outcomes were assessed using analysis of covariance and partial correlations. Insulin antibody levels were assessed using Wilcoxon rank sum. Treatment comparisons for treatment-emergent antibody response (TEAR) and incidence of detectable antibodies were analysed using Fisher's exact test. RESULTS No significant treatment differences were observed for insulin antibody levels, incidence of detectable anti-insulin glargine antibodies, or incidence of TEAR [overall and endpoint, by last-observation-carried-forward (LOCF)] in patients with T1DM or patients with T2DM, including the insulin-naïve subgroup. A statistically significant difference was noted in the overall incidence of detectable antibodies but not at endpoint (LOCF) nor in TEAR for the prior IGlar subgroup of patients with T2DM. Insulin antibody levels were low (<5%) in both treatment groups. Insulin antibody levels or developing TEAR was not associated with clinical outcomes. CONCLUSIONS LY IGlar and IGlar have similar immunogenicity profiles; anti-insulin glargine antibody levels were low for both treatments, with no observed effect on efficacy and safety outcomes.
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MESH Headings
- Asymptomatic Diseases/epidemiology
- Biosimilar Pharmaceuticals/adverse effects
- Biosimilar Pharmaceuticals/therapeutic use
- Cross Reactions
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/immunology
- Double-Blind Method
- Drug Hypersensitivity/complications
- Drug Hypersensitivity/epidemiology
- Drug Hypersensitivity/etiology
- Drug Hypersensitivity/immunology
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemia/chemically induced
- Hypoglycemia/prevention & control
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/therapeutic use
- Immunogenetic Phenomena/drug effects
- Incidence
- Insulin Antibodies/analysis
- Insulin Glargine/adverse effects
- Insulin Glargine/analogs & derivatives
- Insulin Glargine/therapeutic use
- Insulin, Regular, Human/adverse effects
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/therapeutic use
- Recombinant Proteins/adverse effects
- Recombinant Proteins/therapeutic use
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Affiliation(s)
- L L Ilag
- Eli Lilly and Company, Indianapolis, IN, USA
| | - M A Deeg
- Eli Lilly and Company, Indianapolis, IN, USA
| | - T Costigan
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - T C Blevins
- Texas Diabetes and Endocrinology, Austin, TX, USA
| | - S V Edelman
- University of California, San Diego, San Diego, CA, USA
| | - R J Konrad
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R A Ortmann
- Eli Lilly and Company, Indianapolis, IN, USA
| | - R K Pollom
- Eli Lilly and Company, Indianapolis, IN, USA
| | - W J Huster
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - M J Prince
- Eli Lilly and Company, Indianapolis, IN, USA
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5
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Owens DR, Matfin G, Monnier L. Basal insulin analogues in the management of diabetes mellitus: What progress have we made? Diabetes Metab Res Rev 2014; 30:104-19. [PMID: 24026961 DOI: 10.1002/dmrr.2469] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/15/2013] [Accepted: 09/08/2013] [Indexed: 02/06/2023]
Abstract
Insulin remains the most effective and consistent means of controlling blood glucose levels in diabetes. Since 1946, neutral protamine Hagedorn (NPH) has been the predominant basal insulin in clinical use. However, absorption is variable due to the need for resuspension and the time-action profile (peak activity 4-6 h after subcutaneous administration) confers an increased propensity for between-meal and nocturnal hypoglycaemia. In the 1980s, recombinant DNA technology enabled modifications to the insulin molecule resulting in the soluble long-acting insulin analogues, glargine and detemir. Both exhibit a lower risk of hypoglycaemia compared with neutral protamine Hagedorn due to improved time-action profiles and reduced day-to-day glucose variability. Glargine is indicated for administration once daily and detemir once or twice daily. Degludec is the latest prolonged-acting insulin which forms long subcutaneous multi-hexamers that delay absorption. Recent phase III trials in type 1 and type 2 diabetes show that degludec was non-inferior to comparators (predominantly glargine) with a minimal although inconsistent reduction in overall hypoglycaemia and a small absolute difference in nocturnal hypoglycaemia. Newer developmental agents include LY2605541 and glargine U300. LY2605541 comprises insulin lispro combined with polyethylene glycol, thereby increasing its hydrodynamic size and retarding absorption from the subcutaneous tissue. Glargine U300 is a new formulation of glargine resulting in a flatter and more prolonged time-action profile than its predecessor. This article reviews recent advances in basal insulin analogues, including a critical appraisal of the degludec trials.
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MESH Headings
- Animals
- Chemistry, Pharmaceutical/trends
- Clinical Trials as Topic
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 2/drug therapy
- Drugs, Investigational/adverse effects
- Drugs, Investigational/chemistry
- Drugs, Investigational/therapeutic use
- Humans
- Hypoglycemic Agents/adverse effects
- Hypoglycemic Agents/chemistry
- Hypoglycemic Agents/therapeutic use
- Insulin, Long-Acting/adverse effects
- Insulin, Long-Acting/chemistry
- Insulin, Long-Acting/genetics
- Insulin, Long-Acting/therapeutic use
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/chemistry
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/therapeutic use
- Recombinant Proteins/adverse effects
- Recombinant Proteins/chemistry
- Recombinant Proteins/therapeutic use
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Affiliation(s)
- David R Owens
- Diabetes Research Group, Swansea University, Swansea, Wales, UK
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6
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Abstract
Diabetes is a pandemic disease characterized by autoimmune, genetic and metabolic abnormalities. While insulin deficiency manifested as hyperglycemia is a common sequel of both Type-1 and Type-2 diabetes (T1DM and T2DM), it does not result from a single genetic defect--rather insulin deficiency results from the functional loss of pancreatic β cells due to multifactorial mechanisms. Since pancreatic β cells of patients with T1DM are destroyed by autoimmune reaction, these patients require daily insulin injections. Insulin resistance followed by β cell dysfunction and β cell loss is the characteristics of T2DM. Therefore, most patients with T2DM will require insulin treatment due to eventual loss of insulin secretion. Despite the evidence of early insulin treatment lowering macrovascular (coronary artery disease, peripheral arterial disease and stroke) and microvascular (diabetic nephropathy, neuropathy and retinopathy) complications of T2DM, controversy exists among physicians on how to initiate and intensify insulin therapy. The slow acting nature of regular human insulin makes its use ineffective in counteracting postprandial hyperglycemia. Instead, recombinant insulin analogs have been generated with a variable degree of specificity and action. Due to the metabolic variability among individuals, optimum blood glucose management is a formidable task to accomplish despite the presence of novel insulin analogs. In this article, we present a recent update on insulin analog structure and function with an overview of the evidence on the various insulin regimens clinically used to treat diabetes.
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MESH Headings
- Animals
- Diabetes Mellitus, Type 1/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Diabetic Angiopathies/prevention & control
- Drug Monitoring
- Evidence-Based Medicine
- Humans
- Hyperglycemia/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/chemistry
- Hypoglycemic Agents/metabolism
- Hypoglycemic Agents/therapeutic use
- Insulin/administration & dosage
- Insulin/analogs & derivatives
- Insulin/metabolism
- Insulin/therapeutic use
- Insulin, Regular, Human/administration & dosage
- Insulin, Regular, Human/analogs & derivatives
- Insulin, Regular, Human/genetics
- Insulin, Regular, Human/therapeutic use
- Recombinant Proteins/administration & dosage
- Recombinant Proteins/chemistry
- Recombinant Proteins/therapeutic use
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Affiliation(s)
- Ahter D. Sanlioglu
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Medical Biology and Genetics; Akdeniz University Faculty of Medicine; Antalya, Turkey
| | - Hasan Ali Altunbas
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Akdeniz University Faculty of Medicine; Antalya, Turkey
| | - Mustafa Kemal Balci
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Akdeniz University Faculty of Medicine; Antalya, Turkey
| | | | - Salih Sanlioglu
- Human Gene and Cell Therapy Center; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Department of Medical Biology and Genetics; Akdeniz University Faculty of Medicine; Antalya, Turkey
- Correspondence to: Salih Sanlioglu,
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