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Hanif N, Wu H, Xu P, Li Y, Bibi A, Zulfiqar A, Iqbal MZ, Tahir M, Zhang X, Ali A. Proteomic Changes to the Updated Discovery of Engineered Insulin and Its Analogs: Pros and Cons. Curr Issues Mol Biol 2022; 44:867-888. [PMID: 35723344 PMCID: PMC8929101 DOI: 10.3390/cimb44020059] [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: 12/28/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
The destruction of β-cells of the pancreas leads to either insulin shortage or the complete absence of insulin, which in turn causes diabetes Mellitus. For treating diabetes, many trials have been conducted since the 19th century until now. In ancient times, insulin from an animal's extract was taken to treat human beings. However, this resulted in some serious allergic reactions. Therefore, scientists and researchers have tried their best to find alternative ways for managing diabetes with progressive advancements in biotechnology. However, a lot of research trials have been conducted, and they discovered more progressed strategies and approaches to treat type I and II diabetes with satisfaction. Still, investigators are finding more appropriate ways to treat diabetes accurately. They formulated insulin analogs that mimic the naturally produced human insulin through recombinant DNA technology and devised many methods for appropriate delivery of insulin. This review will address the following questions: What is insulin preparation? How were these devised and what are the impacts (both positive and negative) of such insulin analogs against TIDM (type-I diabetes mellitus) and TIIDM (type-II diabetes mellitus)? This review article will also demonstrate approaches for the delivery of insulin analogs into the human body and some future directions for further improvement of insulin treatment.
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Affiliation(s)
- Naeema Hanif
- State Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Rice Research Institute, Sichuan Agricultural University, Chengdu 611130, China; (N.H.); (P.X.)
- Department of Biomedical Sciences, National University of Science and Technology, Islamabad 44000, Pakistan
| | - Hezhou Wu
- Hunan Taohuayuan Agricultural Technologies Co., Ltd., Yueyang 415000, China;
| | - Peizhou Xu
- State Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Rice Research Institute, Sichuan Agricultural University, Chengdu 611130, China; (N.H.); (P.X.)
| | - Yun Li
- Chengdu Academy of Agricultural and Forestry Sciences, Chengdu 611130, China;
| | - Amir Bibi
- Department of Plant Breeding and Genetics, University of Agriculture, Faisalabad 38000, Pakistan;
| | - Asma Zulfiqar
- Department of Botany, Quaid-e-Azam Campus, University of Punjab, Lahore 05422, Pakistan;
| | - Muhammad Zafar Iqbal
- College of Grassland Science and Technology, Sichuan Agricultural University, Chengdu 611130, China; (M.Z.I.); (M.T.)
| | - Muhammad Tahir
- College of Grassland Science and Technology, Sichuan Agricultural University, Chengdu 611130, China; (M.Z.I.); (M.T.)
| | - Xiangyang Zhang
- Branch of China National Hybrid Rice Research and Development Centre, Sichuan Tiland Huizhi Biology Science and Technology Co., Ltd., Chengdu 611130, China
| | - Asif Ali
- State Key Laboratory of Crop Gene Exploration and Utilization in Southwest China, Rice Research Institute, Sichuan Agricultural University, Chengdu 611130, China; (N.H.); (P.X.)
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Cersosimo E, Lee PG, Pandya N. Challenges of Diabetes Care in Older People With Type 2 Diabetes and the Role of Basal Insulin. Clin Diabetes 2019; 37:357-367. [PMID: 31660009 PMCID: PMC6794221 DOI: 10.2337/cd18-0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IN BRIEF The use of long-acting basal insulin analogs is a recommended strategy in older people with diabetes because of their lower risk of hypoglycemia compared to intermediate-acting insulins. In this article, we review the results from recent clinical trials of second-generation basal insulin preparations. We conclude that, although these preparations have improved the management of insulin-requiring older people with type 2 diabetes, there is a need for additional and more specific studies to address the complexities of hyperglycemia management in this population.
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Affiliation(s)
- Eugenio Cersosimo
- Texas Diabetes Institute, University Health System and the University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Pearl G. Lee
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Naushira Pandya
- Department of Geriatrics, Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
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Zhang T, Ji L, Gao Y, Zhang P, Zhu D, Li X, Ji J, Zhao F, Zhang H, Guo X. Observational Registry of Basal Insulin Treatment in Patients with Type 2 Diabetes in China: Safety and Hypoglycemia Predictors. Diabetes Technol Ther 2017; 19:675-684. [PMID: 29090977 DOI: 10.1089/dia.2017.0111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The Observational Registry of Basal Insulin Treatment (ORBIT) study evaluated the safety of basal insulin (BI) in real-world settings in China. METHODS We analyzed 9002 patients with type 2 diabetes (T2D) inadequately controlled with oral hypoglycemic agents from 8 geographic regions and 2 hospital tiers in China who initiated and maintained BI treatment. Body weight and hypoglycemic episodes were recorded at baseline and 3 and 6 months. Serious adverse events (SAEs) were recorded at 3 and 6 months. RESULTS Age, gender, inpatient/outpatient status, body mass index, glycated hemoglobin (HbA1c) at baseline and at the end of study, T2D duration, microvascular complications, BI type, combination with insulin secretagogues, self-monitoring of blood glucose frequency, and insulin dosage, all predicted hypoglycemia. BI use generally did not induce significant weight gain (0.02 kg); weight gain with insulin detemir (-0.30 kg) was less than that with neutral protamine Hagedorn (NPH) insulin (0.20 kg) or insulin glargine (0.05 kg). Overall, general hypoglycemia incidence (5.6% vs. 7.7%) and annual event rate (1.6 vs. 1.8) were similar before and after BI initiation, whereas a slight decrease was noted in severe hypoglycemia incidence (0.6%-0.3%) and frequency (0.05-0.03 events/patient-year). The general hypoglycemia rate was lowest with insulin glargine, whereas there was no significant difference in severe hypoglycemia among the three BI groups. Overall, 3.5% of patients had at least one SAE during the study. Most SAEs were found to be unrelated to BI treatment. CONCLUSIONS Real-world BI use, particularly insulin detemir and glargine, was associated with only slight weight gain and low hypoglycemia risk in patients with T2D in China.
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Affiliation(s)
| | - Linong Ji
- 2 Peking University People's Hospital , Beijing, China
- 3 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Yan Gao
- 1 Peking University First Hospital , Beijing, China
| | - Puhong Zhang
- 3 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Dongshan Zhu
- 3 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Xian Li
- 3 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Jiachao Ji
- 3 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Fang Zhao
- 3 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Heng Zhang
- 3 The George Institute for Global Health at Peking University Health Science Center , Beijing, China
| | - Xiaohui Guo
- 1 Peking University First Hospital , Beijing, China
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Ji L, Zhang P, Zhu D, Lu J, Guo X, Wu Y, Li X, Ji J, Jia W, Yang W, Zou D, Zhou Z, Gao Y, Garg SK, Pan C, Weng J, Paul SK. Comparative effectiveness and safety of different basal insulins in a real-world setting. Diabetes Obes Metab 2017; 19:1116-1126. [PMID: 28230322 DOI: 10.1111/dom.12920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 02/16/2017] [Accepted: 02/16/2017] [Indexed: 12/01/2022]
Abstract
AIMS To compare glucose control and safety of different basal insulin therapies (BI, including Insulin NPH, glargine and detemir) in real-world clinical settings based on a large-scale registry study. METHODS In this multi-center 6-month prospective observational study, patients with type 2 diabetes (HbA1c ≥ 7%) who were uncontrolled by oral anti-diabetic drugs (OADs) and were willing to initiate BI therapy were enrolled from 209 hospitals within 8 regions of China. Type and dose of BI were at the physician's discretion and the patients' willingness. Interviews were conducted at 0 months (visit 1), 3 months (visit 2) and 6 months (visit 3). Outcomes included change in HbA1c, hypoglycemia rate and body weight from baseline at 6 months. RESULTS A total of 16 341 and 9002 subjects were involved in Intention-To-Treat (ITT) and per-protocol (PP) analysis, respectively. After PS regression adjustment, ITT analysis showed that reduction in HbA1c in glargine (2.2% ± 2.1%) and detemir groups (2.2% ± 2.1%) was higher than that in the NPH group (2.0% ± 2.2%) (P < .01). The detemir group had the lowest weight gain (-0.1 ± 2.9 kg) compared with the glargine (+0.1 ± 3.0 kg) and NPH (+0.3 ± 3.1 kg) groups (P < .05). The glargine group had the lowest rate of minor hypoglycaemia, while there was no difference in severe hypoglycaemia among the 3 groups. The results observed in PP analyses were consistent with those in ITT analysis. CONCLUSION In a real-world clinical setting in China, treatment with long-acting insulin analogues was associated with better glycaemic control, as well as less hypoglycaemia and weight gain than treatment with NPH insulin in type 2 diabetes patients. However, the clinical relevance of these observations must be interpreted with caution.
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Affiliation(s)
- Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, P.R. China
- Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P.R. China
| | - Puhong Zhang
- Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P.R. China
| | - Dongshan Zhu
- Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P.R. China
| | - Juming Lu
- Department of Endocrinology, The General Hospital of the People's Liberation Army, Beijing, P.R. China
| | - Xiaohui Guo
- Department of Endocrinology, Peking University First Hospital, Beijing, P.R. China
| | - Yangfeng Wu
- Diabetes Research Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P.R. China
| | - Xian Li
- Biostatistics and Economic Evaluation Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P.R. China
| | - Jiachao Ji
- Biostatistics and Economic Evaluation Program, The George Institute for Global Health at Peking University Health Science Center, Beijing, P.R. China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, P.R. China
| | - Wenying Yang
- Department of Endocrinology, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Dajin Zou
- Department of Endocrinology, The Second Military Medical University, Shanghai, P.R. China
| | - Zhiguang Zhou
- Department of Endocrinology, Xiangya Second Hospital, Changsha, P.R. China
| | - Yan Gao
- Department of Endocrinology, Peking University First Hospital, Beijing, P.R. China
| | - Satish K Garg
- Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, Colorado
| | - Changyu Pan
- Department of Endocrinology, The General Hospital of the People's Liberation Army, Beijing, P.R. China
| | - Jianping Weng
- Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, P.R. China
| | - Sanjoy K Paul
- Melbourne EpiCentre, University of Melbourne, Melbourne, Australia
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Pettus J, Santos Cavaiola T, Tamborlane WV, Edelman S. The past, present, and future of basal insulins. Diabetes Metab Res Rev 2016; 32:478-96. [PMID: 26509843 DOI: 10.1002/dmrr.2763] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/23/2015] [Accepted: 10/04/2015] [Indexed: 12/14/2022]
Abstract
Insulin production by the pancreas follows a basic pattern where basal levels of insulin are secreted during fasting periods, with prandial increases in insulin associated with food ingestion. The aim of insulin therapy in patients with diabetes is to match the endogenous pattern of insulin secretion as closely as possible without causing hypoglycaemia. There are several optimal pharmacokinetic and pharmacodynamic properties of long-acting basal insulins that can help to achieve this aim, namely, as follows: activity that is flat and as free of peaks as possible, a duration of action of ≥24-h, and as little day-to-day variation as possible. The long-acting basal insulins are a fundamental therapy for patients with type 1 and type 2 diabetes, and those that are currently available have many benefits; however, the development of even longer-acting insulins and improved insulin delivery techniques may lead to better glycemic control for patients in the future. Established long-acting basal insulins available in the United States and Europe include insulin glargine 100 units/mL and insulin detemir, both of which exhibit similar glycemic control to that of the intermediate-acting neutral protamine Hagedorn insulin, but with a reduction in hypoglycaemia. Newer insulin products available include new insulin glargine 300 units/mL (United States and Europe) and the ultra-long-acting insulin degludec (Europe) with basal insulin peglispro currently in development. These new insulins demonstrate different pharmacokinetic/pharmacodynamic profiles and longer durations of action (>24 h) compared with insulin glargine 100 units/mL, which may lead to potential benefits. The introduction of biosimilar insulins may also broaden access to insulins by reducing treatment costs. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeremy Pettus
- Division of Endocrinology and Metabolism, University of California San Diego, San Diego, CA, USA
| | - Tricia Santos Cavaiola
- Division of Endocrinology and Metabolism, University of California San Diego, San Diego, CA, USA
| | | | - Steven Edelman
- Division of Endocrinology and Metabolism, University of California San Diego, San Diego, CA, USA
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Czech M, Rdzanek E, Pawęska J, Adamowicz-Sidor O, Niewada M, Jakubczyk M. Drug-related risk of severe hypoglycaemia in observational studies: a systematic review and meta-analysis. BMC Endocr Disord 2015; 15:57. [PMID: 26458540 PMCID: PMC4603823 DOI: 10.1186/s12902-015-0052-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 09/30/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) leads to multiple complications, including severe hypoglycaemia events (SHEs). SHEs can impact a patient's quality of life and compliance and may directly result in additional costs to the health care system. The aim of this review was to evaluate the risk of severe hypoglycaemia in patients with type 1 (T1) and 2 (T2) DM as observed in everyday clinical practice for various drug regimens. METHODS We conducted a systematic review of observational (retrospective or prospective) studies in the MEDLINE, Embase, and Cochrane Library databases that covered at least 100 children or adults with T1/T2 DM. In T1 DM, basal-bolus/pre-mix insulin (human or analogue) and insulin pump were reviewed, and in T2 DM, basal-bolus/pre-mix insulin (human or analogue), oral antidiabetic drugs supported with basal insulin (human or analogue), sulfonylureas in monotherapy, and combined oral treatment were reviewed. In order to estimate SHE rates, we extracted data on the time horizon of the study, number of patients, number of SHEs, and number of patients experiencing at least one SHE. We used a random effects model to estimate the annual SHE rate. We considered the risk for other antidiabetic medications in T2 DM to be negligible and the results of our main review yielded no observational data for premixes in T1 DM so they were assessed based on relative rates taken from additional systematic reviews. The study, being a desk research, did not involve any human subjects (including human material or human data) and no ethical committee approval was asked for. For the same reason there was no need to collect informed consent for participation in the study. RESULTS We identified 76 observational studies encompassing 707,722.30 patient-years. The estimated annual SHE rate varied from 0.168 (95 % CI 0.123-0.237) for insulin pump up to 1.628 for biphasic human insulin in T1 DM patients, and from 0.0035 for oral antidiabetic drugs up to 0.554 (95 % CI 0.157-7.534) for basal-bolus with human insulin in T2 DM patients. CONCLUSIONS Our review indicates that SHE rates differ between patients depending on treatment regimen. However, SHEs are also driven by other factors. Proper modelling techniques are needed to use various types of information in published studies.
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Affiliation(s)
- Marcin Czech
- Novo Nordisk Pharma sp. z o.o, Warsaw, Poland.
- Department of Pharmacoeconomics, Medical University of Warsaw, Warsaw, Poland.
- Business School, Warsaw University of Technology, Warsaw, Poland.
| | - Elżbieta Rdzanek
- HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K, Warsaw, Poland.
| | - Justyna Pawęska
- HealthQuest spółka z ograniczoną odpowiedzialnością Sp. K, Warsaw, Poland.
| | | | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
| | - Michał Jakubczyk
- Decision Analysis and Support Unit, Warsaw School of Economics, Al. Niepodległości 162, 02-554, Warsaw, Poland.
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