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Attri B, Nagendra L, Dutta D, Shetty S, Shaikh S, Kalra S, Bhattacharya S. Prandial Insulins: A Person-Centered Choice. Curr Diab Rep 2024; 24:131-145. [PMID: 38568467 DOI: 10.1007/s11892-024-01540-8] [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] [Accepted: 03/21/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE OF REVIEW Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management. RECENT FINDINGS Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods. The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.
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Affiliation(s)
- Bhawna Attri
- Department of Endocrinology, Sarvodaya Hospital, Faridabad, Haryana, India
| | - Lakshmi Nagendra
- Department of Endocrinology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Deep Dutta
- Department of Endocrinology, Center for Endocrinology Diabetes Arthritis and Rheumatism (CEDAR) Super-Speciality Healthcare, Dwarka, Delhi, India
| | - Sahana Shetty
- Department of Endocrinology, Kasturba Medical College, Manipal, Karnataka, India
| | - Shehla Shaikh
- Department of Endocrinology, Saifee Hospital, Mumbai, Maharashtra, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Saptarshi Bhattacharya
- Department of Endocrinology, Indraprastha Apollo Hospitals, Sarita Vihar, Mathura Road, Delhi, 110076, India.
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Prasanna Kumar KM, Chowdhury S, Bantwal G, Unnikrishnan AG, Kalra S, Aggarwal S, Singh AK, Pandit K, Shukla R, Vishwanathan V, Khobragade K, Sarda PS. Insulin Access Enhancement in India: Expert Views on Integrating Interchangeable Biosimilar Insulin Glargine. Cureus 2024; 16:e60983. [PMID: 38910730 PMCID: PMC11193911 DOI: 10.7759/cureus.60983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Achieving and maintaining optimal glycemic targets is the fundamental goal of the management of diabetes. However, failure of oral antidiabetic drugs (OADs) to sustain the targeted glycemic levels in individuals with progressing disease often requires initiation of insulin therapy. This article consolidates the expert opinions of 377 doctors who participated in 34 advisory board meetings held digitally (n=23) and in person (n=11) across India. The present report underscores the need for readily available alternatives, such as biosimilar insulins, in the Indian healthcare market to make insulin accessible to every patient with diabetes. The introduction of biosimilar insulins in the Indian healthcare market is the key to making insulin accessible to every patient with diabetes. Biosimilars are biologic products that closely resemble reference/originator biologics and demonstrate no clinically meaningful differences in safety and effectiveness. The concept of interchangeability serves as a pivotal differentiator for biosimilars, underlining their reliability and safety, and plays a significant role in their broader acceptance and integration into healthcare systems. The 'interchangeability' designation by the United States Food and Drug Administration (USFDA) elevates the biosimilar concept, promoting faster and broader adoption of insulin biosimilars, especially benefiting patients prone to non-adherence to insulin therapy. Healthcare providers are encouraged to consider the option of initiating or transitioning to biosimilar insulin glargine to address the insulin accessibility challenges.
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Affiliation(s)
- K M Prasanna Kumar
- Department of Endocrinology, Center For Diabetes and Endocrine Care (CDEC), Bengaluru, IND
| | | | - Ganapathi Bantwal
- Endocrinology and Diabetes, St. John's Medical College Hospital, Bengaluru, IND
| | | | - Sanjay Kalra
- Endocrinology, Bharti Research Institute of Diabetes & Endocrinology (BRIDE), Karnal, IND
| | - Sameer Aggarwal
- Endocrinology, Apex Plus Superspeciality Hospital, Rohtak, IND
| | | | - Kaushik Pandit
- Endocrinology, Diabetes and Metabolism, Fortis Medical Centre, Kolkata, IND
| | - Rishi Shukla
- Endocrinology, Center For Diabetes and Endocrine Disease, Kanpur, IND
| | - Vijay Vishwanathan
- Diabetology, M. Viswanathan (MV) Hospital for Diabetes, Chennai, IND
- Diabetology, Prof. M. Viswanathan Diabetes Research Centre, Chennai, IND
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Saboo B, Chandalia H, Ghosh S, Kesavadev J, Kochar IPS, Prasannakumar KM, Sarda A, Bantwal G, Mehrotra RN, Rai M. Insulin Glargine in Type 1 Diabetes Mellitus: A Review of Clinical Trials and Real-world Evidence Across Two Decades. Curr Diabetes Rev 2024; 20:e100323214554. [PMID: 36896906 PMCID: PMC10909813 DOI: 10.2174/1573399819666230310150905] [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: 08/16/2022] [Revised: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Over the past two decades, insulin glargine 100 U/mL (Gla-100) has emerged as the "standard of care" basal insulin for the management of type 1 diabetes mellitus (T1DM). Both formulations, insulin glargine 100 U/mL (Gla-100) and glargine 300 U/mL (Gla- 300) have been extensively studied against various comparator basal insulins across various clinical and real-world studies. In this comprehensive article, we reviewed the evidence on both insulin glargine formulations in T1DM across clinical trials and real-world studies. METHODS Evidence in T1DM for Gla-100 and Gla-300 since their approvals in 2000 and 2015, respectively, were reviewed. RESULTS Gla-100 when compared to the second-generation basal insulins, Gla-300 and IDeg-100, demonstrated a comparable risk of overall hypoglycemia, but the risk of nocturnal hypoglycemia was higher with Gla-100. Additional benefits of Gla-300 over Gla-100 include a prolonged (>24- hours) duration of action, a more stable glucose-lowering profile, improved treatment satisfaction, and greater flexibility in the dose administration timing. CONCLUSION Both glargine formulations are largely comparable to other basal insulins in terms of glucose-lowering properties in T1DM. Further, risk of hypoglycemia is lower with Gla-100 than Neutral Protamine Hagedorn but comparable to insulin detemir.
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Affiliation(s)
- Banshi Saboo
- Department of Endocrinology, Diabetes Care & Hormone Clinic, Ahmedabad, Gujarat, India
| | - Hemraj Chandalia
- Diabetes Endocrine Nutrition Management and Research Centre (DENMARC), Mumbai, Maharashtra, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME&R, Kolkata, West Bengal, India
| | - Jothydev Kesavadev
- Department of Endocrinology, Jothydev's Diabetes and Research Centre, Trivandrum, Kerala, India
| | - IPS Kochar
- Department of Endocrinology, Indraprastha Apollo Hospital, New Delhi, India
| | - KM Prasannakumar
- Centre for Diabetes and Endocrine Care, Bangalore Diabetes Hospital, Bengaluru, Karnataka, India
| | - Archana Sarda
- Sarda Centre for Diabetes and Self-care, Aurangabad, Maharashtra, India
| | - Ganapathi Bantwal
- Department of Endocrinology, St. John’s Medical College & Hospital, Bangalore, Karnataka, India
| | - RN Mehrotra
- Department of Endocrinology, Apollo Hospitals, Jubilee Hills, Hyderabad, Telangana, India
| | - Madhukar Rai
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India
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Chadha M, Jain SM, Chawla R, Dharmalingam M, Chaudhury T, Talwalkar P, Tripathi S, Singh S, Gutch M, Dasgupta A. Evolution of Guideline Recommendations on Insulin Therapy in Type 2 Diabetes Mellitus Over the Last Two Decades: A Narrative Review. Curr Diabetes Rev 2023; 19:e160123212777. [PMID: 36650625 PMCID: PMC10617785 DOI: 10.2174/1573399819666230116150205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/08/2022] [Accepted: 11/10/2022] [Indexed: 01/19/2023]
Abstract
The prevalence of type 2 diabetes mellitus has been increasing worldwide. As the therapeutic options for type 2 diabetes mellitus have evolved over the last 2 decades, national and global guidelines related to type 2 diabetes mellitus pharmacotherapy issued by various organizations have tended to vary in their recommendations. This narrative review aimed to analyze the key recommendations by major global and national guidelines on the initiation of insulin therapy in patients with type 2 diabetes mellitus over the last 20 years. Strategies for insulin therapy for titration and intensification were also assessed. All guidelines recommend initiation of insulin (basal/ premixed/other formulations) when glycemic targets are not achieved despite lifestyle measures and oral antidiabetic drugs. In the recent decade, early initiation of insulin has been recommended when the glycated hemoglobin levels are >10% or blood glucose levels are ≥300 mg/dL (16.7 mmol/L). Initiation is recommended at a dose of 10 units or 0.1-0.2 U/kg. Titration is advised to achieve the optimal dosage, while intensification is recommended when glycemic targets are not achieved despite titrating to an acceptable level. Glucose monitoring at periodic intervals is recommended for adequate glycemic control. The guidelines further suggest that the choice of insulin should be individualized, considering the clinical status of patients with type 2 diabetes mellitus. The physicians as well as patients should be a part of the decisions made regarding the therapeutic choice of regimen, preparation, and delivery device.
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Affiliation(s)
- Manoj Chadha
- Department of Endocrinology, P.D. Hinduja Hospital, Mumbai, Maharashtra, India
| | - Sunil M. Jain
- TOTALL Diabetes Hormone Institute, Indore, Madhya Pradesh, India
| | - Rajeev Chawla
- Department of Endocrinology, North Delhi Diabetes Centre, Rohini, New Delhi, India
| | - Mala Dharmalingam
- Department of Endocrinology, MSR Medical College & Hospital, Bangalore, Karnataka, India
| | | | | | - Sudhir Tripathi
- Department of Endocrinology & Metabolism, Sir Gangaram Hospital, New Delhi, India
| | - S.K. Singh
- Department of Endocrinology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India
| | - Manish Gutch
- Department of Endocrinology and Diabetes, Medanta Hospital, Lucknow, Uttar Pradesh, India
| | - Arundhati Dasgupta
- Department of Endocrinology, Rudraksh Superspeciality Care, Siliguri, West Bengal, India
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Castillo-Laborde C, Hirmas-Adauy M, Matute I, Jasmen A, Urrejola O, Molina X, Awad C, Frey-Moreno C, Pumarino-Lira S, Descalzi-Rojas F, Ruiz TJ, Plass B. Barriers and Facilitators in Access to Diabetes, Hypertension, and Dyslipidemia Medicines: A Scoping Review. Public Health Rev 2022; 43:1604796. [PMID: 36120091 PMCID: PMC9479461 DOI: 10.3389/phrs.2022.1604796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Identify barriers and facilitators in access to medicines for diabetes, hypertension, and dyslipidemia, considering patient, health provider, and health system perspectives. Methods: Scoping review based on Joanna Briggs methodology. The search considered PubMed, Cochrane Library, CINAHL, Academic Search Ultimate, Web of Science, SciELO Citation Index, and grey literature. Two researchers conducted screening and eligibility phases. Data were thematically analyzed. Results: The review included 219 documents. Diabetes was the most studied condition; most of the evidence comes from patients and the United States. Affordability and availability of medicines were the most reported dimension and specific barrier respectively, both cross-cutting concerns. Among high- and middle-income countries, identified barriers were cost of medicines, accompaniment by professionals, long distances to facilities, and cultural aspects; cost of transportation emerges in low-income settings. Facilitators reported were financial accessibility, trained health workers, medicines closer to communities, and patients’ education. Conclusion: Barriers and facilitators are determined by socioeconomic and cultural conditions, highlighting the role of health systems in regulatory and policy context (assuring financial coverage and free medicines); providers’ role bringing medicines closer; and patients’ health education and disease management.
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Affiliation(s)
- Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- *Correspondence: Carla Castillo-Laborde,
| | - Macarena Hirmas-Adauy
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Anita Jasmen
- Biblioteca Biomédica, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Oscar Urrejola
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Xaviera Molina
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Camila Awad
- Centro de Epidemiología y Políticas de Salud, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Catalina Frey-Moreno
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Sofia Pumarino-Lira
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Fernando Descalzi-Rojas
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Tomás José Ruiz
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Barbara Plass
- Carrera de Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Hasnani D, Saboo B, Chaturvedi A, Sikdar M, Shankar A, Choudhury R, Saboo B, Singh NM, Jha S, Chavda V. Current insulinization trends in India. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kesavadev J, Gowda A, Kumar H, Yalamanchi SR, Lodha S, Singh KP, Basu D, Asirvatham A, Shah N, Pathan MK, Revanna M, Mukherjee JJ. Safety of Insulin Degludec/Insulin Aspart in Patients with Diabetes Mellitus over a Period of 1 Year during Routine Clinical Care in India: SMART (Study of Management of Diabetes with Ryzodeg™ Treatment). Med Sci (Basel) 2021; 10:1. [PMID: 35076540 PMCID: PMC8788540 DOI: 10.3390/medsci10010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
This post-authorization study was conducted to evaluate the safety of insulin degludec/insulin aspart (IDegAsp) in adult patients with diabetes mellitus (DM) during routine clinical care under a real-world setting in India. Eligible patients received IDegAsp for a minimum of 12 months during routine clinical management. Data were collected at 0, 3, 6, and 12 months. In total, 1029 adult patients with DM were included; 65.2% (n = 671) were men; mean age was 55.0 ± 12.2 years, and the mean duration of diabetes mellitus was 10.8 ± 7.4 years. Thirty adverse events were reported in 23 patients (2.2%) during the follow-up: two adverse events in two patients were serious with fatal outcomes, which were unrelated to IDegAsp use. At baseline, there were 176 confirmed hypoglycemic events in 67 (6.7%) patients while they were on their previous treatment options. At 12 months of treatment with IDegAsp, 11 confirmed hypoglycemic events were reported in 11 (1.1%) patients since the previous visit; there were no reported episodes of severe hypoglycemia. Mean glycosylated hemoglobin value reduced from 9.5% ± 1.8% at baseline to 7.7% ± 1.1% at 12 months. This study showed the safety of IDegAsp in patients with diabetes mellitus over a period of 1 year during routine clinical care.
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Affiliation(s)
| | - Ambanna Gowda
- Fortis Hospital, Cunningham Road, Bengaluru 560052, India;
| | - Harish Kumar
- Amrita Institute of Medical Sciences, Kochi 682041, India;
| | | | | | | | - Debasis Basu
- Apollo Gleneagles Hospital, Kolkata 700067, India; (D.B.); (J.J.M.)
| | | | | | | | - Manjunatha Revanna
- Novo Nordisk India Private Limited, Bengaluru 560066, India; (M.K.P.); (M.R.)
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Mukherjee JJ, Rajput R, Majumdar S, Saboo B, Chatterjee S. Practical aspects of usage of insulin in India: Descriptive review and key recommendations. Diabetes Metab Syndr 2021; 15:937-948. [PMID: 33933807 DOI: 10.1016/j.dsx.2021.04.018] [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: 12/01/2020] [Revised: 04/02/2021] [Accepted: 04/18/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS Insulin therapy is an integral part of diabetes management. However, reliable and easily accessible information on a number of basic facts concerning insulin therapy, including storage of insulin, managing insulin therapy during travel, nuances of insulin use while driving, and dose adjustments during sick days is lacking. This document aims to make readily available, reliable, and easy to implement information on these essential but relatively less discussed aspects of insulin therapy. METHOD Literature search was performed using PubMed and Cochrane Library from inception till 1st of July 2019. The relevant topics were reviewed by a panel of 5 specialists and 23 contributing physicians and endocrinologists, who had assembled at Bengaluru, India for the 13th National Insulin Summit. After a thorough review of the literature, and following detailed discussions, the committee arrived at these recommendations. RESULTS Unopened vials and cartridges of insulin should be stored at 2 °C-8 °C in a refrigerator and protected from direct sunlight. For opened vials and in-use cartridges, manufacturer's instructions must be followed at all times. While traveling by air, dose adjustments are required only when flying across more than five time zones in the east or west directions. Insulin therapy should not be omitted or stopped during an acute illness; rather the doses need careful adjustments based on self-monitoring of blood glucose. CONCLUSION Recommendations and guidelines, covering many common aspects of insulin therapy are readily available. This consensus document aims to make recommendations for those essential aspects of insulin therapy that are crucial for its success but are relatively less known and less discussed.
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Affiliation(s)
- Jagat Jyoti Mukherjee
- Division of Endocrinology, Department of Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Rajesh Rajput
- Department of Endocrinology, Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
| | - Sujoy Majumdar
- Department of Endocrinology, Peerless Hospital, Kolkata, West Bengal, India
| | - Banshi Saboo
- Department of Medicine, DiaCare, Ahmedabad, Gujarat, India
| | - Sanjay Chatterjee
- Division of Endocrinology, Department of Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
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Kumar A, Sharma S, Gupta A, Dasgupta A, Asirvatham A, Talwalkar P, Das A, Mohan V. Indian reality of managing type 2 diabetes: an expert review of global and national guidelines for optimum insulin use. JOURNAL OF DIABETOLOGY 2020. [DOI: 10.4103/jod.jod_59_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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