1
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Ma S, He R, Jiang T, Hu Z, Ye Z, Mi W. Development of an isotope dilution mass spectrometry assay for the quantification of insulin based on signature peptide analysis. Anal Bioanal Chem 2024; 416:3085-3096. [PMID: 38556594 DOI: 10.1007/s00216-024-05258-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 04/02/2024]
Abstract
An isotope dilution mass spectrometry (IDMS) method that involves peptide-based protein analysis was developed to accurately quantify insulin. In this study, a signature peptide (GFFYTPK) obtained from tryptic digestion of insulin was selected as a surrogate for insulin. Then, the optimal conditions for signature peptide analysis through mass spectrometry detection and enzymatic digestion were determined. The analytical performance of this method was assessed and validated using porcine insulin-certified reference material. The linear range of the insulin calibration curve ranged from 0.05 ~ 2 mass ratios, with recoveries ranging from 96.15 to approximately 101.15%. The limit of detection was 0.19 ng/mL, and the limit of quantification was 0.63 ng/mL. The quantitative results corresponded well with a certified value that was obtained from measuring a porcine insulin reference material with amino acid-based IDMS. In addition, the target peptide GFFYTPK can be found in other species of insulin. This method was also applied for the quantification of human insulin-certified reference material. Finally, we applied the method to quantify the concentrations of simulated serum insulin. These findings suggested that this signature peptide-based IDMS approach can accurately quantify insulin levels, can assign a certified value to insulin reference materials, and has the potential to quantify serum insulin with traceable measurements.
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Affiliation(s)
- Shangying Ma
- College of Life Sciences, China Jiliang University, Xueyuan Street 258, Hangzhou, 310018, China
| | - Rimei He
- Guangxi Zhuang Autonomous Region Institute of Metrology and Test, Nanning, 530200, China
| | - Tingting Jiang
- College of Life Sciences, China Jiliang University, Xueyuan Street 258, Hangzhou, 310018, China
| | - Zhishang Hu
- National Institute of Metrology, No.18 Beisanhuan Donglu, Beijing, 100029, China.
| | - Zihong Ye
- College of Life Sciences, China Jiliang University, Xueyuan Street 258, Hangzhou, 310018, China.
| | - Wei Mi
- National Institute of Metrology, No.18 Beisanhuan Donglu, Beijing, 100029, China.
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2
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Lee J, Park HL, Park SY, Lim CH, Kim MH, Lee JM, Chang SA, Oh JH. Gastroparesis might not be uncommon in patients with diabetes mellitus in a real-world clinical setting: a cohort study. BMC Gastroenterol 2024; 24:30. [PMID: 38212710 PMCID: PMC10782575 DOI: 10.1186/s12876-023-03106-6] [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: 10/26/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND This study investigated the frequency of diabetic gastroparesis and associated risk factors in a real-world clinical setting. METHODS This retrospective cross-sectional study included patients who underwent assessments of solid gastric emptying time (GET) by technetium-99 m scintigraphy between May 2019 and December 2020. We categorized patients into three groups according to gastric retention of technetium-99 m: rapid (< 65% at 1 h or < 20% at 2 h), normal (≤60% at 2 h and/or ≤ 10% at 4 h), and delayed (> 60% at 2 h and/or > 10% at 4 h). RESULTS Patients with diabetes mellitus (DM) were more likely to show abnormal GET than those without DM (119 [70.8%] vs. 16 [44.4%]). The mean glycated A1c was 10.3% in DM patients. DM patients with normal GET were significantly younger (57.2 years, P = 0.044) than those with delayed (65.0 years) or rapid GET (60.2 years). Fasting glucose levels were the lowest in the normal GET group and the highest in the rapid GET group (delayed: 176.3 mg/dL, normal: 151.2 mg/dL, rapid: 181.0 mg/dL, P = 0.030). However, glycated A1c was not significantly different among the delayed, normal, and rapid GET groups in patients with DM. Patients with delayed and rapid GET showed a higher frequency of retinopathy (6.0 vs. 15.5%, P = 0.001) and peripheral neuropathy (11.3 vs. 24.4%, P = 0.001) than those with normal GET. In the multinomial logistic regression analysis, retinopathy demonstrated a positive association with delayed GET, while nephropathy showed a significant negative correlation. CONCLUSION DM gastroparesis in the clinical setting was not uncommon. Abnormal GET, including delayed and rapid GET, was associated with DM retinopathy or peripheral neuropathy.
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Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Hye Lim Park
- Division of Nuclear medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Su Young Park
- Division of Nuclear medicine, Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Chul-Hyun Lim
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea
| | - Min-Hee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Jung Min Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Sang-Ah Chang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 03312, South Korea
| | - Jung-Hwan Oh
- Division of Gastroenterology, Department of Internal Medicine, The Catholic University of Korea, Seoul, 03312, Republic of Korea.
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3
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Vaidyanathan J, Wang YMC, Tran D, Seo SK. Leveraging Clinical Pharmacology Data to Assess Biosimilarity and Interchangeability of Insulin Products. Clin Pharmacol Ther 2023; 113:794-802. [PMID: 36052570 DOI: 10.1002/cpt.2731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/26/2022] [Indexed: 11/09/2022]
Abstract
There is over a hundred years of clinical experience with insulin for the treatment of diabetes. The US Food and Drug Administration (FDA) approved the first insulin biosimilar interchangeable product in 2021 for improving glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Several recombinant insulin products are available in the United States, including the recently approved biosimilar insulins. The approval of the biosimilar insulin products was based on comparative analytical characterizations and comparative pharmacokinetic (PK) and pharmacodynamic (PD) data. The primary objective of this review is to discuss the scientific considerations in the demonstration of biosimilarity of a proposed insulin biosimilar to a reference product and the role of clinical pharmacology studies in the determination of biosimilarity and interchangeability. Euglycemic clamp studies are considered a "gold standard" for insulin PK and PD characterization and have been widely used to determine the time-action profiles of rapid-acting, intermediate-acting, and long-acting insulin products. Clinical pharmacology aspects of study design, including selection of appropriate dose, study population, PK, and PD end points, are presented. Finally, the role of clinical pharmacology studies in the interchangeability assessment of insulin and the regulatory pathways used for insulin and the experience with follow-on insulins and the two recently approved biosimilar insulin products is discussed.
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Affiliation(s)
- Jayabharathi Vaidyanathan
- 1Office of Clinical Pharmacology, Office of Translational Sciences, Center of Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Yow-Ming C Wang
- 1Office of Clinical Pharmacology, Office of Translational Sciences, Center of Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Doanh Tran
- 1Office of Clinical Pharmacology, Office of Translational Sciences, Center of Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Shirley K Seo
- 1Office of Clinical Pharmacology, Office of Translational Sciences, Center of Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
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4
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Flury M, Eckert A, Datz N, Kapellen T, Boettcher C, Raile K, Wolf J, Rami-Merhar B, Karges B, Neu A, Holl RW. Entwicklung der Insulintherapie in der pädiatrischen Diabetologie- Auswertung des DPV-Registers von 1995-2021. DIABETOL STOFFWECHS 2023. [DOI: 10.1055/a-2004-4449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ZusammenfassungDer Einsatz von Insulin zur Therapie des Diabetes mellitus Typ 1 beim Menschen hat vor 100
Jahren erstmals zum Überleben betroffener Patienten nach Manifestation der Erkrankung geführt.
War zuvor die Diagnose mit der Gewissheit verknüpft, dass es sich um eine unmittelbar
lebensbedrohliche Erkrankung handelt, wurde mit dem Einsatz des Hormons Insulin ab 1922 die
Perspektive eröffnet, den Verlauf der Erkrankung zu beeinflussen und die Prognose für die
Patienten damit zu verbessern.Ziel der vorliegenden Arbeit ist die Analyse von 92366 Patienten eines pädiatrischen
Patientenkollektivs aus Deutschland, Österreich, Luxemburg und der Schweiz im Hinblick auf den
Einsatz der verschiedenen Insulinarten im Zeitraum 1995–2021.Der Anteil der Insulinanaloga stieg insbesondere seit dem Jahr 2000 stark an, auch da die
Nutzung von Insulinpumpen mit Analoginsulin im Vergleich zur intensivierten Insulintherapie
mit Pen für alle Altersgruppen deutlich anstieg. Bereits im Jahr 2010 betrug der Anteil der
Insulinanaloga in der Diabetestherapie bei Kindern insgesamt > 60 %.Im Jahr 2022 können Diabetologen auf mehr als zehn Insulinarten und mindestens fünf
verschiedene Therapieformen zur Behandlung des Diabetes mellitus Typ 1 zurückgreifen.
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Affiliation(s)
- Monika Flury
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Pädiatrische Endokrinologie und Diabetologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Alexander Eckert
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- DZD, Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
| | - Nicolin Datz
- Diabetologie, Endokrinologie und Allgemeine Pädiatrie, Diabeteszentrum für Kinder und Jugendliche, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Thomas Kapellen
- Kinderendokrinologie und Diabetologie, MEDIAN Kinderklinik "Am Nicolausholz", Bad Kösen, Germany
- Klinik für Kinder- und Jugendmedizin, Universität Leipzig, Leipzig, Germany
| | - Claudia Boettcher
- Pädiatrische Endokrinologie, Diabetologie und Stoffwechsel, Inselspital Universitätsspital Bern Universitätsklinik für Kinderheilkunde, Bern, Switzerland
| | - Klemens Raile
- Klinik für Pädiatrie m.S. Endokrinologie und Diabetologie, Charité Universitätsmedizin Berlin - Campus Virchow-Klinikum, Berlin, Germany
| | - Johannes Wolf
- Diabeteszentrum für Kinder und Jugendliche, Klinik für Kinder- und Jugendmedizin, Paderborn, Germany
| | - Birgit Rami-Merhar
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Beate Karges
- Sektion Endokrinologie und Diabetologie, RWTH Aachen, Universitätsklinikum, Aachen, Germany
| | - Andreas Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tubingen, Germany
| | - Reinhard Walter Holl
- Institut für Epidemiologie und medizinische Biometrie, ZIBMT, Universität Ulm, Ulm, Germany
- DZD, Deutsches Zentrum für Diabetesforschung, Neuherberg, Germany
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5
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Кузнецов КО, Михеева АЮ, Ишмухаметова АА, Толстых ТА, Галляметдинова АР, Ботирова ЗУ, Забирова АА, Шарипова АШ, Шайхлисламова АБ, Абрахманова ДР. [Diabetic gastroenteropathy: modern methods of diagnosis and treatment]. PROBLEMY ENDOKRINOLOGII 2022; 68:67-78. [PMID: 36337020 PMCID: PMC9762451 DOI: 10.14341/probl13082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/14/2022] [Accepted: 07/13/2022] [Indexed: 11/09/2022]
Abstract
Diabetes mellitus is a chronic disease with a growing prevalence worldwide, however, the prevalence of its complications, including gastroenteropathy, is also increasing. The pathophysiology of diabetic gastroenteropathy (DH) combines hyperglycemia, vagus nerve dysfunction, decreased expression of nitric oxide synthase in the myenteric plexus, changes in the interstitial Cajal cell network, as well as oxidative stress. Clinical signs of DH are gastroesophageal reflux, gastroparesis, constipation, abdominal pain and diarrhea. Among the diagnostic methods are manometry with pH measurement (assessment of esophageal motility), gastric emptying scintigraphy, respiratory test (to assess gastroparesis), aspiration and cultivation of the contents of the jejunum (to diagnose bacterial overgrowth syndrome). To date, there is no definitive treatment for DH - an interdisciplinary approach is aimed at slowing the progression of the disease, relieving symptoms and restoring gastrointestinal function. Patients are recommended a diet low in simple sugars and high in fiber; optimization of glycemic control with a target glycemia of less than 180 mg/dl. As for drug therapy, the use of prokinetics and antiemetics is justified, and in case of excessive bacterial growth syndrome, antibacterial therapy (rifaximin) is carried out. Modern approaches to the treatment of DH are also accumulating, including the use of botulinum toxin, pyloroplasty and electrical stimulation of the stomach in individual patients. Despite the constant development of new treatments, they are not yet able to completely cure DH in the near future, which makes it necessary to conduct further research in this area.
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Affiliation(s)
- К. О. Кузнецов
- Российский национальный исследовательский медицинский университет им. Н.И. Пирогова
| | - А. Ю. Михеева
- Национальный медицинский исследовательский центр им. В.А. Алмазова
| | - А. А. Ишмухаметова
- Первый Московский государственный медицинский университет им. И.М. Сеченова
| | - Т. А. Толстых
- Первый Московский государственный медицинский университет им. И.М. Сеченова
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6
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Ahn DT. Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy. J Diabetes Sci Technol 2022; 16:605-609. [PMID: 34933594 PMCID: PMC9294589 DOI: 10.1177/19322968211062624] [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] [Indexed: 12/24/2022]
Abstract
Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)-mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.
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Affiliation(s)
- David T Ahn
- Mary & Dick Allen Diabetes
Center, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
- David Ahn, MD, Mary & Dick
Allen Diabetes Center, Hoag Memorial Hospital Presbyterian, 520
Superior Avenue, Suite 150, Newport Beach, CA 92663, USA.
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7
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Concepción Zavaleta MJ, Gonzáles Yovera JG, Moreno Marreros DM, Rafael Robles LDP, Palomino Taype KR, Soto Gálvez KN, Arriola Torres LF, Coronado Arroyo JC, Concepción Urteaga LA. Diabetic gastroenteropathy: An underdiagnosed complication. World J Diabetes 2021; 12:794-809. [PMID: 34168729 PMCID: PMC8192258 DOI: 10.4239/wjd.v12.i6.794] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
This article is an extensive review that provides an update on the pathophysiology, symptoms, diagnosis, and treatment of diabetic gastroenteropathy. There is no reported prevalence, but it has been described that patients with type 1 diabetes have a cumulative incidence at 10 years of 5.2%, and type 2 patients, 1%. Also, in the group of type 1 diabetes, it has been observed that women are more likely to present this condition (5.8% vs 3.5%). Many factors are associate with its development (e.g., hyperglycemia, vagal dysfunction, loss of expression of neural nitric oxide synthase in the myenteric plexus, alterations in the Cajal interstitial cell network, and oxidative stress). Gastrointestinal discomfort could be perceived 70% higher in diabetic patients, describing that 25% of diabetic patients experience gastrointestinal symptoms. Diabetic enteropathy could affect any portion of the gastrointestinal tract, but esophageal alterations were described in more than 60% of diabetic patients, also 60% of them present constipation, and 20%, diarrhea. Gastric emptying scintigraphy is useful to evaluate gastroparesis, therefore, gastric retention of more than 60% at 2 h has a sensitivity of 100% and specificity of 20% for diagnosis; however, other studies such as breath tests, with a sensitivity of 89% and a specificity of 80%, or the endoscopic capsule contribute to the diagnosis. There is no cure; however, management must be multidisciplinary, focused on slowing the progression of diabetic gastroenteropathy, reducing symptoms, and restoring function; that includes nutritional recommendation, maintain glucose levels kept below 180 mg/dL, use of prokinetics, anti-emetics; nowadays, it has been special interest in surgical treatment, such as pyloroplasty, also gastric electrical stimulation appears to be another alternative.
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8
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Beran D, Lazo-Porras M, Mba CM, Mbanya JC. A global perspective on the issue of access to insulin. Diabetologia 2021; 64:954-962. [PMID: 33483763 PMCID: PMC8012321 DOI: 10.1007/s00125-020-05375-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/03/2020] [Indexed: 02/08/2023]
Abstract
The discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO's framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients' abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO's Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes.
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Affiliation(s)
- David Beran
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Maria Lazo-Porras
- Division of Tropical and Humanitarian Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Camille M Mba
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
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9
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Ruiz SMA, Bernad Bernad MJ, Arellano RL, Torres RD, Del Carmen Caballero Chacón S, Estrada DV. In Vitro and In Vivo Profiles and Characterization of Insulin Nanocarriers Based in Flexible Liposomes Designed for Oral Administration. LETT DRUG DES DISCOV 2019. [DOI: 10.2174/1570180816666190110112929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Alternatives routes of delivery for Insulin have been evaluated to improve
treatment for Diabetes Mellitus. The oral route is the most convenient physiologically; it releases in a
similar way to endogenous secretion. Flexible liposomes have deformable abilities to pass through
membranes with adequate therapeutic effects, but they have been tested only dermally.
Objective:
Our aim was to develop an oral nanocarrier based on flexible liposomes for insulin with
polymer addition to reduce gastrointestinal degradation.
Methods:
Different percentages of polyethylene glycol were added to a conventional formulation of
flexible liposomes. The manufacturing procedure was the heating method. Z potential, size particle,
polydispersity index and encapsulation percentage were evaluated. A release profile was performed
in the stomach and intestinal pH mediums by two-stage reverse dialysis method. The in-vivo test was
performed in experimental diabetic rats by oral, transdermal and subcutaneous routes.
Results:
All the formulations showed polydispersity but adequate Z potential. The 10% PEG
formulation obtained the best insulin enclosure with 81.9%. The insulin integrity after preparation
was confirmed by polyacrylamide gel electrophoresis. PEG and non-PEG formulations showed
similar behavior in acid release profile but the release and stability of lipid structures were better and
longer in intestinal pH conditions. In vivo tests showed a reduction to normal glucose levels only in
subcutaneous route.
Conclusion:
The polymer inclusion in flexible liposomes generates an adequate nanocarrier for
proteins in terms of stability and composition; although its in-vivo use reduces glucose levels in
subcutaneous route, the effect was not adequate in oral route.
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Affiliation(s)
- Sara Melisa Arciniegas Ruiz
- Physiology and Pharmacology department, Veterinary Medicine School, Universidad Nacional Autonoma de Mexico. Mexico Universidad 3000, Circuito Exterior S/N Delegacion Coyoacan, C.P. 04510, Ciudad Universitaria. CD.MX, Mexico
| | - María Josefa Bernad Bernad
- Pharmaceutical Technology, Chemistry Faculty, Universidad Nacional Autonoma de Mexico, Mexico Universidad 3000, Circuito Exterior S/N Delegacion Coyoacan, C.P. 04510. Ciudad Universitaria. CD.MX, Mexico
| | - Raquel Lopez Arellano
- Laboratory of Pharmaceutical Assays, Facultad de Estudios Superiores (FES) Cuautitlan, Universidad Nacional Autonoma de Mexico, Mexico Campo Cuatro, Carretera Cuautitlan-Teoloyucan Km. 2.5, Col. San Sebastian Xhala, Cuautitlan Izcalli, Estado de Mexico, CP. 54714, Mexico
| | - Roberto Diaz Torres
- Multidisciplinary Research Department, Facultad de Estudios Superiores (FES) Cuautitlan, Universidad Nacional Autonoma de Mexico, Mexico Campo Cuatro, Carretera Cuautitlan-Teoloyucan Km. 2.5, Col. San Sebastian Xhala, Cuautitlan Izcalli, Estado de Mexico, CP. 54714, Mexico
| | - Sara Del Carmen Caballero Chacón
- Physiology and Pharmacology department, Veterinary Medicine School, Universidad Nacional Autonoma de Mexico. Mexico Universidad 3000, Circuito Exterior S/N Delegacion Coyoacan, C.P. 04510, Ciudad Universitaria. CD.MX, Mexico
| | - Dinorah Vargas Estrada
- Physiology and Pharmacology department, Veterinary Medicine School, Universidad Nacional Autonoma de Mexico. Mexico Universidad 3000, Circuito Exterior S/N Delegacion Coyoacan, C.P. 04510, Ciudad Universitaria. CD.MX, Mexico
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10
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Abstract
Insulin is an important polypeptide hormone that regulates carbohydrate metabolism.
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Affiliation(s)
- Yixiao Shen
- Department of Food Science
- Shenyang Agricultural University
- Shenyang
- China
| | - Witoon Prinyawiwatkul
- School of Nutrition and Food Sciences
- Louisiana State University
- Agricultural Center
- Baton Rouge
- USA
| | - Zhimin Xu
- School of Nutrition and Food Sciences
- Louisiana State University
- Agricultural Center
- Baton Rouge
- USA
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11
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Candido R, Wyne K, Romoli E. A Review of Basal-Bolus Therapy Using Insulin Glargine and Insulin Lispro in the Management of Diabetes Mellitus. Diabetes Ther 2018; 9:927-949. [PMID: 29654514 PMCID: PMC5984925 DOI: 10.1007/s13300-018-0422-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED Basal-bolus therapy (BBT) refers to the combination of a long-acting basal insulin with a rapid-acting insulin at mealtimes. Basal insulin glargine 100 U/mL and prandial insulin lispro have been available for many years and there is a substantial evidence base to support the efficacy and safety of these agents when they are used in BBT or basal-plus therapy for patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM). With the growing availability of alternative insulins for use in such regimens, it seems timely to review the data regarding BBT with insulin glargine 100 U/mL and insulin lispro. In patients with T1DM, BBT with insulin glargine plus insulin lispro provides similar or better glycemic control and leads to less nocturnal hypoglycemia compared to BBT using human insulin as the basal and/or prandial component, and generally provides similar glycemic control and rates of severe hypoglycemia to those achieved with insulin lispro administered by continuous subcutaneous insulin infusion (CSII). Studies evaluating BBT with insulin glargine plus insulin lispro in patients with T2DM also demonstrate the efficacy and safety of these insulins. Available data suggest that BBT with insulin glargine and insulin lispro provides similar levels of efficacy and safety in pediatric and adult populations with T1DM and in adult patients and those aged more than 65 years with T2DM. These insulin preparations also appear to be safe and effective for controlling T2DM in people of different ethnicities and in patients with T1DM or T2DM and comorbidities. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Riccardo Candido
- Diabetes Centre District 3, Azienda Sanitaria Universitaria Integrata di Trieste, Via Puccini 48/50, 34100, Trieste, Italy.
| | - Kathleen Wyne
- The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Ester Romoli
- Eli Lilly Italia SPA, via A. Gramsci 731/733, 50019, Sesto Fiorentino, Italy
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Moyers JS, Volk CB, Cao JXC, Zhang C, Ding L, Kiselyov VV, Michael MD. Internalization and localization of basal insulin peglispro in cells. Mol Cell Endocrinol 2017; 454:23-38. [PMID: 28576743 DOI: 10.1016/j.mce.2017.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Basal insulin peglispro (BIL) is a novel, PEGylated insulin lispro that has a large hydrodynamic size compared with insulin lispro. It has a prolonged duration of action, which is related to a delay in insulin absorption and a reduction in clearance. Given the different physical properties of BIL compared with native insulin and insulin lispro, it is important to assess the cellular internalization characteristics of the molecule. METHODS AND MATERIALS Using immunofluorescent confocal imaging, we compared the cellular internalization and localization patterns of BIL, biosynthetic human insulin, and insulin lispro. We assessed the effects of BIL on internalization of the insulin receptor (IR) and studied cellular clearance of BIL. RESULTS Co-localization studies using antibodies to either insulin or PEG, and the early endosomal marker EEA1 showed that the overall internalization and subcellular localization pattern of BIL was similar to that of human insulin and insulin lispro; all were rapidly internalized and co-localized with EEA1. During ligand washout for 4 h, concomitant loss of insulin, PEG methoxy group, and PEG backbone immunostaining was observed for BIL, similar to the loss of insulin immunostaining observed for insulin lispro and human insulin. Co-localization studies using an antibody to the lysosomal marker LAMP1 did not reveal evidence of lysosomal localization for insulin lispro, human insulin, BIL, or PEG using either insulin or PEG immunostaining reagents. BIL and human insulin both induced rapid phosphorylation and internalization of human IR. CONCLUSIONS Our findings show that treatment of cells with BIL stimulates internalization and localization of IR to early endosomes. Both the insulin and PEG moieties of BIL undergo a dynamic cellular process of rapid internalization and transport to early endosomes followed by loss of cellular immunostaining in a manner similar to that of insulin lispro and human insulin. The rate of clearance for the insulin lispro portion of BIL was slower than the rate of clearance for human insulin. In contrast, the PEG moiety of BIL can recycle out of cells.
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Affiliation(s)
- Julie S Moyers
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
| | - Catherine B Volk
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Julia X C Cao
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Chen Zhang
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - Liyun Ding
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - M Dodson Michael
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
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Jiráček J, Žáková L. Structural Perspectives of Insulin Receptor Isoform-Selective Insulin Analogs. Front Endocrinol (Lausanne) 2017; 8:167. [PMID: 28798723 PMCID: PMC5529358 DOI: 10.3389/fendo.2017.00167] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 06/29/2017] [Indexed: 01/16/2023] Open
Abstract
A significant drawback of the exogenous administration of insulin to diabetics is the non-physiological profile of insulin action resulting in the insufficient suppression of hepatic glucose production, which is the main contributing factor to diabetic hyperglycemia under fasting conditions and the basis of the challenge to restore a more physiological glucose profile in diabetes. The insulin receptor (IR) exists in two alternatively spliced variants, IR-A and IR-B, with different tissue distribution. While peripheral tissues contain different proportions of both isoforms, hepatic cells almost exclusively contain IR-B. In this respect, IR-B-selective insulin analogs would be of great interest for their potential to restore more natural metabolic homeostasis in diabetes. Recent advances in the structural biology of insulin and IR have provided new clues for understanding the interaction of both proteins. This article discusses and offers some structural perspectives for the design of specific insulin analogs with a preferential binding to IR-B.
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Affiliation(s)
- Jiří Jiráček
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czechia
- *Correspondence: Jiří Jiráček,
| | - Lenka Žáková
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czechia
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Machado-Alba JE, Medina-Morales DA, Echeverri-Cataño LF. Comparison of medication adherence in diabetes mellitus patients on human versus analogue insulins. Expert Opin Drug Saf 2016; 16:133-137. [PMID: 28002970 DOI: 10.1080/14740338.2017.1273346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objetive: This study evaluated the results of treatment adherence scales in two cohorts of patients with diabetes mellitus treated either with human or analogue insulins. METHODS A cohort study was conducted in diabetes mellitus patients older than 18 that were being treated with human or analogue insulins. Two instruments were applied to each patient [medication possession ratio, Morisky-Green test] to evaluate treatment adherence. RESULTS A total of 238 patients, were included. The majority (69.4%) of the subjects had human insulin and 30.6% had insulin analogue prescriptions. Out of the total, 163 (68.5%) cases were classified as adherent to therapy, according to the type of insulin, as follows: 69.9% for conventional and 65.3% for analogues; without differences between the groups (CI95%:0.450-1.458). The adherence to treatment was more probable in patients with elementary-secondary education (OR:2.341; CI95%:1.199-4.568) and less probable for those in the age range of 31-45 years (OR:0.427; CI95%:0.187-0.971). CONCLUSIONS The results of this study show that there are no significant statistical differences in adherence when comparing human with analogue insulin therapy. Strategies to improve treatment adherence are particularly important since they improve the clinical results.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- a Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia , Universidad Tecnológica de Pereira-Audifarma S.A ., Pereira , Colombia
| | - Diego Alejandro Medina-Morales
- a Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia , Universidad Tecnológica de Pereira-Audifarma S.A ., Pereira , Colombia
| | - Luis Felipe Echeverri-Cataño
- a Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia , Universidad Tecnológica de Pereira-Audifarma S.A ., Pereira , Colombia
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Machado-Alba JE, Medina-Morales DA. Comparison of the impact of human vs analogue insulins on glycosylated haemoglobin in a population with diabetes mellitus. Int J Clin Pract 2016; 70:996-1002. [PMID: 28032423 DOI: 10.1111/ijcp.12904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/02/2016] [Indexed: 11/27/2022] Open
Abstract
AIMS To compare the effect on metabolic control of treatment with conventional and analogue insulins for patients with diabetes mellitus. METHODS Retrospective cohort study held in cities of Colombia (Pereira and Manizales). People insured by the paid healthcare system, who were diagnosed with diabetes mellitus type 1 and 2, and treated with conventional and analogue insulin for at least 6 months prior to the start of the study were sampled and followed up for 18 months. Data were collected from clinical records for each patient. Treatment groups were compared according to the type of insulin received. RESULTS A total of 313 patients were included; overall, 56.9% were women and the mean age was 57.3 years. No statistically significant difference was found in glycosylated haemoglobin reduction at 3, 6 and 18 months when comparing patients receiving glargine vs NPH insulin (P=.403) and NPH plus zinc crystalline insulin vs glargine plus glulisine (P=.514). The percentage of patients with metabolic control increased from 27.8% to 34.2% during follow-up with all types of insulin. CONCLUSIONS Insulin analogues were not superior to human insulin for glycaemic control. A significant proportion of patients did not attain the treatment goals; therefore, it is necessary to implement measures to improve the monitoring and control of diabetes mellitus.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- Director Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia
| | - Diego Alejandro Medina-Morales
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Facultad Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia
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Nagaraj V, Kazim AS, Helgeson J, Lewold C, Barik S, Buda P, Reinbothe TM, Wennmalm S, Zhang E, Renström E. Elevated Basal Insulin Secretion in Type 2 Diabetes Caused by Reduced Plasma Membrane Cholesterol. Mol Endocrinol 2016; 30:1059-1069. [PMID: 27533789 PMCID: PMC5045496 DOI: 10.1210/me.2016-1023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Elevated basal insulin secretion under fasting conditions together with insufficient stimulated insulin release is an important hallmark of type 2 diabetes, but the mechanisms controlling basal insulin secretion remain unclear. Membrane rafts exist in pancreatic islet cells and spatially organize membrane ion channels and proteins controlling exocytosis, which may contribute to the regulation of insulin secretion. Membrane rafts (cholesterol and sphingolipid containing microdomains) were dramatically reduced in human type 2 diabetic and diabetic Goto-Kakizaki (GK) rat islets when compared with healthy islets. Oxidation of membrane cholesterol markedly reduced microdomain staining intensity in healthy human islets, but was without effect in type 2 diabetic islets. Intriguingly, oxidation of cholesterol affected glucose-stimulated insulin secretion only modestly, whereas basal insulin release was elevated. This was accompanied by increased intracellular Ca2+ spike frequency and Ca2+ influx and explained by enhanced single Ca2+ channel activity. These results suggest that the reduced presence of membrane rafts could contribute to the elevated basal insulin secretion seen in type 2 diabetes.
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Affiliation(s)
- Vini Nagaraj
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Abdulla S Kazim
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Johan Helgeson
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Clemens Lewold
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Satadal Barik
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Pawel Buda
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Thomas M Reinbothe
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Stefan Wennmalm
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Enming Zhang
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
| | - Erik Renström
- Department of Clinical Sciences Malmö (V.N., A.S.K., J.H., C.L., S.B., P.B., T.M.R., E.Z., E.R.), Lund University Diabetes Centre, Lund University, SE-20502 Malmö, Sweden; and Science for Life Laboratory (S.W.), KTH Royal Institute of Technology, SE-171 77 Stockholm, Sweden
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Machado-Alba JE, Medina-Morales DA, Echeverri-Cataño LF. Evaluation of the quality of life of patients with diabetes mellitus treated with conventional or analogue insulins. Diabetes Res Clin Pract 2016; 116:237-43. [PMID: 27321341 DOI: 10.1016/j.diabres.2016.04.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/25/2016] [Accepted: 04/21/2016] [Indexed: 12/30/2022]
Abstract
AIMS The results of two scales that measure quality of life of patients with diabetes mellitus treated with conventional or analogue insulin were evaluated and compared. METHODS Descriptive, observational, cross-sectional study, conducted in the cities of Pereira and Manizales, Colombia, in a care facility between 1 August 2013 and 30 March 2014. A total of 238 patients diagnosed with diabetes mellitus type 1 or type 2 who had been undergoing treatment with conventional or analogue insulin for at least 6months. Comparison of the results of the Diabetes 39 (specific) and European Quality of Life-5 Dimensions (EQ-5D) (generic) tools it was performed. Comparisons between the results of the two instruments were performed. Tests for parametric and non-parametric distribution (Pearson's correlation coefficient, Mann-Whitney U test, Student's t-test and Wilcoxon test) were used. RESULTS The mean age was 57.7±16.6years. Conventional insulin was prescribed to 69.6% of patients, and analogue insulin was prescribed to 30.4% of patients. Diabetes-39 (D-39) showed 24.7% of subjects with a high quality of life. No statistically significant differences were found when comparing patients prescribed conventional or analogue insulin (p=0.35; 95% confidence interval [CI]: 0.375-1.419). In the EQ-5D survey, 45.7% claimed to have a high quality of life, without statistically significant differences between groups (p=0.56; 95%CI: 0.676-2.047). CONCLUSIONS No differences between patients receiving conventional insulin versus analogue insulin were detected in terms of quality of life. The group aged over 60years requires special attention to improve their quality of life, and programs should focus on those individuals.
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Affiliation(s)
- Jorge Enrique Machado-Alba
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.
| | - Diego Alejandro Medina-Morales
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.
| | - Luis Felipe Echeverri-Cataño
- Grupo de Investigación en Farmacoepidemiología y Farmacovigilancia, Universidad Tecnológica de Pereira-Audifarma S.A., Pereira, Colombia.
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Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, Roura LC, McIntyre HD, Morris JL, Divakar H. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care . Int J Gynaecol Obstet 2015; 131 Suppl 3:S173-S211. [PMID: 29644654 DOI: 10.1016/s0020-7292(15)30033-3] [Citation(s) in RCA: 516] [Impact Index Per Article: 57.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Moshe Hod
- Division of Maternal Fetal Medicine, Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark
| | - David A Sacks
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Eran Hadar
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mukesh Agarwal
- Department of Pathology, UAE University, Al Ain, United Arab Emirates
| | - Gian Carlo Di Renzo
- Centre of Perinatal and Reproductive Medicine, Department of Obstetrics and Gynecology, University of Perugia, Perugia, Italy
| | - Luis Cabero Roura
- Maternal Fetal Medicine Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Jessica L Morris
- International Federation of Gynecology and Obstetrics, London, UK
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19
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20
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Nuevas insulinas en la diabetes tipo 1. Med Clin (Barc) 2015; 145:70-5. [DOI: 10.1016/j.medcli.2014.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 04/10/2014] [Indexed: 11/16/2022]
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El-Sabagh M, Taniguchi D, Sugino T, Obitsu T, Taniguchi K. Insulin-independent actions of glucagon-like peptide-1 in wethers. Anim Sci J 2014; 86:385-91. [DOI: 10.1111/asj.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/17/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Mabrouk El-Sabagh
- Graduate School of Biosphere Science; Hiroshima University; Higashi-Hiroshima Japan
- Faculty of Veterinary Medicine; Kafrelsheikh University; Kafrelsheikh Egypt
| | - Dai Taniguchi
- Graduate School of Biosphere Science; Hiroshima University; Higashi-Hiroshima Japan
| | - Toshihisa Sugino
- Graduate School of Biosphere Science; Hiroshima University; Higashi-Hiroshima Japan
| | - Taketo Obitsu
- Graduate School of Biosphere Science; Hiroshima University; Higashi-Hiroshima Japan
| | - Kohzo Taniguchi
- Graduate School of Biosphere Science; Hiroshima University; Higashi-Hiroshima Japan
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22
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Abstract
The currently available basal insulin does not completely mimic the endogenous insulin secretion. This has continued to promote the search for ideal basal insulin. The newer basal insulin have primarily focused on increasing the duration of action, reducing variability, and reducing the incidence of hypoglycemia, particularly nocturnal. However, the changing criteria of hypoglycemia within a short span of a few years along with the surprising introduction of major cardiac events as another outcome measure has not only clouded the assessment of basal insulin but has also polarized opinion worldwide about the utility of the newer basal insulin. A critical review of both the pre and post FDA analysis of all the basal insulin in this article attempts to clear some of the confusion surrounding the issues of hypoglycemia and glycemic control. This article also discusses all the trials and meta-analysis done on all the current basal insulin available along with their head-to-head comparison with particular attention to glycemic control and hypoglycemic events including severe and nocturnal hypoglycemia. This in-depth analysis hopes to provide a clear interpretation of the various analyses available in literature at this point of time thereby acting as an excellent guide to the readers in choosing the most appropriate basal insulin for their patient.
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Affiliation(s)
- Awadhesh Kumar Singh
- Senior Consultant Endocrinologist, G.D Diabetes Hospital, Kolkata, West Bengal, India
- Sun Valley Diabetes Hospital, Guwahati, Assam, India
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Abstract
A stress-free actively managed perioperative experience is crucial to successful ambulatory surgery for diabetes patients. Practitioners who integrate diabetes treatment regimens into their perioperative management can facilitate a good outcome, smooth recovery, and rapid return to normal life. Hypoglycemia, hyperglycemia, and glucose variability must be avoided and patients should be maintained near their usual blood glucose.
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Affiliation(s)
- Mary Ann Vann
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
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24
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Abstract
Treatment of type 1 diabetes mellitus (T1DM) requires lifelong administration of exogenous insulin. The primary goal of treatment of T1DM in children and adolescents is to maintain near-normoglycemia through intensive insulin therapy, avoid acute complications, and prevent long-term microvascular and macrovascular complications, while facilitating as close to a normal life as possible. Effective insulin therapy must, therefore, be provided on the basis of the needs, preferences, and resources of the individual and the family for optimal management of T1DM. To achieve target glycemic control, the best therapeutic option for patients with T1DM is basal-bolus therapy either with multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Many formulations of insulin are available to help simulate endogenous insulin secretion as closely as possible in an effort to eliminate the symptoms and complications of hyperglycemia, while minimizing the risk of hypoglycemia secondary to therapy. When using MDI, basal insulin requirements are given as an injection of long- or intermediate-acting insulin analogs, while meal-related glucose excursions are controlled with bolus injections of rapid-acting insulin analogs. Alternatively, CSII can be used, which provides a 24-h preselected but adjustable basal rate of rapid-acting insulin, along with patient-activated mealtime bolus doses, eliminating the need for periodic injections. Both MDI treatment and CSII therapy must be supported by comprehensive education that is appropriate for the individual needs of the patient and family before and after initiation. Current therapies still do not match the endogenous insulin profile of pancreatic β-cells, and all still pose risks of suboptimal control, hypoglycemia, and ketosis in children and adolescents. The safety and success of a prescribed insulin regimen is, therefore, dependent on self-monitoring of blood glucose and/or a continuous glucose monitoring system to avoid critical hypoglycemia and glucose variability. Regardless of the mode of insulin therapy, doses should be adapted on the basis of the daily pattern of blood glucose, through regular review and reassessment, and patient factors such as exercise and pubertal status. New therapy options such as sensor-augmented insulin pump therapy, which integrates CSII with a continuous glucose sensor, along with emerging therapies such as the artificial pancreas, will likely continue to improve safe insulin therapy in the near future.
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Affiliation(s)
- Faisal S Malik
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington and Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
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25
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Hansen MR, Villar HO, Feyfant E. Development of an Informatics Platform for Therapeutic Protein and Peptide Analytics. J Chem Inf Model 2013; 53:2774-9. [DOI: 10.1021/ci400333x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Mark R. Hansen
- Altoris, Inc., 7770 Regents Rd
#557, San Diego, California 92122, United States
| | - Hugo O. Villar
- Altoris, Inc., 7770 Regents Rd
#557, San Diego, California 92122, United States
| | - Eric Feyfant
- Aileron Therapeutics, 281 Albany
Street, Cambridge, Massachusetts 02139, United States
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27
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Mathieu C. How long should a long acting insulin analogue be? Diabetes Res Clin Pract 2013; 100:170-2. [PMID: 23237882 DOI: 10.1016/j.diabres.2012.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 11/20/2022]
Abstract
After the discovery of insulin in the last century, rapidly efforts were undertaken to prolong the duration of action of injected insulin, in a naïve attempt to achieve physiological insulin profiles by just one injection of insulin a day [1]. However, the insulin profile achieved by beta-cells is quite different from a continuous supply of insulin. Indeed, when reflecting on the gold standard in insulin therapy, the beta-cell itself, one can distinguish between on the one hand the small amounts of insulin being produced almost continuously aimed at keeping anabolism going and on the other hand the peaks of insulin released at moments where meals are entering the system. The main target organ for both the basal and the bolus insulin secretion of the beta-cell is the liver, with a substantial first pass effect. The major asset of the insulin secretion of the beta-cell is that it is glucose-sensitive and thus, in periods without meals, no peaks of insulin release will occur, but more importantly, when metabolism needs to switch to catabolism, also the basal secretion will diminish and shut down, allowing gluconeogenesis and glycogenolysis in liver to occur.
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Affiliation(s)
- Chantal Mathieu
- Endocrinology, UZ Gasthuisberg, Herestraat 49, 3000 KU Leuven, Belgium.
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28
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Abstract
Basal insulin have been developed over the years. In recent times newer analogues have been added to the armanentarium for diabetes therapy. This review specifically reviews the current status of different basal insulins.
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Affiliation(s)
- S. V. Madhu
- Department of Medicine, Division of Endocrinology and Metabolism, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - M. Velmurugan
- Department of Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
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