Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study)

Advancements in transdermal drug delivery: A comprehensive review of physical penetration enhancement techniques

Transdermal drug administration has grown in popularity in the pharmaceutical research community due to its potential to improve drug bioavailability, compliance among patients, and therapeutic effectiveness. To overcome the substantial barrier posed by the stratum corneum (SC) and promote drug absorption within the skin, various physical penetration augmentation approaches have been devised. This review article delves into popular physical penetration augmentation techniques, which include sonophoresis, iontophoresis, magnetophoresis, thermophoresis, needle-free injection, and microneedles (MNs) Sonophoresis is a technique that uses low-frequency ultrasonic waves to break the skin's barrier characteristics, therefore improving drug transport and distribution. In contrast, iontophoresis uses an applied electric current to push charged molecules of drugs inside the skin, effectively enhancing medication absorption. Magnetophoresis uses magnetic fields to drive drug carriers into the dermis, a technology that has shown promise in aiding targeted medication delivery. Thermophoresis is the regulated heating of the skin in order to improve drug absorption, particularly with thermally sensitive drug carriers. Needle-free injection technologies, such as jet injectors (JIs) and microprojection arrays, offer another option by producing temporary small pore sizes in the skin, facilitating painless and effective drug delivery. MNs are a painless, minimally invasive method, easy to self-administration, as well as high drug bioavailability. This study focuses on the underlying processes, current breakthroughs, and limitations connected with all of these approaches, with an emphasis on their applicability in diverse therapeutic areas. Finally, a thorough knowledge of these physical enhancement approaches and their incorporation into pharmaceutical research has the potential to revolutionize drug delivery, providing more efficient and secure treatment choices for a wide range of health-related diseases.

Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition)

With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence-based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.

A self-controlled, cross-over study of intensive insulin treatment with needle-based injection versus needle-free injection in hospitalized patients with type 2 diabetes

Background and Aims

Needle injection and needle-free injection were proven effective in improving glycated hemoglobin (HbA1c) in type 2 diabetes mellitus (T2DM) patients. However, it is unclear if needle-free and needle injections of insulin during intensive insulin therapy in hospitalized patients provide similar efficacy and safety benefits.

Methods

A self-controlled cross-over study was conducted on 62 patients with T2DM who received intensive long-acting and short-acting insulin injections with or without needles. The 7-point blood glucose test was performed on the 6th day after insulin administration and the injection method switched on the 7th day of hospitalization. The difference was compared in 7-point blood glucose levels.

Results

The blood glucose levels at fasting (mean difference=-1.09 ± 2.38mmol/L, 95% CI, -1.69 to -0.48, p=0.0007) and post-breakfast (-1.14 ± 3.02mmol/L, 95%CI, -1.91 to -0.37, p=0.004) were better when patients were receiving needle-free injections compared to when receiving a needle injection. Indeed, daily blood glucose fluctuation, which presented as the area under the curve of glycemia, was decreased in needle-free injection periods (-0.3.48 ± 9.64, 95%CI, -5.95 to -1.01, p=0.0065). There was no significant difference in the dose of long-acting insulin between the two injection methods (-0.32 ± 2.69, 95%CI, -0.99 to 0.37, p>0.05). The dose of fast-acting insulin during the needle-free period was lower than that of when patients received needle injections (-1.66 ± 6.45, 95%CI, -3.29 to -0.025, p<0.05). There was no significant difference in satisfaction between the two regimens (-0.59 ± 1.55,95%CI, -0.938 to 0.509, p=0.557), but there was a significant difference in pain experience, favoring needle-free injections (p < 0.001).

Conclusion

Glycemia was better controlled by needle-free insulin injections in hospitalized T2DM patients subjected to intensive glycemic control. These patients also experienced less pain than when insulin was injected with a needle.

The Absorption of Needle-Free Insulin Aspart Through Jet Injector in Different Body Parts of Healthy Individuals

The absorption of needle-free fast-acting insulin injected into different body parts of healthy male subjects was studied in an attempt to provide clinical guidance for diabetic patients who take needle-free insulin injections in terms of providing reference in the clinical guidance regarding the correct use of needle-free insulin injections among diabetic patients. This randomized, open-label, cross-over trial was conducted on eight healthy adult male volunteers, in which the skin thickness at three injection sites (abdomen, upper arm, and thigh), the time to peak, peak rate, and area under the glucose infusion rate (GIR) curve of plasma insulin were measured through the hyperinsulin-normal glucose clamp test after the injection of insulin aspart with a needle-free syringe at three different sites to analyze the correlation between insulin absorption index at different injection sites and skin thickness. The values of the skin thickness of the abdomen, upper arm, and thigh measured by ultrasonic wave were 2.45 ± 0.34 mm, 2.18 ± 0.50 mm, and 1.93 ± 0.55 mm, respectively. There was a significant difference in the skin thickness of the abdomen and thigh (P = 0.014). The hyperinsulin-normal glucose clamp model was successfully established for each subject. Approximately 0-2 h after injection of insulin aspart with needle-free syringes, the area under the GIR-time curve of the abdomen, upper arm, and thigh was 29,400.75 ± 2,645.00 ml, 30,230.50 ± 4,937.87 ml, and 30,179.63 ± 6,188.57 ml, respectively. There was no significant difference in the area under the GIR curve between any two injection sites (P >0.05). The time to peak of GIR at different injection sites was 38.68 ± 13.57 min in the abdomen, 40.86 ± 12.70 min in the upper arm, and 37.03 ± 13.29 min in the thigh, respectively, in which no significant difference was found between each of them (P >0.05). The GIR curve after injection at the three different sites was consistent with each other. There was no significant difference in insulin absorption after the injection of insulin aspartate into the abdomen, upper arm, and thigh with a needleless syringe in healthy male adult volunteers, and there was no correlation between skin thickness at the injection site and insulin absorption. Injection sites did not affect the absorption of insulin in needle-free injections.

Hong Kong Poison Information Centre: Annual report 2019

Background:

The Hong Kong Poison Information Centre (HKPIC) provides consultation service to health care professionals and collect epidemiological data on poisoning in Hong Kong since 2005.

Objective:

To report and analyse the data of Hong Kong Poison Information Centre on poisoning in 2019.

Methods:

This was a retrospective review of all poisoning cases recorded in the Poison Information and Clinical Management System of Hong Kong Poison Information Centre in 2019.

Results:

A total of 4016 poisoned cases were analysed, which involved 1698 men (42.3%), 2312 women (57.6%) and 6 sex-unspecified patients (0.1%). Majority of cases (77.3%) were between 13 and 69 years of age, and 10.5% were teenagers 13–19 years of age. Self-harm/suicidal attempt (42.1%), unintentional exposure (18.1%) and abusive substance use (11.1%) were common reasons of poisoning. Excluding ethanol, which was the common co-ingestant, the five most common types of poison were benzodiazepines, paracetamol, household products, zopiclone and Chinese herbal medicine. While most patients were managed with supportive treatment, 16.5% and 16.8% of the consultation cases were treated with decontamination and antidotes, respectively. Majority of cases recovered uneventfully, but 1.0% died and 4.7% had a major outcome. A total of six interesting cases and two outbreaks were discussed in this report.

Conclusion:

This 14th annual report provided updated epidemiological information on the pattern of poisoning in Hong Kong and highlighted a number of important changes compared with our previous reports.