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Insulin Analogues Advantages

Safety Of Insulin Analogues As Compared With Human Insulin In Pregnancy

Safety Of Insulin Analogues As Compared With Human Insulin In Pregnancy

Introduction: Diabetes during pregnancy may lead to maternal, fetal and neonatal complications. In order to limit unwarranted outcomes, strict glycemic control is essential. In the past, human insulin was the only insulin formulation administered in pregnancy. However, insulin analogues have also been used for this indication in recent years. Areas covered: This article reviews the published data regarding the safety of insulin analogue use during pregnancy. We present the qualities, advantages and pitfalls of insulin analogue use in pregnancy compared with human insulin. Insulins lispro, aspart and detemir are safe in pregnant women with type 1 diabetes. Correspondingly, they were reclassified for the treatment of pregnant women with diabetes from category C to category B. For insulin glargine use in pregnancy, most studies are small and retrospective. Yet, no major safety concerns were reported. Insulin glulisine and degludec have not been studied in pregnancy. Expert opinion: Insulin analogues are viable therapeutic options for diabetes in pregnancy, specifically lispro, aspart and detemir. Though data in limited, their safety and efficacy are comparable with human insulin. Remarkably, the analogues are superior to human insulin regarding hypoglycaemia risk. More data, specifically for their use in pregnancies complicated by gestational diabetes or type 2 diabetes, is needed. Continue reading >>

Analogue Insulin

Analogue Insulin

Tweet Analogue insulin is a sub-group of human insulin. Analogue insulin is laboratory grown but genetically altered to create either a more rapid acting or more uniformly acting form of the insulin. This can have advantages for blood sugar management. Analogue insulins have been available since just before the start of the new millennium. How is human analogue insulin produced? Similar to human insulin, analogue insulin is laboratory created by growing insulin proteins within E-coli bacteria (Escherichia coli). The process goes further through changing the order of amino acids to allow the insulin to be used by the body either more rapidly or more uniformly by the body than with regular human insulin. This type of process is known as undergoing ‘recombinant DNA’ technology. What types of analogue insulin are available? Analogue insulin is available in two main forms, rapid acting and long acting, as well as premixed combinations. Examples of analogue insulin: Rapid acting: Humalog, NovoRapid Long acting: Lantus, Levemir, Tresiba Premixed analogue insulins: Humalog Mix 25, Humalog Mix 50, NovoMix 30 Tweet Type 2 diabetes mellitus is a metabolic disorder that results in hyperglycemia (high blood glucose levels) due to the body: Being ineffective at using the insulin it has produced; also known as insulin resistance and/or Being unable to produce enough insulin Type 2 diabetes is characterised by the body being unable to metabolise glucose (a simple sugar). This leads to high levels of blood glucose which over time may damage the organs of the body. From this, it can be understood that for someone with diabetes something that is food for ordinary people can become a sort of metabolic poison. This is why people with diabetes are advised to avoid sources of dietary suga Continue reading >>

The Use Of Premixed Insulin Analogues In The Treatment Of Patients With Type 2 Diabetes Mellitus: Advantages And Limitations

The Use Of Premixed Insulin Analogues In The Treatment Of Patients With Type 2 Diabetes Mellitus: Advantages And Limitations

Background:Intensive, target-oriented therapy is the standard of care in the management of patients with type 2 diabetesmellitus (DM). Early and aggressive use of insulin that is as close as possible to the physiologic pattern of insulin secretion from healthy pancreatic β-cells is advocated to achieve glycemic goals and reduce complications of DM.Objective:The objective of this article was to review the characteristics, advantages, and drawbacks of premixedinsulin analogues and to evaluate their role in the treatment of patients with type 2 DM.Methods:A PubMed search of articles from 1990 to 2006 was undertaken using the search terms type 2 diabetes, basalbolus therapy, premixed insulins, biphasic insulins, and insulin analogues. Pertinent content from relevant articles was extracted and combined with the authors' knowledge, experience, and clinical expertise.Results:The advent of insulin analogues has streamlined the treatment of patients with DM. When to initiate insulin during the course of treatment is the subject of much debate. Insulin therapy targeting both fasting and postprandial hyperglycemia is important in achieving optimal blood glucose (BG) control in patients with type 2 DM. A practical and feasible option is the use of >1 injection of premixed insulin analogues. Premixed insulin preparations provide both basal and prandial coverage because of their biphasic pharmacokinetic properties. Clinical trials have shown that these agents improve glycemic control, are associated with an acceptably low rate of severe hypoglycemia, and have a high degree of patient acceptance. Limitations include the inability to adjust the long- and short-acting components separately, to use a flexible regimen of self-titration and premeal bolus-insulin calculations, and to adequ Continue reading >>

Long-acting Insulin Analogues In Type 2 Diabetes: Advantage Over Human Insulin Not Proven

Long-acting Insulin Analogues In Type 2 Diabetes: Advantage Over Human Insulin Not Proven

Long-term effects of insulin detemir are not assessable / Evidence base is insufficient, even if unpublished data are considered It has so far not been proven that long-acting insulin analogues (LAIAs) have an advantage over conventional human insulin in the treatment of patients with type 2 diabetes. Even though the results of a 5-year study are available for one of the two LAIAs assessed (insulin glargine), the potential long-term benefits and harms of this drug class have still not been sufficiently investigated. This is the result of the final report published by the Institute for Quality and Efficiency in Health Care (IQWiG) on 19 March 2009. The final report is part of a comprehensive commission package awarded by the Federal Joint Committee, by means of which key therapy options for people with diabetes are to be assessed. The reports on rapid-acting insulin analogues in diabetes mellitus type 1 and type 2 have already been completed. Only one study lasting longer than 12 months was available For the assessment of the LAIAs, IQWiG searched for studies that either compared one of the two currently approved LAIAs for the treatment of type 2 diabetes (insulin glargine and insulin detemir) with human insulin, or compared the benefits of the two LAIAs with each other. A precondition for study inclusion was that patients had been randomly allocated to one of the treatment groups and that the treatment period had lasted at least 24 weeks, as the aim of the project was to assess the potential benefits and harms of long-term therapy. A database search and queries to the manufacturers resulted in the retrieval of a total of 18 studies for inclusion in the evaluation. Of these studies, 15 (glargine: 9; detemir: 6) compared an LAIA with neutral protamine Hagedorn (NPH) insul Continue reading >>

Insulin Analogues: Reviewing The Pros And Cons In Managing Diabetes Mellitus

Insulin Analogues: Reviewing The Pros And Cons In Managing Diabetes Mellitus

Jennifer H. Martin1,2*, Anthony Russell1,3, Trisha O’Moore-Sullivan1,3 and Johannes B. Prins1,3,4 1The University of Queensland, Brisbane, Australia 2Department of Internal Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia 3Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Australia 4CEO, Mater Medical Research Institute, Brisbane, Australia *Corresponding Author: Dr. Jennifer H. Martin Department of Medicine The University of Queensland Princess Alexandra Hospital Woolloongabba 4102, Queensland, Australia Tel: +617 3176 3072 E-mail: [email protected] Citation: Martin JH, Russell A, O’Moore-Sullivan T, Prins JB (2011) Insulin Analogues: Reviewing the Pros and Cons in Managing Diabetes Mellitus. J Pharmacogenomics Pharmacoproteomics 2:106. doi: 10.4172/2153-0645.1000106 Copyright: © 2011 Martin JH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Visit for more related articles at Journal of Pharmacogenomics & Pharmacoproteomics Keywords History; Insulin; Recombinant; Methods of delivery Discovery and Development of Insulin Insulin is an anabolic polypeptide hormone secreted by the beta cells of the pancreatic islets of Langerhans. Before the discovery of insulin, scientists used various extracts from the pancreas to lower blood glucose in laboratory animals. However it was re-infusion of a pancreatic extract into a pancreatectomised dog that improved hyperglycemia. This discovery led to the development of a procedure for beef pancreas extract and in 1923, Lilly® patented Iletin (mixed porcine/bovine isophane). This wa Continue reading >>

Two Types Of Insulin: Human And Analog

Two Types Of Insulin: Human And Analog

Glucose is a type of sugar from food that the body uses for energy. The level of glucose in the bloodstream usually rises after a meal. To be efficiently utilized by the body, glucose in the bloodstream needs to enter the body’s cells. If glucose is unable to enter the cells, blood glucose levels rise leading to hyperglycemia. Long-term hyperglycemia damages nerves, blood vessels and vital organs. Insulin is a hormone produced by the beta cells of the pancreas. The beta cells release more insulin whenever there is a rise in blood glucose levels. Insulin enables glucose to enter the cells, thereby restoring normal blood glucose levels and allowing efficient glucose metabolism. People with type 1 diabetes can no longer produce insulin because the disease has destroyed the beta cells of their pancreas. People with type 2 diabetes can produce insulin but their body does not respond well to it, a condition known as insulin resistance. Insulin resistance also develops in pregnant women with gestational diabetes because the placenta (organ that connects the fetus to the mother’s blood supply) produces insulin-blocking hormones. Insulin therapy replaces or supplements the body’s own insulin, thereby restoring normal or near-normal blood sugar levels. It is one of the cornerstones of diabetes management, providing intensive blood glucose control crucial in preventing diabetes-related complications. Why is insulin injected into the fat under the skin rather than taken as a pill? Because insulin taken in pill form would be broken down by digestive enzymes and rendered ineffective. The first generation of man-made insulin is called “human insulin.” Developed through the 1960s and 1970s and approved for pharmaceutical use in 1982, human insulin is the name given to synthet Continue reading >>

Rapid Acting Analogues In Diabetes Mellitus Management

Rapid Acting Analogues In Diabetes Mellitus Management

Ashok Kumar Das Additional Director of Health Services & Director, Professor, Dept. of Medicine, JIPMER, Pondicherry Abstract Rapid-acting human insulin analogues, provide more rapid absorption than regular human insulin after subcutaneous administration. The limitations of regular human insulin like variation in absorption kinetics, slow absorption rate, inappropriate prandial control and injection timing were addressed by these modern insulins. Studies have shown strong evidence of better glycaemic control, without an increased risk of hypoglycaemia, together with evidence supporting improved convenience and flexibility of insulin aspart compared with regular human insulin in adult diabetic subjects. These analogues have been associated with improved hospital outcomes with or without critical illness and managing emergencies like DKA. Insulin aspart has unaltered pharmacokinetics in renal failure as well, making it to be modern insulin of choice in emergencies. Insulin aspart and lispro have been approved to be used in GDM by the USFDA and have shown to provide better maternal and foetal outcomes than regular human insulin. Insulin aspart, lispro and glulisine have been used in insulin pumps and studies have shown them to provide better glycaemic control and stability than MDI. The standard preparation of insulin aspart has the potential to better mimic the physiological response to meals than regular human insulin. Overall, there is a good body of evidence to support the efficacy, tolerability and ease of administration of insulin aspart in patients with type 1 and type 2 diabetes. In general, the extensive clinical data with these rapid acting modern insulins is well accepted and that they help to improve diabetes management significantly. Introduction The diabetes Continue reading >>

Insulin Regimens

Insulin Regimens

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 1 Diabetes article more useful, or one of our other health articles. The appropriate insulin regimen for each patient with diabetes will depend on their type of diabetes and their individual needs and circumstances. Regimens which attempt to improve glycaemic control will require more active involvement of the patient, both with the number of injections and with the need for close self-monitoring of blood glucose. See the separate Diabetes Education and Self-management Programmes article. Insulin regimens should be tailored to the individual, taking into account the patient's type of diabetes, previous control, age, dexterity, eyesight, and personal and cultural preferences. Insulin is usually injected into the upper arms, thighs, buttocks or abdomen. The absorption may be increased if the limb is used in strenuous exercise after the injection. Lipodystrophy can be minimised by using different injection sites in rotation. Local allergic reactions may occur but are rare.[1] Effective patient education for people using insulin treatment is essential, including 'sick day' guidance. See also the separate Diabetes and Intercurrent Illness article. Insulin Passports and patient information booklets should be offered to patients receiving insulin.[2] Insulins are classified according to their duration of action.[3] Short-acting insulins Short-acting (soluble) insulin is usually injected 15 to 30 minutes before meals. Soluble insulin is also the most appropriate form of insulin for use in diabetic emergencies - eg, diabetic ketoacidosis and at the time of Continue reading >>

Therapeutics Of Diabetes Mellitus: Focus On Insulin Analogues And Insulin Pumps

Therapeutics Of Diabetes Mellitus: Focus On Insulin Analogues And Insulin Pumps

Copyright © 2010 Vasiliki Valla. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aim. Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas. Results. Intensive insulin therapy with multiple daily injections (MDI) allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM) systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial “closed-loop” systems mimicking the pancreatic activity have been also developed. Conclusions. Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients. 1. Int Continue reading >>

Insulin Analogues In Children And Teens With Type 1 Diabetes: Advantages And Caveats

Insulin Analogues In Children And Teens With Type 1 Diabetes: Advantages And Caveats

This article reviews the advantages to and caveats of the use of newer insulin formulations (insulin analogues) and regimens in children and teens who have type 1 diabetes, their affect on glycemic control, frequency of hypoglycemic events, daily insulin requirements, and adverse affects such as excessive weight gain, which provides a further major challenge in adolescents. We also address briefly the use of adjunctive agents in the treatment of type 1 diabetes in children and teens. To access this article, please choose from the options below Continue reading >>

Long Acting Insulin Analogues Versus Nph Insulin (human Isophane Insulin) For Type 2 Diabetes Mellitus

Long Acting Insulin Analogues Versus Nph Insulin (human Isophane Insulin) For Type 2 Diabetes Mellitus

NPH (Neutral Protamine Hagedorn) insulin is the current standard for basal insulin in the blood glucose lowering therapy in people with type 2 diabetes mellitus. The mode of action of this insulin is highly variable, which may be the cause for the difficulties some people with diabetes have to achieve current goals for long-term metabolic control. Therefore, new insulins which are thought to show more favourable properties of action have been developed: insulin glargine and insulin detemir. Because of their theoretical advantages, it is thought that treatment with these new insulin analogues might lead to a beneficial effect, for example less hypoglycaemia or a better metabolic control, possibly resulting in higher quality of life and treatment satisfaction less late diabetic complications such as problems with eyes, kidneys or feet and myocardial infarction, stroke or death. Although epidemiological studies indicate that high concentrations of blood glucose carry a higher risk for these late complications, evidence for a beneficial effect of glucose-lowering therapy is conflicting. Following from the different results of large clinical trials, interventions seem to carry different substance specific beneficial or adverse effects. As a consequence, conclusions on the effects of different blood glucose lowering interventions on these outcomes can not be drawn from their effect on blood glucose concentration alone. Methodological quality of all the studies was rated low ("C"). Eight studies investigated altogether 2293 people. Trials lasted between 24 and 52 weeks. Our analysis of the currently available long-term trials comparing long acting insulin analogues with NPH insulin showed that insulin glargine and insulin detemir were almost identically effective compared to N Continue reading >>

Evidence For The Use Of Short-acting Insulin Analogues

Evidence For The Use Of Short-acting Insulin Analogues

Evidence for the use of insulin analogues In the last two decades, insulin analogues have gained widespread popularity, with most patients in the Western world using short-acting analogues rather than human (regular) insulin, and long-acting analogues driving out NPH insulin. While there are definitely some circumstances in which the insulin analogues may offer a benefit, many patients will do very well with the cheaper conventional insulins. Thus, the decision to start insulin analogues in an individual patient should be taken only when the conventional insulins have been proven inadequate. The short-acting insulin analogues are known for their more rapid absorption after subcutaneous injection, resulting in an earlier insulin peak and a shorter duration of action compared to human regular insulin. This is generally thought to translate into three clinical benefits: the ability to inject the insulin-analogue just before the meal lower postprandial glucose excursions a reduced the risk of (nocturnal) hypoglycaemia As for the first point, it is true that the more rapid onset of action allows for a shorter time-interval between injection and meal. It has been shown that the instruction to inject regular insulin more than 20 minutes before a meal is widely disregarded, and a shorter time interval between injection and meal is appreciated by patients. It should however be noted that many factors influence the pharmacokinetics of insulin absorption. Thus, it was demonstrated that in obese patients (with a thick subcutaneous fat layer) the absorption of s.c. injected insulin and insulin analogues is clearly slowed down, so that earlier injection may still be necessary, and the benefits of the short-acting insulin analogues may not materialize in all of these patients. As for Continue reading >>

Publications

Publications

Diabetes mellitus (DM) is associated with a huge social and economic burden. Achieving guidelines glycemic targets can help reduce the burden of type 2 DM (T2DM)-related complications; however many patients fail to meet these goals. The introduction of insulin analogs, including biphasic insulin analogs, has helped to reduce barriers to patient adherence and to improve outcomes. This review examines the clinical benefits and cost utility of biphasic insulin analogs versus other treatment approaches, in particular human biphasic insulins. Biphasic insulin analogs have a greater flexibility of dosing as compared to equivalent human insulin preparations, resulting in greater convenience and patient satisfaction, and in observational studies, improved efficacy in terms of glycemic control in patients inadequately controlled on human biphasic insulin. Biphasic insulin analogs have shown improved postprandial glucose (PPG) control and a reduced risk of hypoglycemia compared with biphasic human insulin. Treatment with biphasic insulin analogs is cost-effective versus other options in the long term. Biphasic insulin analog treatment of uncontrolled T2DM should be considered an appropriate investment of healthcare resources. Introduction It is well known that diabetes mellitus (DM) is associated with a huge social and economic burden, representing the third most common reason for hospitalization (as a first-listed diagnosis) in the U.S. in 2006 and accounting for 10.6 percent of hospital discharges (1). In 2005, discharge data from patients with diabetes as a first-listed diagnosis documented approximately 2.8 million days of hospital stay, corresponding to an average length of stay of 4.7 days (1). In 2007, the costs for DM were $174 billion in the U.S., composed of $116 billio Continue reading >>

Pharmacoeconomic Advantages Of Insulin Analogs

Pharmacoeconomic Advantages Of Insulin Analogs

Jerry Meece, RPh, FACA, CDE Director of Clinical Services Plaza Pharmacy and Wellness Center Gainesville, Texas US Pharm. 2006;HS42-HS50. By 2010, the cost of diabetes care--including screening, prevention, and treatment programs--is expected to reach $156 billion. Pharmacotherapy--including insulin, its delivery systems and supplies, and oral antidiabetic agents--represents 13% of diabetes-related expenditures.1 Economic studies have firmly established the value of intensive glycemic control, reporting reduced morbidity and mortality and improved quality of life.2-6 One study estimated that over 10 years, cost savings of between $50 billion and $72 billion--or 4% to 6% of health care expenditures per year--would accrue if hemoglobin A1c (HbA1c) is maintained at a level of at least 7% or 6.5%, respectively.7 Other studies have shown that with proper education and management addressing hypoglycemia and weight gain, adding insulin to type 2 diabetes regimens may decrease health care costs significantly in as little as two months.2,8-10 Since increased body weight also affects cardiovascular disease, hyperlipidemia, and hypertension--each with its own economic implications--prevention of weight gain should exert long-term cost savings. The pharmacokinetic and pharmacodynamic properties of insulin analogs, such as aspart, lispro, glulisine, glargine, and detemir, as well as premixed analogs, such as biphasic insulin aspart [BIAsp] 70/30 (containing a mixture of 70% protaminated and 30% soluble insulin aspart) and lispro 75/25 (containing 75% insulin lispro protamine suspension and 25% insulin lispro) provide more physiological and reliable time-action profiles than regular human insulin (RHI) or neutral protamine Hagedorn (NPH) insulin and represent a significant advancemen Continue reading >>

Insulin Analogs: Impact On Treatment Success, Satisfaction, Quality Of Life, And Adherence

Insulin Analogs: Impact On Treatment Success, Satisfaction, Quality Of Life, And Adherence

Abstract A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns. The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile. The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure. To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment. The long-acting basal analog insulin detemir Continue reading >>

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