While further study will be required, advances in basal insulin replacement may offer advantages over existing options for starting and progressing insulin strategies in patients with both type 1 and. Newer insulin analogs diabetes, obesity and metabolism. Insulin in the form of hexamer will not bind to its receptors because, hexamer has to slowly equilibrate back into monomers to be clinically useful 5. They also have a low hypoglycemic risk, even in combination with basal insulin. The long acting insulin analogs are suitable for background or basal insulin replacement. Glp1 analogues have a lasting effect on pancreatic. Making early insulin initiation safer and simpler 317 have a shorter duration of action after subcutaneous injection fig. Compare the relative ease of using newer insulin devices e.
Identify the types of insulin currently available for treatment of type 2 dm. Jan 04, 2015 newer insulins in clinical practice 1. Clinical effectiveness and costeffectiveness of continuous subcutaneous insulin infusion for diabetes. Basal insulin analogues are a highly effective method of reducing fasting and overall blood glucose, while glp1 mimetics are advocated for those where weight gain is a concern. She has signs of early diabetic background retinopathy. Newer insulin analogues and using basal bolus regimen with prandial short acting insulin can result in optimal glycemic control in these children. Sep 11, 2012 a 68 year old woman with a body mass index weight kgheight m2 of 31 has a five year history of type 2 diabetes.
Diabetes meds on a budget diabetes education services. Some evidence that continuous subcutaneous insulin. Newer insulin regimens in diabetes postgraduate medical journal. Recently 2 new basal insulin analogs have been developed with superior pharmacokinetic and pharmacodynamics properties. Review of insulin and its analogues in diabetes mellitus.
The new insulin analogues glargine and detemir have made significant improvements in the management of type 1 diabetes. Another longacting analogue, insulin detemir is yet to come to the market. Sandeep julka consulting endocrinologist history 1921. Premixed insulin formulations include conventional e. Pdf newer insulin analogues and inhaled insulin researchgate. Review article from the new england journal of medicine insulin analogues nejm group.
The newer insulin analogues have several improvements due to their modified action profile. In part, this may be due to improvement accuracy in technologies such that the majority of the currently available cgms have an mean absolute relative difference of newer insulin analogues might even get a. Recent findings new types of insulin have revolutionized diabetic care. Describe the action profiles of the different insulin therapies and relate these profiles to treatment regimens for patients with type 2 dm. Openurl1pubmed2web of science3 this report by cummins and colleagues is. Insulin is easily broken down by extreme temperatures, which means you need to be careful if you live in a part of the u. An insulin analog is an altered form of insulin, different from any occurring in nature, but still available to the human body for performing the same action as human insulin in terms of glycemic control. New insulin analogues and insulin delivery devices for the p. Efficacy, safety and clinical use of newer basal insulins. Mauriac syndrome in the age of newer insulin analogues abstract the authors describe a five yearold plump looking female child with poorly controlled type 1 diabetes mellitus, hepatomegaly and growth retardation. While providing similar efficacy in lowering hba 1c to firstgeneration insulin analogues, the newer insulin treatment options provide additional clinical benefits, including a more stable, ultralong duration of action that enables oncedaily administration with flexibility in daily injection time, together with a lower risk of hypoglycaemia. Review of insulin and its analogues in diabetes mellitus krishnappa mane, chaluvaraju kc, niranjan ms, zaranappa and manjuthej tr department of pharmaceutical chemistry, government college of pharmacy, bangalore 560 027, india. Several newer insulin analogues available only now in india viz.
A group of researchers has developed synthetic insulin analogues selenoinsulin seins through the replacement of the interchain disulfide in bovine pancreatic insulin bpins with a diselenide. Ddiabetes mellitus iabetes mellitus dm is a metabolic disorder resulting from a. A major concern about all newer insulin analogues is their altered mitogenic properties and resultant risk of carcinogenicity on long term use. New delivery modes of insulin both by the inhaledbuccal route and premeasured pen have been introduced. Through genetic engineering of the underlying dna, the amino acid sequence of insulin can be changed to alter its adme absorption. The progressive nature of t2dm means that many individuals require multiple therapeutic strategies to maintain glycaemic targets. Type 1 diabetes introduction a syndrome of uncontrolled type 1 diabetes, growth restriction and hepatomegaly which used to be commonly referred to as the mauriac syndrome during the pre long acting insulin era is being increasingly reported of late albeit. It is important to take insulin detemir and glargine at the same time s every day to maintain the most predictable levels of basal insulin. Review article from the new england journal of medicine insulin analogues. Most patients with t1dm should follow a regimen of multiple daily injections of basalbolus insulin, but those not meeting individual glycemic targets or those with frequent or severe hypoglycemia or pronounced dawn phenomenon.
The secondgeneration basal insulin analogues provide physicians with new treatment options for achieving targeted glycaemic control. Basal insulin analogues in the treatment of diabetes mellitus. Insulin aspart novolog, novo nordisk and insulin glulisine apidra, sanofiaventis are other short acting insulin analogs that could be used as an alternative to regular insulin. Insulin analogues are less likely to cause weight gain or low nighttime blood sugar levels than standard human insulins.
This means a lot of people are on insulin therapy and even more will be starting as the epidemic marches on. Nonetheless, newer insulin analogues as well as newer insulin regimens may be appropriate in a defined group of patients with diabetes. Mauriac syndrome in the age of newer insulin analogues. Human insulin animal insulins used since inception until the advent of human insulin in the 1980s are now only minimally used. Insulin preparations are expressed in international units iu. In individuals with type 2 diabetes, the timeaction profiles and the duration of action of the albuminbound insulin analogues, insulin detemir and nn344, were comparable with those of insulin. These longacting insulins cant be mixed in the same syringe with other insulins this could change how the. Newer analogues exist as monomers and are absorbed much faster insulin aspart or lispro or absorbed very slowly insulin glargine or detemir. Key words diabetes, insulins, rdna technology, glycaemic, therapeutic. Insulin analogues are created by recombinant dna technology in order to generate insulins with pharmacokinetic profiles that simulate the different phases of endogenous secretion of insulin. Afrezza is a rapidacting inhaled insulin that is administered at the. Identify patients appropriate for insulin therapy in the treatment of type 2 dm. This article examines the use of these newer insulins in clinical practice.
It is claimed that the main advantages of rapidacting preparations include. In individuals with type 2 diabetes, the timeaction profiles and the duration of action of the albuminbound insulin analogues, insulin detemir and. Insulin glulisine is a short acting analogue with a. The interest in producing insulin formulations that are safer has yielded insulin analogues that afford more flexible treatment regimens and a lower risk of hypoglycemia. The role of glp1 mimetics and basal insulin analogues in. The interest in producing insulin formulations that are safer has yielded insulin analogues that afford more flexible treatment regimens and a lower. Analogue insulin is laboratory grown but genetically altered to create either a more rapid acting or more uniformly acting form of the insulin. Contents introduction classification rationale for development individual analogues special features merits of analogues over standard insulins drawbacks of analogues popular regimes using analogues novel delivery systems using analogues summary. Are newer insulin analogues better for people with type 1. Insulin delivery short acting insulin analogues like aspartlispro used. The introduction of rapid acting and long acting insulin has enabled more precise glucose control to be achieved. Making early insulin initiation safer and simpler 315 introduction in recent times, there have been two striking developments in the area of insulin therapy. Guide to starting and adjusting insulin for type 2 diabetes. The decision to use a particular insulin analogue should be individualized depending on pharmaco.
New insulin analogues and insulin delivery devices for the. She is reasonably active but takes treatment for hypertension, hyperlipidaemia, and angina. Basal insulin analog therapy is the most common method of introducing insulin replacement therapy for the majority of patients with type 2 diabetes mellitus. Insulin analogues dr divya krishnan calicut medical college 2. This article focuses on the benefits and restrictions of these new agents. The decision to use a particular insulin analogue should be individualized depending on pharmacoeconomics rather than being protocol centric. What do you need to know about the newer insulin analogues. Some evidence that continuous subcutaneous insulin infusion. Insulin therapy in adults with type 1 diabetes mellitus. The newer additions to this armamentarium are insulin glulisine, insulin detemir and albulin. Ensure patient is comfortable with loading and working a pen or syringe. Fastacting insulin analogs were designed to give more freedom to the diabetic patient so that they could administer insulin near mealtime lispro. Novel long and short acting insulin analogues, the socalled designer insulins, developed.
In insulin lispro the two residues in the bchain of insulin are substituted for one another, the lysine at position 29 and the proline at position 28 varewij and janssen, 2012. Through genetic engineering of the underlying dna, the amino acid sequence of insulin can be changed to alter its adme absorption, distribution, metabolism, and excretion. In part, this may be due to improvement accuracy in technologies such that the majority of the currently available cgms have an mean absolute relative difference of human or animal with analogue insulins, including a metaanalysis of comparative effectiveness and safety if sufficient data are available, as well as the preparation of grade tables. Her current treatment for diabetes is with metformin 850 mg twice daily and gliclazide 160 mg daily.
It is claimed that the main advantages of rapidacting preparations include faster onset of action and shorter duration. Efficacy, safety and clinical use of newer basal insulins analogs. The firstgeneration analogues rapid and long acting analogues, and the secondgeneration, newer longacting analogues have been summarised in table 1. While the newer insulin analogs are significantly more expensive than nph insulin, with higher corresponding outofpocket costs to patients, researchers have had a difficult time demonstrating greater effectiveness or any definitive differences in any longterm outcomes between nph and the insulin analogs. Jan 22, 2014 insulin delivery short acting insulin analogues like aspartlispro used. Insulin type and dosagetiming should be chosen by an experienced medical professional working closely with the diabetic patient. Contrary to the usual phenotype of thin emaciated appearance in type 1 diabetes mellitus. Evidence addressing the costeffectiveness of analogue insulins as well as the risk of. Pdf these analogues have shown equal or superiorefficacy and have lower incidence of hypoglycaemia. For patients with type 1 diabetes, who have an absence of endogenous insulin, these newer agents help us to design insulin regimens that more closely mimic the action of a healthy pancreas by selecting combinations of immediateacting insulins e. Insulin was first isolated and extracted in 1921 and has been available since 1925. Steps for starting insulin for patients with a1c above target on oral medications, the addition of basal or long acting insulin is a usual next step. New or analogue insulins are molecularengineered formulations designed to improve the pharmacokinetics, absorption profile and duration of action of human insulin. Cardiovascular outcome trials of the newer antidiabetic.
Human insulin produced by recombinant dna technology. This can have advantages for blood sugar management analogue insulins have been available since just before the start of the new millennium. Newer insulins in clinical practice linkedin slideshare. Type 1 diabetes introduction a syndrome of uncontrolled type 1 diabetes, growth restriction and hepatomegaly which used to be commonly referred to as the mauriac syndrome during the pre long acting insulin era is being increasingly reported of late albeit sporadically 14. Dec 26, 2017 mauriac syndrome in the age of newer insulin analogues.
179 137 1305 269 1159 1026 72 729 105 1381 375 926 441 1236 152 1085 1471 1329 188 1424 1415 598 747 1450 176 161 1461 502 1408 198 299 1077 398 1026 1069 1447 1496 122 178 731 1036 94 501 570 287