2. Current methods in insulin therapy
Current methods of insulin delivery include using syringes, continuous subcutaneous insulin infusion (CSII), and insulin pens. Use of syringes is the most common method, and there is a wide choice of products that are easy to read and operate. CSII, also referred to as an insulin pump system, is designed to provide a continuous supply of insulin infusion around the clock and can be individualized and adjusted as per the specific needs of the patient. CSII is a way to simulate the physiology of daily insulin secretion where an appropriate level of insulin is delivered. The use of an insulin pump is superior to multi-dose insulin injections because it is easier to use and therefore provides the patient with more flexibility. A disadvantage is that insulin pump therapy is expensive compared to the use of traditional syringes and vials. Insulin pen devices offer an alternative method for insulin delivery that is more accurate and less painful versus vials and syringes. Reusable insulin pens offer a number of advantages including durability and flexibility in carrying a multiple days’ supply.
3. Future Trends
Injectable insulin: Two promising new insulin preparations include a long-acting basal insulin analogue called insulin degludec and an ultrafast-acting insulin analogue, human insulin Linjeta™ (formally called VIAject®). Insulin degludec is novel, ultra-long-acting basal insulin. Insulin degludec is almost identical to human insulin in structure except for the last amino acid deleted from the B-chain and addition of a glutamyl link from LysB29 to a hexadecandioic fatty acid. It forms soluble multi-hexamers after subcutaneous injection, resulting in an ultra-long action profile with a half life of more than 24 hours. Insulin degludec has proven to be non-inferior to currently available, long-acting insulin analogue insulin glargine in trials carried out in both type 1 and type 2 diabetes. In an exploratory phase 2 trial in subjects with type 1 diabetes, insulin degludec was found to be safe and well tolerated and had comparable glycemic control to insulin glargine, but with reduced rates of hypoglycemia. In a multicenter phase 3 clinical trial in adults with type 1 diabetes, at one year, compared to insulin glargine, glycemic control was similar to glycemic control using glargine with decreased nocturnal hypoglycemia.Similarly, in an open-label phase 3 non-inferiority trial in type 2 diabetes patients, improvement in glycemic control was comparable to insulin glargine at one year follow-up (drop in HbA1C by 1.1% in the degludec group and 1.2% in the glargine group) with fewer hypoglycemic episodes in insulin degludec users. Insulin degludec is not yet approved by the FDA.
(To be continue..)
