Overcoming obstacles: new management options

Abstract

The outlook for patients with type 2 diabetes looks set to improve with the availability of new diabetes management options that provide more comprehensive control of blood glucose levels and/or encourage better patient compliance than previous alternatives. New insulin analogues, such as insulin lispro, aspart and glargine, allow more physiological insulin replacement and greater freedom in the timing and content of meals, compared with regular insulin preparations. The development of novel non-invasive routes of insulin administration promises to further improve diabetes management. Many barriers to initiating insulin relate to the need for frequent insulin injections, fears that insulin injections will be painful and difficult to administer, and concerns about hypoglycaemia and weight gain. Thus, each measure that reduces these barriers will help to prevent inappropriate delays in starting insulin therapy as well as to promote better compliance with therapy. The output from continuous glucose monitoring devices will assist accurate insulin replacement, which is difficult using point-estimates of blood glucose. Such devices will hopefully also circumvent the need for finger stick tests. There are several novel therapies in development that will further expand the portfolio of treatment options for patients with type 2 diabetes. Improved quality and choice of diabetes management options will provide doctors with the tools they require to develop tailored treatment plans, increase the probability that treatment goals are achieved and thereby reduce the risk of patients developing late-stage diabetes-related complications.European Journal of Endocrinology 151 T23-T27

Isolated ileal interposition in enteroendocrine L cells differentiation

“…17,18 Some insulin analogues are associated with a more physiological pattern of recovery; these drugs are more flexible to use and convenient to prescribe, and they allow greater freedom in diet while still providing improved quality of life. 6,7,25 Formulations eliminating the need for subcutaneous injections might correct some limitations of typical insulin therapy, thus improving glycaemic control and increasing patient quality of life. 21 Some formulations that allow non-invasive administration of insulin are in the testing phase, including the inhalable insulin powders Exubera (Pfizer), Technosphere (MannKind), Aerdose (Aerogen), BAI (Kos), Alveair (Coremed), and Bio-Air (BioSante).…”

Structural changes in intestinal enteroendocrine cells after ileal interposition in normal rats

“…17,18 Some insulin analogues are associated with a more physiological pattern of recovery; these drugs are more flexible to use and convenient to prescribe, and they allow greater freedom in diet while still providing improved quality of life. 6,7,25 Formulations eliminating the need for subcutaneous injections might correct some limitations of typical insulin therapy, thus improving glicemic control and increasing patient quality of life. 21 Some formulations that allow non-invasive administration of insulin are in the testing phase, including the inhalable insulin powders Exubera (Pfizer), Technosphere (MannKind), Aerdose (Aerogen), BAI (Kos), Alveair (Coremed), and Bio-Air (BioSante).…”

Organic consequences of ileal transposition in rats with diet-induced obesity

“…148,155 There are barriers for both patients and doctors who undertake the initiation and intensification of insulin therapy; these barriers correlate with poor individual motivation, a lack of familiarity with application, the need for frequent insulin injections, fear that the injection will be painful and difficult to administer and concerns regarding hypoglycemia and weight gain. 155,160,163 Consequently, an inappropriate delay in the initiation of early insulin therapy prevents the achievement of the recommended glucose levels and the maintenance of adequate glycemic control. 146,154,160 To achieve a successful insulin therapy, the patient must be adequately informed and motivated by the participation and support of a multidisciplinary team.…”

“…145,152,153 In addition to the new classes of antidiabetic medications, the development of insulin analogues and other non-invasive alternatives to the use of insulin are promising options for the management of diabetes mellitus type 2. 146,163 Such agents may assist in overcoming some of the challenges associated with this disease to achieve enhanced glycemic control, despite the difficulties associated with the natural disease progression and the loss of efficacy related to the use of long-term oral agents. 159 Novel basal insulin analogues, including pre-mixes such as lispro, aspart and glargine, represent a more physiological replacement to previous therapies because they provide greater freedom, flexibility and convenience with respect to the drug administration.…”

“…Concerning the content of the diet, they provide a better quality of life compared to regular insulin formulations. 144,146,163 Innovative formulations without the need for subcutaneous injections can overcome some of the shortcomings associated with typical insulin therapy and thereby facilitate the early use of insulin. These effects allow the achievement and continuance of long-term glycemic control, which enhances quality of life.…”