Ultrafast-Acting Insulins: State of the Art

Heinemann, Lutz; Muchmore, Douglas B.

doi:10.1177/193229681200600402

Cited by 87 publications

(103 citation statements)

References 78 publications

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“…These include micro-needle, intradermal infusion sets for pump therapy, [12][13][14][15] changes in excipients in RAIA formulations to accelerate insulin molecule monomerization 16 and treating the insulin infusion site with hyaluronidase to breakdown interstitial barriers to dispersion of injected liquids. 17 In comparison to these approaches, local warming relies on a relatively simple physiological approach which, in this study, we have demonstrated is suited for injection as well as pump therapy.…”

Section: Discussionmentioning

confidence: 99%

Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes

Bitton¹,

Feldman²,

A³

et al. 2015

J Diabetes Sci Technol

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Exaggerated postprandial glycemic excursions in the first hours after a meal and an increased risk of late postprandial hypoglycemia are commonly observed following bolus injections of regular human insulin due to the delayed peak and the prolonged duration of action of this insulin preparation. 1 In contrast, plasma insulin concentrations peak earlier (generally thought to be within the first hour) and plasma insulin concentrations return to baseline more quickly with rapid-acting insulin analogs (RAIAs).2 Nevertheless, even with the more favorable absorption characteristics of RAIAs, postmeal hyperglycemia remains difficult to control in insulin-requiring diabetic patients due to delays in the peak action of these analogs to 120 or more minutes after injection. The time to peak insulin concentrations following bolus injections of both human regular and RAIAs are dose dependent, 3 with higher doses leading to delayed peaks and prolonged duration of action of these insulins. Moreover, the FDA-approved prescribing information package inserts for RAIAs state that the time course of action of these insulins may vary in different individuals or at different times in the same individual. 4 Such variations in insulin action are dependent on many conditions, including the site of injection, local blood supply and local skin temperature. 4 The impact of the site of injection on the rate of absorption of regular insulin (ie, abdomen > arm > leg) was first described by Koivisto and Felig in 1980. 5 They also demonstrated that increasing the skin temperature to 30°C to 37°C via sauna use increased the rate of insulin absorption and 578881D STXXX10.1177/1932296815578881Journal Abstract Background: Delays in the time-action profiles of premeal boluses of rapid-acting insulin analogs contribute to early postmeal hyperglycemia in patients with diabetes. We tested whether applying local heat to skin around the injection site to increase the rate of insulin absorption reduces postprandial hyperglycemia in patients with type 2 diabetes. Methods: Fourteen patients with type 2 diabetes (4 females; age 61.6 ± 8.4 years, HbA1c 8.42 ± 1.13%; BMI 29.10 ± 5.61 kg/m 2 ) on intensified insulin therapy underwent 5-hour meal tolerance tests (MTTs) with a standardized liquid meal after an overnight fast on 2 study days. Subjects injected 0.2 U/kg of insulin aspart or lispro subcutaneously into the abdominal skin on both days with and without the use of the InsuPad device. Results: Following the premeal bolus injection of rapid-acting insulin analog, infusion site warming led to a rise in plasma insulin levels to peak concentrations that were significantly earlier than without skin warming (mean ± SD 52 ± 26.7 vs 80 ± 51.3 minutes, P < .005) as well as increase in plasma insulin levels during the first hour after injection (mean ± SD 63.5 ± 32.7 IU vs 48.0 ± 25.0 uU.min/ml, P = .019). As a result, the area under the curve of the postprandial glucose excursion during the first 2 hours (the primary study outcome) and the entire 5 hours after ...

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Section: Discussionmentioning

confidence: 99%

Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes

Bitton¹,

Feldman²,

A³

et al. 2015

J Diabetes Sci Technol

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“…Linjeta jest preparatem złożonym z ludzkiej insuliny krótkodziałającej, kwasu etylenodiaminooctowego i cytrynowego. Taki skład, powoduje odłączenie jonów cynkowych od cząsteczek insuliny i zapobiega ich agregacji w heksamery, dzięki czemu insulina pozostaje w postaci monomerów i znacznie szybciej się wchłania [4,5]. Porównując wpływ insuliny Linjeta, Lispro oraz insulin ludzkiej szybkodziałającej na glikemię poposiłkową u pacjentów z cukrzycą typu 1 uzyskano istotnie niższe wartości w grupie Linjeta (0-180 min; 157 ± 30 mg/dl; p = 0.002 vs. insulina ludzka szybkodziałająca) i w grupie Lispro (170 ± 42 mg/dl; p = 0.668 vs. insulina ludzka szybkodziałająca).…”

Section: Ultraszybkodziałające Analogi Insulinunclassified

“…Linjeta is a formulation containing short-acting human insulin, EDTA, and citric acid. These components result in hexameric insulin dissociation into insulin monomers and a more rapid insulin absorption [4,5].…”

Section: Rapid-acting Insulinmentioning

confidence: 99%

Insulinoterapia — nowe kierunki poszukiwań

Cichocka

Wietchy²,

Nabrdalik

et al. 2016

Endokrynologia Polska

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Insulin therapy is the most effective method of lowering blood glucose. Over 100 years have passed the studies for the optimisation of insulin action. To date, subcutaneous insulin administration has been the basic route of insulin delivery. The search for insulin therapy is simultaneously conducted in the following directions: the optimisation of insulin action, automatisation, and the decrease in the invasiveness of insulin delivery methods. The optimisation of insulin action has led to the discovery of ultra-rapid-acting human insulin analogues, ultra-long-acting human insulin analogues, and biosimilar insulin. Automatisation referred to the "artificial pancreas" and closing the loop system in insulin pump therapy. The decrease in the invasiveness of insulin delivery methods is focused on alternative routes of insulin administration. StreszczenieInsulina to najskuteczniejszy lek obniżający glikemię. Od blisko 100 lat trwają badania nad optymalizacją insulinoterapii. Na chwilę obecną, nadal podstawową drogą podawania insuliny jest podaż podskórna. Badania w zakresie insulinoterapii wiodą w kilku kierunkach równocześnie: optymalizacji, automatyzacji i zmniejszenia inwazyjności podawania insuliny. Optymalizacja parametrów działania insuliny prowadzi do wprowadzenia ultraszybkodziałających analogów insuliny, nowych insulin bazowych oraz insulin biopodobnych. Automatyzacja terapii pompowej wiedzie do zamknięcia pętli i stworzenia "sztucznej trzustki". Zmniejszenie inwazyjności to wykorzystanie alternatywnych, innych niż podskórna, dróg podawania insuliny.

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“…A 52-week study of glargine insulin and Technosphere inhaled insulin used together lowered A1C from 8.7% to 8.0% (21). In contrast, A1C values in a study of injected basal-bolus insulin fell from 8.1-8.3% to 6.5-6.7%, but with substantial weight gain and hypoglycemia (22).…”

mentioning

confidence: 91%

“…As such, inhaled insulin is still a convenience product rather than a proven advance in insulin therapy. However, it is at the forefront of several faster insulins that are in development (22,23). And the question remainsdis faster better?…”

mentioning

confidence: 99%

Technosphere Inhaled Insulin: Is Faster Better?

Leahy

2015

Diabetes Care

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Ultrafast-Acting Insulins: State of the Art

Cited by 87 publications

References 78 publications

Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes

Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes

Insulinoterapia — nowe kierunki poszukiwań

Technosphere Inhaled Insulin: Is Faster Better?

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