Insulin substitute
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Insulin Substitutes: Current Research and Future Directions
Introduction to Insulin Substitutes
Insulin substitutes are critical for managing diabetes, particularly for patients with type 1 diabetes who require lifelong insulin therapy. Traditional insulin therapy involves multiple daily injections or continuous subcutaneous insulin infusion (CSII). However, recent advancements have introduced various alternatives aimed at improving glycemic control, reducing hypoglycemia, and enhancing patient convenience.
Basal Insulin Substitution: NPH vs. Glargine
Research comparing different basal insulin regimens has shown that insulin glargine, administered once daily, offers several advantages over the traditional NPH insulin given four times daily. Studies indicate that glargine results in lower mean daily blood glucose levels and a higher percentage of blood glucose values within the target range compared to NPH1. Additionally, glargine reduces HbA1c levels and the frequency of mild hypoglycemia episodes, making it a simpler and more effective regimen for patients1.
Continuous Subcutaneous Insulin Infusion (CSII) vs. Glargine
CSII, which provides continuous insulin delivery via a pump, has been shown to offer better glucose control compared to glargine. Patients using CSII experience lower mean blood glucose levels and longer periods within the target glucose range, although there is a tendency for more episodes of hypoglycemia2. Despite these benefits, the choice between CSII and glargine should be individualized based on patient needs and preferences.
Advances in Insulin Formulations and Delivery Methods
The development of newer insulin products, including modified and concentrated insulins, has significantly advanced insulin replacement therapy. These innovations aim to mimic natural insulin action more closely, improve adherence, and enhance safety. For instance, combinations of longer-acting basal insulin with rapid-acting insulin or glucagon-like peptide-1 receptor agonists have been introduced to optimize glycemic control3.
Oral and Inhaled Insulin: The Quest for Non-Invasive Delivery
Efforts to develop non-invasive insulin delivery methods, such as oral and inhaled insulin, are ongoing. Although no effective oral insulin preparation is currently available, research continues to explore various formulations and protective mechanisms to enhance oral bioavailability6. Inhaled insulin has also emerged as a promising alternative, offering a less invasive option for insulin administration3.
Hybrid Pancreatic Tissue Substitutes
Innovative approaches, such as hybrid pancreatic tissue substitutes, are being explored to provide a more physiological regulation of insulin release. These substitutes combine insulin-secreting cells with glucose-responsive materials, potentially offering a more natural and less invasive treatment for diabetes5. This approach aims to address the limitations of current insulin therapies by providing a more dynamic and responsive insulin delivery system.
Conclusion
The landscape of insulin substitution is rapidly evolving, with significant advancements in both insulin formulations and delivery methods. From the improved efficacy of glargine over NPH to the superior glucose control offered by CSII, these innovations are enhancing the management of diabetes. Additionally, the development of non-invasive delivery methods and hybrid pancreatic substitutes holds promise for the future, potentially transforming diabetes care and improving patient outcomes.
Sources and full results
Most relevant research papers on this topic
Intensive replacement of basal insulin in patients with type 1 diabetes given rapid-acting insulin analog at mealtime: a 3-month comparison between administration of NPH insulin four times daily and glargine insulin at dinner or bedtime.
Glargine insulin at dinner or bedtime reduces blood glucose levels and reduces mild hypoglycemia compared to NPH insulin four times daily in type 1 diabetic patients.
RCT
Rigorous Journal
Highly CitedBasal insulin substitution with glargine or continuous subcutaneous insulin infusion in adult type 1 diabetes patients-a randomized controlled trial.
Continuous subcutaneous insulin infusion (CSII) provides better glucose control compared to glargine in adult type 1 diabetes patients, with longer periods of glucose values within target and more episodes below 3.5 mmol/L.
RCTInsulin: Making Sense of Current Options.
Newer insulin products and devices improve insulin replacement options, with individualized decisions based on patient needs, self-care ability, comorbidities, and cost considerations.
Comparative Benefits and Harms of Basal Insulin Analogues for Type 2 Diabetes
Basal insulin analogues show promising efficacy and safety for treating type 2 diabetes, but more research is needed to confirm their comparative efficacy and safety.
Meta-AnalysisRigorous JournalHybrid pancreatic tissue substitute consisting of recombinant insulin‐secreting cells and glucose‐responsive material
A hybrid pancreatic substitute consisting of insulin-secreting cells and glucose-responsive material has the potential to provide more physiologic regulation of insulin release than cells alone or in an inert material.
Historical Review of Oral Substitutes for Insulin
Oral insulin preparations have not been effective and most have severe toxic side effects, making them a long-term research goal.
Insulins today and beyond
Insulin formulations, treatment strategies, and glucose-sensing technologies have evolved to provide more aggressive insulin therapy for patients with type 1 and type 2 diabetes, enhancing their ability to maintain near-normoglycaemia.
Highly CitedHigh-Protein, Low-Glycaemic Meal Replacement Decreases Fasting Insulin and Inflammation Markers—A 12-Month Subanalysis of the ACOORH Trial
Meal replacement-based lifestyle interventions effectively reduce fasting insulin levels and inflammation markers, potentially aiding in diabetes prevention and obesity treatment.
RCT
Large Human Trial
Very Rigorous JournalA novel method for insulin detection
DIANA is a sensitive, nonradioactive method for measuring the potency of insulin mimetics during drug development, aiding in the development of oral insulin substitution treatments.
Insulin administration: present strategies and future directions for a noninvasive (possibly more physiological) delivery
Innovative pharmaceutical formulations show promise for less-invasive insulin administration, preserving hormone stability and ensuring therapeutic effectiveness for people with type 1 diabetes.
Rigorous Journal