Insulin in the treatment of type 2 diabetes mellitus.
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Adult↗
Biomedical subjects
R Keith Campbell
Publications and source records attributed to R Keith Campbell.
Novel insulins and strict glycemic control. Analogues approximate normal insulin secretory response.
Our ability to gain strict glycemic control in diabetes has improved with the introduction of novel insulins. New formulations, novel insulin molecules, and various methods of insulin delivery are able to more closely approximate the normal physiologic insulin response than conventional preparations. In this article, the authors review the development of insulin formulations and the pharmacology of currently available insulin molecules and those soon to be on the market.
Humans↗
Role of the pharmacist in diabetes management.
The role of pharmacists in diabetes management, including patient identification, assessment, education, referral, and monitoring, is described. Pharmacists can help identify patients with diabetes through screening and should target patients at high risk, people with a family history of the disease, and women with a history of gestational diabetes or who delivered a baby weighing more than nine pounds. Patient education should be provided immediately after diagnosis, at a second stage at which time a patient assessment can be performed, and at a third stage during which patients can receive continuing education to reinforce concepts and a motivational boost. One of the pharmacist's most important roles is the referral of patients to other members of the diabetes care team. Although the role of the pharmacist in monitoring diabetes is not well defined, it might include such things as ascertaining whether physician visits and testing to assess long-term glycemic control. Obtaining certification as a diabetes educator is recommended. This process requires at least 1000 hours of experience in providing disease-state management for patients with diabetes and successful completion of an examination. Implementing diabetes management services requires a commitment of time, effort, and resources and may necessitate training of staff and changes in work patterns. The pharmacist can play an important role in diabetes care by screening patients at high risk for diabetes, assessing patient health status and adherence to standards of care, educating patients to empower them to care for themselves, referring patients to other health care professionals as appropriate, and monitoring outcomes. Providing diabetes management services requires market savvy, communication skills, and a commitment of time, effort, and resources. Pharmacists who obtain training in diabetes management reap rewards in professional satisfaction and financial reimbursement.
Diabetes Mellitus↗
Insulin glargine: a new basal insulin.
OBJECTIVE: To review the pharmacology, pharmacokinetics, dosing guidelines, adverse effects, drug interactions, and clinical efficacy of insulin glargine. DATA SOURCES: Primary and review articles regarding insulin glargine were identified by MEDLINE search (1966-July 2001); abstracts were identified through Institute for Scientific Information Web of Science (1995-July 2001) and the American Diabetes Association. Additional information was obtained from the insulin glargine product information. STUDY SELECTION AND DATA EXTRACTION: All of the articles and meeting abstracts identified from the data sources were evaluated, and all information deemed relevant was included in this review. Priority was placed on data from the primary medical literature. DATA SYNTHESIS: Insulin glargine is a long-acting, recombinant human insulin analog that is given once daily as a basal source of insulin in patients with type 1 or type 2 diabetes mellitus. Modification of the basic insulin structure has produced a new insulin that is soluble at an acidic pH, but precipitates in the subcutaneous tissue and is slowly released from a depot. Insulin glargine has a slower onset of action than NPH insulin and a longer duration of action with no peak activity. Once-daily administration of insulin glargine has comparable efficacy to that of NPH insulin administered once or twice daily in basal-bolus regimens when used in combination with intermittent doses of regular insulin or insulin lispro in patients with type 1 and type 2 diabetes, and in conjunction with oral antidiabetic agents in patients with type 2 diabetes. Overall, insulin glargine has an incidence of hypoglycemia comparable to or less than that of NPH insulin, with a reduced incidence of nocturnal hypoglycemia compared with NPH insulin seen in some studies. CONCLUSIONS: Insulin glargine is a long-acting insulin analog capable of providing 24-hour basal insulin coverage when administered once daily at bedtime. Its activity profile, which lacks a pronounced peak, more closely resembles that of endogenous basal insulin than that of other intermediate- or long-acting insulins and appears more likely to be associated with a reduced incidence of hypoglycemia, particularly nocturnal hypoglycemia. Insulin glargine physiologically provides basal insulin but, for most patients, the addition of a rapid-acting insulin, like insulin lispro, before or with meals will need to be included in the treatment regimen to achieve optimal management of blood glucose concentrations.
Amino Acid Sequence↗
Assessing diabetes patients' healthcare needs.
Pharmacists who possess the proper skills and knowledge can intervene with patients in a proactive manner by initiating a dialogue at the point of dispensing medication. After patients complete the DPAQ and the pharmacist assesses the information, a plan of care is developed. Proper documentation (e.g., using the SOAP format) is the first and most important step in caring for patients with diabetes. Such encounters impact on the level of care provided and are professionally and financially rewarding for the pharmacist.
Delivery of Health Care↗
Insulin lispro update.
PURPOSE: This paper provides a review of the literature and clinical studies for insulin lispro and updated information on its advantages over regular insulin for various populations of people with diabetes. METHODS: Information was gathered from a search of Medline articles and from review of clinical studies. RESULTS: Patients in various special populations using insulin lispro, with proper adjustment of basal insulin, had a greater reduction in hemoglobin A1C and fewer episodes of hypoglycemia than patients on regular insulin. CONCLUSIONS: More recently published literature shows that due to its faster onset and shorter duration of action, insulin lispro is useful for not only lowering A1C values, but also for reducing hypoglycemic events in various populations with diabetes, including pediatric and pregnant patients, those with gastroparesis, and insulin pump users.
Blood Glucose↗
Counseling patients with type 2 diabetes and insulin resistance in the outpatient setting.
Insulin resistance is a major health concern. Besides being a leading risk factor for type 2 diabetes, it is also associated with hypertension, dyslipidemia, obesity, and cardiovascular disease. Making lifestyle changes can reduce insulin resistance and help prevent the onset of diabetes. For those with type 2 diabetes, treatment with insulin-sensitizing drugs, such as the TZDs and biguanides, can improve glycemic control and prevent some of the adverse consequences of the disease. Adherence to both lifestyle and medication regimens is very important and should be actively supported by all members of the healthcare team. Diabetes educators, including pharmacists, can increase awareness of the underlying pathophysiology and clinical implications of insulin resistance. Diabetes educators also play a vital role in counseling patients with type 2 diabetes on strategies that reduce their risk of hyperglycemic complications and in providing support, education, and guidance. By understanding the disease and its management, diabetes educators can contribute to improved outcomes and help to reduce the impact of this worldwide epidemic.
Aging↗
Insulin therapy in type 2 diabetes.
OBJECTIVE: To review the increasingly common use of insulin therapy in patients with type 2 diabetes and the practical aspects of initiating insulin therapy in these patients. DATA SOURCES: Recent scientific and clinical literature identified through MEDLINE searches for the years 1995-2001 using the terms oral agents, type 2 diabetes, insulin therapy, glycemic control and diabetic complications, glucose toxicity, insulin lispro, insulin aspart, and insulin glargine. STUDY SECTION: Reports of key large (1,000 patients or more) and significant smaller, randomized, controlled clinical trials were reviewed. For studies comparing insulin analogs, the authors reviewed a sampling of the identified trials for their characteristics and clinical importance. DATA SYNTHESIS: Tight blood glucose control can help reduce the risk of diabetes complications. Evidence suggests that early insulin therapy can help correct the underlying pathogenetic abnormalities in type 2 diabetes and improve long-term glycemic control. For these reasons, some diabetes experts advocate the initiation of insulin therapy earlier in the course of type 2 diabetes than has been common in the past. Insulin regimens should be designed to mimic the body's natural physiologic secretion of insulin, including the basal amounts released continuously by the pancreas and the insulin surges produced in response to glucose loads. Using new insulin analogs is a useful approach to achieving this ideal. Insulin glargine provides a nearly constant, peakless release of insulin when injected subcutaneously once daily. Two new rapid-acting insulin analogs, insulin lispro (Humalog--Lilly) and insulin aspart (NovoLog--Novo Nordisk), enhance patients' flexibility in terms of meals by permitting injection immediately before meals, rather than 30 minutes before meals, as with regular insulin. CONCLUSION: Patients should be reassured that early initiation of insulin therapy is a positive event that should improve their long-term health and does not represent a decline in the course of their disease.
Amino Acid Sequence↗