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Related Experiment Videos

Insulin therapy.

S Yadav1, Ankit Parakh

  • 1Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi 110 002, India. sangita_yadav@hotmail.com

Indian Pediatrics
|November 3, 2006
PubMed
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Intensive insulin therapy is crucial for type 1 diabetes mellitus (T1DM) management. Flexible insulin treatment, like the DAFNE program, improves outcomes, though newer insulin analogs offer limited benefits and cost concerns remain.

Area of Science:

  • Endocrinology
  • Metabolic Disorders
  • Pharmacology

Background:

  • Optimal glycemic control in type 1 diabetes mellitus (T1DM) necessitates intensive insulin therapy.
  • Early and prolonged implementation of intensive therapy is supported by major studies like DCCT and EDIC.
  • Flexible intensive insulin treatment, demonstrated by the DAFNE trial, combines dietary freedom with insulin adjustment for effective management.

Purpose of the Study:

  • To review the current landscape of intensive insulin therapy for T1DM.
  • To evaluate the efficacy and practical considerations of insulin analogs and delivery devices.
  • To address the cost-benefit analysis of newer insulin therapies, particularly in developing countries.

Main Methods:

  • Review of key clinical trials (DCCT, EDIC, DAFNE) on intensive insulin therapy.

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  • Analysis of available insulin types, including newer analogs and delivery systems (pen injectors, pumps).
  • Discussion on the economic implications and long-term data for insulin analog use.

    • Main Results:

    • Pen injectors are feasible for routine T1DM management; pumps may be needed in specific cases.
    • Insulin analogs show similar efficacy to regular insulin, with only minor benefits observed.
    • The cost-benefit of short-acting insulin analogs for children in developing countries remains unclear; long-term data is pending.

    Conclusions:

    • Switching well-controlled patients to newer insulin analogs is premature given the lack of long-term data.
    • The choice of post-meal short-acting insulin in toddlers can be provider-dependent.
    • Non-invasive insulin delivery systems, particularly pulmonary delivery, are under development and show clinical promise.