Prandial Insulins: A Person-Centered Choice

IF 5.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Bhawna Attri, Lakshmi Nagendra, Deep Dutta, Sahana Shetty, Shehla Shaikh, Sanjay Kalra, Saptarshi Bhattacharya
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Abstract

Purpose of Review

Postprandial hyperglycemia, or elevated blood glucose after meals, is associated with the development and progression of various diabetes-related complications. Prandial insulins are designed to replicate the natural insulin release after meals and are highly effective in managing post-meal glucose spikes. Currently, different types of prandial insulins are available such as human regular insulin, rapid-acting analogs, ultra-rapid-acting analogs, and inhaled insulins. Knowledge about diverse landscape of prandial insulin will optimize glycemic management.

Recent Findings

Human regular insulin, identical to insulin produced by the human pancreas, has a slower onset and extended duration, potentially leading to post-meal hyperglycemia and later hypoglycemia. In contrast, rapid-acting analogs, such as lispro, aspart, and glulisine, are new insulin types with amino acid modifications that enhance their subcutaneous absorption, resulting in a faster onset and shorter action duration. Ultra-rapid analogs, like faster aspart and ultra-rapid lispro, offer even shorter onset of action, providing better meal-time flexibility. The Technosphere insulin offers an inhaled route for prandial insulin delivery. The prandial insulins can be incorporated into basal-bolus, basal plus, or prandial-only regimens or delivered through insulin pumps. Human regular insulin, aspart, lispro, and faster aspart are recommended for management of hyperglycemia during pregnancy. Ongoing research is focused on refining prandial insulin replacement and exploring newer delivery methods.

Summary

The article provides a comprehensive overview of various prandial insulin options and their clinical applications in the management of diabetes.

餐前胰岛素:以人为本的选择
综述目的 餐后高血糖症或餐后血糖升高与各种糖尿病相关并发症的发生和发展有关。餐前胰岛素旨在复制餐后胰岛素的自然释放,对控制餐后血糖飙升非常有效。目前,市面上有不同类型的餐前胰岛素,如人用普通胰岛素、速效类似物、超速效类似物和吸入式胰岛素。最近的研究结果人普通胰岛素与人体胰腺分泌的胰岛素相同,起效较慢,持续时间较长,可能导致餐后高血糖和随后的低血糖。相比之下,速效类似物,如利斯平、天冬胰岛素和格列卫胰岛素,是对氨基酸进行修饰的新型胰岛素,可促进皮下吸收,从而加快起效速度,缩短作用持续时间。超快速类似物,如快速天冬胰岛素和超快速利斯妥胰岛素,起效时间更短,为进餐时间提供了更好的灵活性。Technosphere 胰岛素为餐前胰岛素给药提供了一种吸入途径。胰岛素可用于基础胰岛素、基础胰岛素加胰岛素或仅胰岛素治疗方案,也可通过胰岛素泵给药。推荐使用人普通胰岛素、天冬胰岛素、赖脯胰岛素和更快天冬胰岛素来控制孕期高血糖。本文全面概述了糖尿病治疗中的各种餐前胰岛素选择及其临床应用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
9.80
自引率
0.00%
发文量
52
审稿时长
6-12 weeks
期刊介绍: The goal of this journal is to publish cutting-edge reviews on subjects pertinent to all aspects of diabetes epidemiology, pathophysiology, and management. We aim to provide incisive, insightful, and balanced contributions from leading experts in each relevant domain that will be of immediate interest to a wide readership of clinicians, basic scientists, and translational investigators. We accomplish this aim by appointing major authorities to serve as Section Editors in key subject areas across the discipline. Section Editors select topics to be reviewed by leading experts who emphasize recent developments and highlight important papers published over the past year on their topics, in a crisp and readable format. We also provide commentaries from well-known figures in the field, and an Editorial Board of internationally diverse members suggests topics of special interest to their country/region and ensures that topics are current and include emerging research.
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