Insulin therapy efficacy

Recommendations in this section may change based on results from the recent GLUCONTROL trial and the Volume Substitution and Insulin Therapy in Severe Sepsis Study. Both trials where stopped early due to lack of efficacy and safety concerns. 

Whitehouse F, Kruger DF, Fineman M, Shen L, Ruggles JA, Maggs DG, Weyer C, Kolterman OG. A randomized study and open-label extension evaluating the long-term efficacy of pramlintide as an adjunct to insulin therapy in type 1 diabetes. Diabetes Care 2002 25(4) 724-30. 

Efficacy and safety of inhaled insulin (Exubera) compared with subcutaneous insulin therapy in patients with type 1 diabetes. Diabetes Care 2004 27 2622-7. 

Rosenstock J, Einhorn D, Hershon K, Glazer NB, Yu S Pioglitazone 014 Study Group. Efficacy and safety of pioglitazone in type 2 diabetes a randomised placebo controlled study in patients receiving stable insulin therapy. Int J Clin Pract 2002 56 251-7. 

A.E. Mehta, J.L. Milburn, K.S. Hershon, J.L. Chiasson, and S.R. Levin. 2004. Efficacy and safety of inhaled insulin (exubera) compared with subcutaneous insulin therapy in patients with type 2 diabetes results of a 6-month, randomized, comparative trial. Diabetes Care 27 2356-2362. 

Conventional anticonvulsants (e.g., diazepam, phenobarbital, and phenytoin) may be administered to treat pyriminil-induced seizures. Niacinamide has been demonstrated to be an effective antidote in pyriminil poisoning in rats but little information is available regarding its antidotal efficacy in humans. Insulin therapy could be instituted as a preventive measure for possible diabetes mellitus. Orthostatic hypotension due to pyriminil exposure may be treated with conventional mineralocorticoids. 

Ceglia L, Lau J, Pittas AG. Meta-analysis efficacy and safety of inhaled insulin therapy in adults with diabetes mellitus. Ann Int Med 2006 145 665-675. 

Because of the polyfactorial nature of disease states, such as obesity, type 2 diabetes, and Metabolic Syndrome, it is expected that drugs targeting the lipid synthesis and metabolism pathways will be used in the context of combination therapy [7]. Pre-clinical and clinical results to date indicate that pronounced efficacy could be achieved toward the management of associated lipid levels and insulin resistance, and thus, investigation in these areas provides significant promise. 

Diabetes mellitus is a heterogeneous group of disorders characterized by abnormalities in carbohydrate, protein, and lipid metabolism. The central disturbance in diabetes mellitus is an abnormality in insulin production or action or both, although other factors can be involved. Hyperglycemia is a common end point for all types of diabetes mellitus and is the parameter that is measured to evaluate and manage the efficacy of diabetes therapy. 

Albright ES, Desmond R, Bell DSH. Efficacy of conversion from bedtime NPH insulin injection to once- or twice-daily injections of insulin glargine in type 1 diabetic patients using basal/bolus therapy. Diabetes Care 2004 27 632-3. 

Insulin resistance in type 2 diabetes contributes to reduced efficacy of both endogenous and exogenous insulin. When metformin and pioglitazone were compared in patients who had not taken previous drug therapy, they were equally efficacious in glycemic control, but parameters of insulin sensitivity increased much more with pioglitazone (83). 

Models of autoimmune diabetes in nonobese diabetic mice (NOD) mice, insulin-dependent diabetes, and experimental allergic encephalyomyelitis (EAE) were also used to evaluate naked pDNA therapy. In the latter models, a predominant Thl cytokine response is thought to play a role in disease symptoms and etiology. Treatment of these mouse models with a TH2 type cytokine, such as IL-10 or IL-4, has been found to shift the immune response and lessen the severity of disease. Therefore, the efficacy of pDNA delivery of a Th2 cytokine was explored in these specific models. 

Following the success of recombinant proteins such as insulin, therapeutic mAbs today represent the second wave of innovation created by the biotechnology industry during the past 20 years. The recent success of a number of new mAb therapies, for example rituximab (Rituxan ) and infliximab (Remicade ), suggests a resurgence of the biotech industry for the coming years. For serious chronic diseases such as cancer or rheumatoid arthritis, mAb therapy has indeed proven its clinical efficacy. 

The ability to transfer genes into islets and perhaps the insulin producing fl cells appears to represent an excellent opportunity to utilize gene therapy for improving the clinical efficacy of islet cell transplantation. Unlike the case of other organ transplants... 

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