Advances in insulin therapy

A three-article symposium

Symposium coordinator

John R. White Jr, PA-C, PharmD
Professor of Pharmacotherapy
Washington State University College of Pharmacy
Spokane
Primary Care Provider
David C. Wynecoop Memorial Clinic
Wellpinit, Washington

VOL 113 / NO 6 / JUNE 2003 / POSTGRADUATE MEDICINE

• INTRODUCTION TO THE SYMPOSIUM. By John R. White Jr, PA-C, PharmD
• NOVEL INSULINS AND STRICT GLYCEMIC CONTROL: Analogues approximate normal insulin secretory response. By John R. White Jr, PA-C, PharmD, R. Keith Campbell, RPh, CDE, Irl B. Hirsch, MD
• OPTIMIZING INSULIN REGIMENS IN TYPE 1 DIABETES: How to help patients get control of their life. By Nancy J. V. Bohannon, MD
• THE CHANGING MODEL OF INSULIN USE IN TYPE 2 DIABETES: Techniques, tactics for getting to goal. By R. Cooppan, MBChB, FRCP(C)

The discovery of insulin in 1922 by Frederick Banting and his colleagues at the University of Toronto gave the world the notion that diabetes had been conquered. In fact, a headline in a newspaper called Banting "the conqueror of diabetes." The discovery of insulin was one of the greatest medical breakthroughs of the 20th century. However, it quickly was realized that insulin in and of itself was not a panacea. The syndrome of diabetes is much more complex than first hypothesized.

Even with publication of the findings of the Diabetes Control and Complications Trial, the UK Prospective Diabetes Study, and other trials that proved complications can be reduced with strict glycemic control, many physicians choose not to strictly manage blood glucose levels. In the past, part of the rationale was the paucity of effective and safe oral antidiabetic medications and insulin preparations. However, this predicament has been mitigated to a great degree with the introduction of new oral agents and insulin formulations.

These advances make the goal of euglycemic control--and subsequent reduction in complications--a feasible one. This symposium focuses on the pharmacology of the new insulin analogues and the use of insulin in patients with type 1 or type 2 diabetes.

In the first article, Professor R. Keith Campbell, Dr Irl B. Hirsch, and I review the pharmacology of conventional insulin formulations and insulin analogues. We discuss the evolution of insulin therapy, normal insulin secretory patterns, and the problems encountered with the use of conventional insulins.

In the second article, Dr Nancy J. V. Bohannon discusses how the more physiologic insulins have greatly improved blood glucose control in patients with type 1 diabetes. She also comments on how the advent of diabetes teaching centers and certified diabetes educators has contributed to better outcomes in this population.

In the third article, Dr R. Cooppan reviews the indications for insulin in patients with type 2 diabetes who are taking oral agents with unsatisfactory results. He also discusses techniques for the safe and effective initiation and maintenance of insulin therapy in these patients.

Although there is much room for improvement in our management of diabetes, novel insulin molecules may help us close the gap between recommended standards of care and the level of care typically provided. Primary care physicians are the most important players in the management of diabetes; only about 10% of patients with diabetes are cared for by endocrinologists. We hope that this symposium provides a complete but succinct overview of some of the most important advances in insulin therapy since the discovery of insulin.

RETURN TO JUNE 2003 TABLE OF CONTENTS

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