title: Clinical utility of insulin and insulin analogs.
abstract: Diabetes is a pandemic disease characterized by autoimmune, genetic and metabolic abnormalities. While insulin deficiency manifested as hyperglycemia is a common sequel of both Type-1 and Type-2 diabetes (T1DM and T2DM), it does not result from a single genetic defect--rather insulin deficiency results from the functional loss of pancreatic β cells due to multifactorial mechanisms. Since pancreatic β cells of patients with T1DM are destroyed by autoimmune reaction, these patients require daily insulin injections. Insulin resistance followed by β cell dysfunction and β cell loss is the characteristics of T2DM. Therefore, most patients with T2DM will require insulin treatment due to eventual loss of insulin secretion. Despite the evidence of early insulin treatment lowering macrovascular (coronary artery disease, peripheral arterial disease and stroke) and microvascular (diabetic nephropathy, neuropathy and retinopathy) complications of T2DM, controversy exists among physicians on how to initiate and intensify insulin therapy. The slow acting nature of regular human insulin makes its use ineffective in counteracting postprandial hyperglycemia. Instead, recombinant insulin analogs have been generated with a variable degree of specificity and action. Due to the metabolic variability among individuals, optimum blood glucose management is a formidable task to accomplish despite the presence of novel insulin analogs. In this article, we present a recent update on insulin analog structure and function with an overview of the evidence on the various insulin regimens clinically used to treat diabetes.
authors.affiliation: Human Gene and Cell Therapy Center, Akdeniz University Faculty of Medicine, Antalya, Turkey.
authors.forename: Ahter D
authors.initials: AD
authors.lastname: Sanlioglu
authors.forename: Hasan Ali
authors.initials: HA
authors.lastname: Altunbas
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Balci
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Griffith
authors.forename: Salih
authors.initials: S
authors.lastname: Sanlioglu
mesh_terms: D000818:Animals; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000517:prevention & control*; D016903:Drug Monitoring; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000737:chemistry / Q000378:metabolism / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000378:metabolism / Q000627:therapeutic use*; D061386:Insulin, Regular, Human / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000235:genetics / Q000627:therapeutic use; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000737:chemistry / Q000627:therapeutic use
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D061386:Insulin, Regular, Human; D011994:Recombinant Proteins
keywords: diabetes; genetic engineering; insulin; insulin analogues