Magazine article Drug Topics

New Long-Acting Insulin Product Requires Fewer Shots

Magazine article Drug Topics

New Long-Acting Insulin Product Requires Fewer Shots

Article excerpt

The tireless effort aimed at lessening the number of dreaded injections diabetes patients must endure has resulted in the development of yet another longacting insulin product.

Manufactured by Aventis Pharmaceuticals, Lantus (insulin glargine [rDNA origin] injection) was recently approved for once-daily subcutaneous administration at bedtime in the treatment of adult patients with Type 2 diabetes mellitus (DM) who require basal (long-acting) insulin for the control of hyperglycemia. Additionally, the recombinant human insulin analog product is indicated for adult and pediatric patients with Type 1 DM.

Apparently, the product's long duration of action is derived from its pH. According to Matthew C. Riddle, M.D., insulin glargine remains soluble in the mildly acidic environment of its vial, yet it is insoluble at the neutral pH of subcutaneous tissue. So when injected, the product forms a fine precipitate that is gradually absorbed. "The resulting blood levels from a once-daily injection are nearly constant for approximately 24 hours," observed Riddie, a professor of medicine in the division of endocrinology, diabetes, and clinical nutrition at Oregon Health Sciences University.

In discussing the product's upside, Riddle pointed out that insulin glargine has the benefit of "much less variability in absorption than Ultralente insulin." The product also appears to have the additional advantage over NPH insulin in having a 24-hour action without a sharp peak. According to the labeling of insulin glargine, the median time between injection and the end of pharmacological effect was 14.5 hours for NPH human insulin and 24 hours for insulin glargine. But regardless of the differences in the duration of action, both NPH insulin and insulin glargine have demonstrated similar levels of efficacy with regard to metabolic control.

Acknowledging a considerable disadvantage of insulin glargine, Riddle noted that the product cannot be mixed in a syringe with any other currently available insulin since its pharmacokinetic profile may be altered in an unpredictable manner. This inconvenience is not shared with NPH insulin products, which are available in premixed formulations with regular short-acting insulin.

In discussing the side effect profile, Chris Lynch, Pharm. …

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