Diabetes & Metabolic Syndrome: Clinical Research & Reviews 11S (2017) S833–S839

Contents lists available at ScienceDirect

Diabetes & Metabolic Syndrome: Clinical Research &

Reviews
journal homepage: www.elsevier.com/locate/dsx

Review

Evaluation of current trends and recent development in insulin therapy

for management of diabetes mellitus
Muhammad Sarfraz Nawaza,d , Kifayat Ullah Shaha,d,* , Tahir Mehmood Khanb ,
Asim Ur Rehmana,d, Haroon Ur Rashida,d, Sajid Mahmooda,d , Shahzeb Khanc,d,
Muhammad Junaid Farrukhc,d
a
Department of Pharmacy, Quaid-i-Azam University Islamabad, Pakistan
b
School of Pharmacy, Monash University, Jalan Lagoon Selatan,47500 Bandar SunwaySelangor DarulEhsan, Malaysia
c
Department of Pharmacy, University of Malakand, KPK, Pakistan
d
Faculty of Pharmaceutical Sciences, UCSI University, Cheras, Kuala Lumpur, Malaysia

A R T I C L E I N F O A B S T R A C T

Article history: Objective: Diabetes mellitus is a major health problem in developing countries. There are various insulin
Received 17 May 2017 therapies to manage diabetes mellitus. This systematic review evaluates various insulin therapies for
Accepted 1 July 2017 management of diabetes mellitus worldwide. This review also focuses on recent developments being
explored for better management of diabetes mellitus.
Keywords: Research design and method: We reviewed a number of published articles from 2002 to 2016 to find out
Diabetes mellitus the appropriate management of diabetes mellitus. The paramount parameters of the selected studies
Insulin therapy
include the insulin type & its dose, type of diabetes, duration and comparison of different insulin
HbA1c
Diabetes management
protocols. In addition, various newly developed approaches for insulin delivery with potential output
Glycemic control have also been evaluated.
Results: A great variability was observed in managing diabetes mellitus through insulin therapy and the
important controlling factors found for this therapy include; dose titration, duration of insulin use, type
of insulin used and combination therapy of different insulin.
Conclusion: A range of research articles on current trends and recent advances in insulin has been
summarized, which led us to the conclusion that multiple daily insulin injections or continuous
subcutaneous insulin infusion (insulin pump) is the best method to manage diabetes mellitus. In future
perspectives, development of the oral and inhalant insulin would be a tremendous breakthrough in
Insulin therapy.
© 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S834

2. Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S834
2.1. Literature search . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S834
2.2. Studies inclusion and exclusion criteria ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S834
2.3. Data extraction and quality assessment ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S834
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S834
3.1. Study selection and characteristics . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S834
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S835
5. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S836
6. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S838
Future perspective . . . . . . . . . . . . . . . . . . . . . . .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S838

* Corresponding author at: Department of Pharmacy, Quaid-i-Azam University

Islamabad, Pakistan.
E-mail address: kushah@qau.edu.pk (K.U. Shah).

http://dx.doi.org/10.1016/j.dsx.2017.07.003
1871-4021/© 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.
S834 M.S. Nawaz et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 11S (2017) S833–S839
Conflict of interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S838
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S838
1. Introduction
In the current era, Diabetes Mellitus has been reported as the
major growing health care problem [1].The major types of diabetes
mellitus include type1, type2, and gestational diabetes [2].Better
control in sugar level prevents the long term complications in
diabetic patients which may be micro or macro-complications. It
was observed that a better glycemic control in diabetes prevented
morbidity and mortality [3].The study reported from United States
showed that in primary care setup, millions of people with
diabetes were facilitated with diabetes cares centers which were
very much helpful and produced better outcomes for diabetic
patients [4].Currently the use of insulin analogues, by employing
the advanced techniques, have got a noticeable attraction in
management of Diabetes. The latest report on this management
shows that 6 to 7 million Americans are using insulin analogues for
diabetes management [5].
The availability of modern insulin analogues is more beneficial
for the control of diabetes mellitus as their duration of action is
faster than that of the normal insulin in human body [6].
Continuous subcutaneous insulin infusion(CSII pump), now a
days, is most commonly used method to manage hyperglycemia
and hypoglycemia [7].CSII is available in insulin pump form and is
becoming the most popular approach to manage diabetes [8]. The
use of insulin pump is the most effective in management of type 1
diabetes mellitus. Gestational diabetes is the third major type of
diabetes mellitus, diagnosed during pregnancy. In some cases of
gestational diabetes mellitus, the sugar level becomes normal after
delivery [9]. However, some cases of gestational diabetes mellitus
result in type2 diabetes mellitus after delivery. A study shows that
around 366 million people worldwide have been diagnosed with
diabetes mellitus and the number of diabetic patients has been
shown to increase in future and presumably this number would
become 552 million by 2030 [10]. Japanese study has shown that
diabetes mellitus prevalence increased from 8.2% in 1997 to 10.5%
in 2007 [11]. In urban areas there is great effort of Health Care
Professionals in improving glycemic control to prevent complica-
tions. Insulin is the first treatment option for hospital admitted
diabetic patients, usually regular insulin is preferred as it can be
administered intravenously [12].
A clinical trial was conducted, in which type1 diabetic
people participated and there HbA1C value was compared with
the diabetes related complications. This study showed the
strong relationship of HbA1C value with complications i.e. with
the increase in HbA1C value, chances of complications in
diabetic patients also increase [13].Different endocrinology
societies suggest that blood sugar level must be tested before
meal and at bedtime [14]. In insulin users, the blood sugar
testing at bed time is very important to avoid hypoglycemia,
because if the sugar level was low at bed time then there could
be a risk of occurrence of hypoglycemic attack anytime at night
[15].Long acting analogues of insulin i.e. glargine (Lantus solo
star) and detemir (levemir) are more commonly used basal
insulin than intermediate acting NPH, but NPH is still
commonly used in type2 diabetes mellitus [16].Type1 diabetes
mellitus is usually managed by split insulin therapy [17], while
type2 diabetes mellitus is managed by single daily injection of
long acting insulin or premix 30/70,25/75, 50/50 or both human
insulin or insulin analogues along with oral anti-hyperglycemic
agents [18].
2. Methodology
2.1. Literature search
A literature search of different articles in MEDLINE and Google
Scholar, published from 2002 to 2016, was conducted. Our search
strings insulin AND diabetes observational studies, cohort studies,
oral anti-hyperglycemic agents OR insulin AND diabetes observa-
tional studies or cohort studies. Studies were selected indepen-
dently to find the best protocol for diabetes mellitus management.
Only those articles were considered which were published in
English language. AND and OR Boolean used to find texts.
2.2. Studies inclusion and exclusion criteria
Our systematic review contains observational and cohort
studies. We excluded randomized control trials, adverse reaction
reports, studies on neonatal diabetes and studies containing only
oral anti-hyperglycemic agents use for diabetes mellitus manage-
ment.
2.3. Data extraction and quality assessment
The selection of articles is based upon study relevance. A
standardized data collection protocol form using Microsoft office
word document was used. The form includes first author, year of an
area of publication, study objective, study design, diabetes type,
and study duration, number of patients involved in study, relevant
variables, treatment options and findings. National Institute of
Health quality assessment tool is used to assess each study. A
standard quality checklist of observational cohort and cross
sectional studies is given in Table 1 in which Y = yes = 1, N = no =
0 and if a parameter is not available then NA = 1. The study’s rating
is based upon quality points e.g. a study is rated as, good if quality
points > 10, fair if 5 < total < 11 and poor if < 6 [19].
3. Results
3.1. Study selection and characteristics
A database of 490 studies was identified. Forty additional
relevant studies were found from other search engines. 500 studies
were excluded because these studies were not fulfilling the
criteria. Thirty full text articles were assessed for eligibility.
Eighteen text articles, case reports, review articles, letters, other
language articles and no full text articles were excluded. Nine
studies were included in qualitative synthesis. A PRISMA flow
sheet diagram is shown in Fig. 1
Included studies were published from 2002 to 2016. Five
studies were cohort while rest was observational. The total
number of participants of our study is 35062, most of which were
suffering from type 2 diabetes mellitus [20–26].
A large number of research articles and review articles
identified that each protocol was presented in a different way to
manage diabetes mellitus. The differences in different protocols
have been discussed briefly in this review article. It has become
evident from two to three employed protocols that dose of Insulin
adjusted by sliding scale insulin dose model, produces unsatisfac-
tory results [27].It has also become evident from a number of
published articles, that intensive use of Insulin management
therapy decreases the death rate and improves the patient quality
 M.S. Nawaz et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 11S (2017) S833–S839 S835

Table 1
Quality assessment for included studies by using assessment tool by National Insitutional of Health (NIH).

Studies (first author, year, area)

Creteria Suzannee Bjorn Dr. Pedersen Chiara J. Isablle Jyrki Joyce Melanie
M. (2002) Eliasson Bjergaard Mameli Mamza Steineck k. A. Davies
(2014) (2014) (2014) (2014) (2005–12) (2011) (2005) (2005)
1. Was the research question or objective in this Y Y Y Y Y Y Y Y Y
Paper clearly stated?
2. Was the study population clearly specified and defined? N Y N Y N N Y Y Y
3. Was the participation rate eligible persons Y Y Y Y Y Y Y Y Y
at least 50%?
4. Were all the participants selected or recruited from the same or Y N N N Y N N Y N
similar populations(included the same time
Period)? Were inclusion and exclusion criteria for being in the
study pre-specified and applied uniformly to all participants?
5. Was a sample size justification, power description, or variance N N N Y Y N N N N
and effect estimates provided?
6. For the analysis in this paper, were Y Y Y Y Y Y Y Y Y
the exposure(s) of interest measured
Prior to the outcome(s) being measured?
7. Was the timeframe sufficient so that Y N Y Y Y N N N N
one could reasonably expect to see an
association between exposure and outcome if it existed?
8. For exposure that can vary in amount or level, did the study N N N N N N N N N
examine different
levels of the exposure as related to the
outcome(e.g., categories of exposure measured as continuous
variable)?
9. Were the exposure Y Y Y Y Y Y Y Y Y
Measures (independent variables) clearly
defined, valid, reliable, and implemented
consistently across all study participants?
1. Was the exposure(s) assessed more than once over time? Y Y Y Y Y Y N N Y
11. Were the outcome measures (dependent Y Y Y Y Y Y Y Y Y
variables) clearly defined, valid, reliable, and implemented
consistently across all study participants?
12. Were the outcome assessors blinded to the exposure status of NA NA NA NA NA NA NA NA NA
participants?
2. Was loss to follow up after baseline 20% or less? NA NA NA N NA N NA NA NA
14. Were key potential confounding variables measured and Y Y Y Y Y Y Y Y Y
adjusted statistically for their impact on the relationship between good good good good good good good good Good
exposure(s) and outcome(s)?
Quality rating (good, fair, poor)

Y = yes, N = No, NA = not available.

of life [28].Many studies showed the comparison of insulin pump
therapy (continuous subcutaneous insulin infusion) with old
injection technique concluded that insulin pump therapy is less
hazardous than that of injection technique [25,29–32]. In addition,
a number of studies demonstrated that Insulin dose adjustment is
required for patients withdrawn from oral anti-hyperglycemic
agents. Long acting insulin have also been found very effective to
manage the fasting blood glucose level [33]. A cohort study
demonstrated the important factors, include age, race, BMI, sex
and duration of diabetes, affect the level of HbA1c in patients of
type2 diabetes mellitis [21,34].It has also been investigated that
the use of Insulin pump is not affected by demographic character-
istics of a patient but the image of the body and social acceptance
are the potential factors affecting the glycemic level [35,36]. Lau YN
et al., Thalange et al., and Pearson KK studies show the insulin to
carbohydrates relation, in which patients use insulin dose
according to their need, satisfactory results were observed as
patient can increase or decrease the amount of Insulin according to
their demand [37–39]. The combine effect of basal and bolus
insulin with continuous correction dose of regular human insulin
and NPH, in hospital admitted patients, has been found very
effective [40]. A combined study on long acting analogues and
ultra-short acting analogues showed these agents to be satisfacto-
ry hypo- and hyper-glycemic controlling agents [41]. Moreover the
combined effects of human insulin and insulin analogues were also
assessed for glycemic control and found satisfactory [42]. The
analogues were however found better glycemic controlling agents
than human insulin [43,44].Another interesting study has con-
cluded that poor control of fasting glycemic level in gestational
diabetes can potentially produce long term health related issues
after pregnancy. These effects lead to type2 diabetes mellitus [45].
The details of studies included in our systemic review are given in
Table 2.
4. Discussion
This review article shows that good glycemic control in diabetic
patients makes their life better than with poor glycemic control.
The use of best insulin protocols makes the chance less for
hypoglycemia or hyperglycemia and as a result minimum hospital
visit is needed for diabetic patients. The selection of any protocol
for diabetic patients needs specific investigational procedure and
further insulin protocol is designed for specific group of diabetic
patients and not for all. The value of HbA1c < 7 shows a good sign
for diabetic patients as it leads to less chances of micro-vascular
complication and macro-vascular complication. Therefore it is
imperative to decrease the level of HbA1c in diabetic people.
Different literature survey also shows that better glycemic control
in diabetic patients makes less chances of complication, which
reduces the cost of diabetes management as well. A number of
studies show that patients with type1 diabetes need multiple daily
insulin injection to attain HbA1c less than 7; this has also been
S836 M.S. Nawaz et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 11S (2017) S833–S839
Fig. 1. Review of PRISMA 2009 flow diagram.
mentioned in American Diabetic Association (ADA) guideline 2015
that HbA1c should be less than 6.5%. Significant clinical effects
were observed in diabetic patients, if they move from multiple
daily injections to continuous subcutaneous insulin injection
(CSII). In case of diabetic management studies, randomize clinical-
trials do not reflects the clinical results, as these trials are
conducted on limited people and we know diabetes is a
multifactorial metabolic disorder and a group of few patients
study in randomized control trial is not affective and fruitful in
most cases. Lau YN et al. and many other studies shows that for
bolus-basal insulin the sliding scale insulin adjustment model is
preferred but latest studies prove that sliding scale model has
some limitation and can only be used in emergency conditions. In
addition, other studies demonstrated that best glycemic control is
achieved in acute and severe cases while using sliding scale model
approaches. A number of studies also reveals that frequency of
hypoglycemia is more with pre-mix human insulin than bolus-
basal insulin use. Timing of insulin injection and proper blood
glucose monitoring is major parameter to achieve better glycemic
control in diabetes. Insulin administration also varies from person
to person, as insulin is administered according to the need of
diabetic patients. Management of Type1 diabetes has previously
been reported a major challenge but now days it is easily managed
by using multiple daily injection or continuous insulin infusion
pump. Ultra-short acting insulin (modern insulin/analogues)
shows better glucose lowering effect than human insulin. It has
also become evident from the published research, basal long acting
analogues along with ultra-short acting analogues show same
glycemic control as bolus-basal regimen [46]. Long acting
analogues glargine and intermediate acting NPH is better glycemic
controlling agent in glucocorticoids induced hyperglycemia in
type2 diabetes mellitus [47].Recent reviews and research articles
on management of diabetes using insulin have demonstrated that
use of modern insulin (insulin analogues) reduces the chances of
hypoglycemia in diabetic patients and improve the glycemic
control. The combination of intermediate acting insulin (NPH) or
long acting along with oral anti-hyperglycemic agents improve the
glycemic control in type2 diabetic patients. IN-105 is an oral
insulin analogue that has got good stability profile. This has been
reported with improved half-life in GIT tract. Pre-clinical studies of
this product demonstrated a safe profile in a range of species. FDA
has recently approved new inhaled insulin which is not yet a full
time replacement of the inject-able insulin. However it is being
used as alter-native to them at meal time and shows quick effect
within 12–15 min.
5. Limitations
There is no authentic data available about the use of insulin
pump in Pakistan. However: a very few studies are available on
multiple daily insulin injection in diabetes mellitus. Literature
search shows that management of different types of diabetes by
insulin in Asian countries is not clear. Various approaches use to
achieve good glycemic control i.e. insulin to carbohydrate ratio,
insulin pumps and multiple daily injections but these type of
studies are very few in Asian countries.
 M.S. Nawaz et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 11S (2017) S833–S839 S837

Table 2
Detail Characteristics of included studies.

First Objective Study design Diabetes Study Patients Relevant Variable Treatment Finding
author type duration no. option
Year Area
Bjorn Metabolic effect of basal Observational T2DM 6years 5077 Age, weight, BMI, HbA1c, Different All types of insulin i.e., insulin
Eliasson or premixed insulin cohort relative effects of different types of glargine, insulin detemir,
2014 treatment in 5077 insulin insulin combination use, insulin premixed insulin, neutral
Sweden naïve Type 2 diabetes insulin dose, protamine hagedorn insulin,
equally effective in HbA1c
lowering with T2DM but
greater weight gain and
hypoglycemia with premix
insulin.
Dr Ulrik Effect of insulin analogues Cohort T1DM 3years 159 Hypoglycemia Insulin Insulin analogues detemir and
Pedesen on risk of severe analogues aspart reduces the chances of
Bjergaard hypoglycemia in patients severe hypoglycemia compared
2014 with type 1 diabetes with human insulin
Denmark prone to recurrent severe
hypoglycemia
Hiara A 7-year follow-up Cohort T1DM 7years 115 Age, BMI, HbA1c Insulin A significant reduction in
Mameli retrospective HbA1c was observe with
2014 international multicenter continuous subcutaneous
Canada study of insulin pump insulin infusion which lead to
Italy therapy in children and delay the complication
Span adolescents with type 1
diabetes
J Mamza Obesity independently cohort T2DM 12years 2183 Age, weight, sex, gender, Insulin In this study it was observe that
2014 U.K predicts responders to BMI, HbA1c, Blood the use of biphasic insulin 50/
biphasic insulin 50/50 Pressure(SBP,DSBP), 50 is effective in better
following conversion cholesterol, HDL, LDL, glycemic achievement
from other insulin current medication, especially in obese patients,
regimens duration of therapy, and help to improve HbA1c
triglycerides significantly.
Isabelle Insulin pump therapy, Observational T1DM 8years 18168 Age, HbA1c, hypoglycemia Insulin pump This study shows that
Steineck multiple daily injection, Systolic blood pressure, therapy and Cardiovascular mortality lower
2005–12 and cardiovascular diasystolic blood pressure, multiple daily in insulin pump user than
Sweden mortality in 18168 people BMI, HDL, total cholesterol insulin Multiple daily insulin injection.
with type 1 diabetes triglycerides cholesterol injection The use of insulin pump also
the risk of hyperglycemia as
well and reduces the chances of
micro- and macro vascular
complication.
Jyrki K. Starting or switching to Observational T2DM 1.5years 557 Age, BMI, %male and Insulin A significant glycemic control
2011 biphasic insulin aspart30 female, hypoglycemia, analogue was observing in uncontrolled
Finland in type2 diabetes HbA1c, blood sugar (biphasic type 2 diabetic patients by
fasting, weight aspart30) initiation and titration of
biphasic insulin analogues
aspart30. The frequency of
hypoglycemia is minor by use
of ultra short acting insulin
analogue.
Joyce A. The influence of insulin Observational T2DM 2years 6222 Age race, HbA1c, Oral It was observe that HbA1c value
2005 use on glycemic control hypoglycemia hypoglycemic is higher than predicted that
American agents plus shows there is insulin dose
insulin R&N titration need to get better
glycemic control along with
HbA1c
Melanie Improvement of glycemic Cohort T2DM 6months 2493 HbA1c, BMI, age, weight, analogue Glargine is safe and effective in
Davies control in subjects with duration of diabetes, Insulin improving sugar control in
2005 U.K poorly controlled type2 previous treatment, T2DM. Proper dose titration
diabetes current treatment, FBG, lead to lower chances of
sex, hypoglycemia and better
glycemic control.
Suzanne Comparison of insulin Cohort T2DM 4months 88 Age, weight, cholesterol, Insulin plus This study shows that
M. monotherapy and VLDL, HbA1c, triglyceride, oral aggressive insulin therapy
2002 U.K combination therapy with blood sugar fasting hypoglycemic significantly improved
insulin and metformin agents glycemic control in type2
diabetic subjects to level
compare able to those achieved
by adding metformin to insulin.
Insulin with metformin avoid
weight gain and hypoglycemia
while insulin with trioglitazone
effective in lowering HbA1c

Abbreviations: T2DM = Type 2 diabetes mellitus, T1DM = Type 1 diabetes mellitus, BMI = Body mass index, HbA1c = Glycated haemoglobin, B.P = Blood pressure,
MDI = Multiple daily injection, SBP = Systolic blood pressure, DSBP = Diasystolic blood pressure, OHA = Oral hypoglycemic agents, R&N = Regular and neutral protamine
hagedorne insulin, BSF = Blood sugar fasting, HDL = High density lipids, VLDL = Very low density lipid.
S838 M.S. Nawaz et al. / Diabetes & Metabolic Syndrome: Clinical Research & Reviews 11S (2017) S833–S839
6. Conclusion
A plethora of recent published studies on management of
diabetes, which have been reported in this systematic review have
led us to the conclusion, that there are no static nature
management strategies to control hyperglycemia in diabetic
patients but there is need of some sort of modification in insulin
adjustment and insulin type selection strategies to achieve
individual care. As we know that insulin demand varies from
person to person due to difference in types of diabetes, life style,
age and body weight etc. Therefore this comprehensive review
refined and specified the guideline or strategies for diabetes
mellitus management which includes, in type1 diabetes multiple
daily insulin injection or insulin pump is better, while in type 2
long acting analogues along with oral anti-hyperglycemic agents
are beneficial and in gestational diabetes only insulin specific type
is preferred to control glycemic level. In emergency case regular
human insulin is most common in practice. Moreover this review
also summarized the recent development in Insulin delivery
routes. The recent development in insulin therapy including
buccal, inhaled and oral insulin could potentially lead to attractive
dosage forms which would address the major challenges with
inject-able insulin therapy.
Future perspective
In future perspectives, there have been reported some new
approaches for delivery of insulin, which offer attractive benefits
over the current methods. These approaches include delivery of
insulin through oral buccal, pulmonary, nasal, ocular and rectal
routes. In addition the artificial pancreas, with closed- loop system
has also been reported a potential approach to treat diabetes. A
novel ultra-long acting basal insulin; degludec has also been found
very effective.
Conflict of interests
The authors declare that there is no conflict of interest
regarding the publication of this article.
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