Vol 59, No 3 (2008)
Review paper
Published online: 2008-05-08
New developments in the treatment of type 1 diabetes mellitus
Endokrynol Pol 2008;59(3):246-253.
Abstract
In recent years, insulin analogues are the benefits of the use in functional intensive insulin therapy for the treatment of diabetes. Shortacting
insulin (lispro, aspart and glulisine) and long-acting insulin (glargine and detemir) have been developed for the management of
diabetes. Short-acting insulin analogues are an alternative to regular human insulin before meals. These new short-acting insulin analogues
show more rapid onset of activity and a shorter duration of action. As a result of these pharmacokinetic differences, an improved
postprandial glycemic control is achieved, without increasing the risk of hypoglycemia. In addition, these insulin analogues can be administered
immediately before a meal. The long-acting insulin analogues provide basal insulin levels for 24 h when administered once
(glargine) or two (detemir) daily. Compared with previous intermediate- or long-acting conventional insulin, these insulins shows a flat
profile of plasma insulin levels . The use of these long-acting insulin analogues appears to be associated with a reduced incidence of
hypoglycemia, especially at night. The availability of these new insulin analogues has the potential to significantly improve long-term
control over blood glucose in diabetic patients. In recent years more and more frequently the method of multiple daily injections (MDI) of
insulin is being replaced by the method of continuous subcutaneous insulin infusion (CSII). It is the most physiological way to administer
insulin. In recent years treatment with insulin pumps has been used more frequently in the pediatric patients and in the treatment of
diabetes in pregnancy. Use of continuous glucose monitoring systems enables detection of glycemia fluctuations unrevealed by selfmonitoring
of blood glucose, such as night hypoglycemias and early postprandial hyperglycemias. Real-time systems allow to reduce
HbA1c levels and limit number of excursions. Non-invasive glucose measurement devices are introduced. Fully automated continuous
glucose monitoring systems integrated with insulin pumps operating in closed-loop model, requiring no patient assistance, are still being
researched. Commercially available systems operate in open-loop model, where the patient has to decide on administration and dose of
insulin.
Keywords: diabetes type 1functional intensive insulin therapyinsulin analoguesmethod of multiple daily injections (MDI)continuous subcutaneous insulin infusion (CSII)insulin pumpscontinuous glucose monitoringclosed-loop modelopen-loop model