Comparative Trials with Monocomponent (MC) and Monospecies (MS) Pork Insulins in the Treatment of Diabetes mellitus. Influence on Antibody Levels, on Insulin Requirement and on Some Complications

Andreani, D; Iavicoli, M; Tamburrano, G; Menzinger, G.; Maltarello, C

doi:10.1055/s-0028-1093821

Cited by 26 publications

(16 citation statements)

References 3 publications

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“…The present study confirms previous reports that the transfer of diabetics, particularly those on large doses [14] of conventional (mainly bovine) insulin, to highly purified porcine insulin may be associated with substantial falls in insulin dosage [2,4,15] and/ or improvement in diabetic control [3]. Such changes are, in themselves, open to the interpretation that non-specific effects associated with closer patient supervision, such as more rigid adherence by the patient to his diet, may be responsible.…”

Section: Discussionsupporting

confidence: 93%

Change of insulin dosage, circulating free and bound insulin and insulin antibodies on transferring diabetics from conventional to highly purified porcine insulin

1978

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Fifty-eight patients on long term conventional mainly bovine insulins have been transferred to highly purified porcine insulin preparations. There was an overall reduction of 22% in daily insulin dosage and improved diabetic control as shown by decreased blood glucose concentration. Increased concentrations of serum free insulin and falls in serum bound insulin levels were also found. There were reductions in the serum binding capacities and affinity constants on changeover from conventional to highly purified insulin due to a combination of the effects of differential conventional/purified porcine binding and the substitution of a low antigenicity insulin. However, 12 of the patients receiving higher doses of insulin experienced marked hypoglycaemic reactions immediately on insulin changeover despite initial dosage reductions of 30% and prior to any changes in antibody characteristics.

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Section: Discussionsupporting

confidence: 93%

Change of insulin dosage, circulating free and bound insulin and insulin antibodies on transferring diabetics from conventional to highly purified porcine insulin

1978

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“…In all cases the changeover was to highly purified porcine insulin. These results agree with those of studies on non-pregnant diabeticpatients [20,24,29,31]. Furthermore, very low levels of insulin antibodies have been reported in newly diagnosed diabetic patients treated with highly purified porcine insulin [32,33].…”

Section: Discussionsupporting

confidence: 90%

Insulin immunogenicity in pregnancy: maternal and fetal studies

et al. 1983

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Antibodies to insulin were found in 92% of the 138 insulin-treated pregnant diabetic patients studied. No effect of pregnancy was shown on insulin antibody levels. Higher insulin antibody levels were significantly associated with the previous use of conventional insulins. Change from conventional to highly purified porcine insulin during pregnancy produced a significant reduction in insulin antibody levels. The combination of protamine zinc and soluble insulin used before pregnancy was found to be the most immunogenic. Insulin antibodies were freely transferred to the fetus but not detectable after the first 8 months of life. No insulin antibodies were found in the cord blood or during the next few weeks in the infants of mothers who had no antibodies to their injected insulin. There was a tendency for higher insulin antibody levels to be associated with indices of neonatal morbidity but not with percentile birth weights and C-peptide levels in cord sera.

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“…Of seven reports which examined the relationship between dose reductions and changes in insulin binding capacity, four [5,[12][13][14] did and three [2,4,15] did not show an association. These studies all failed to take account of changes in diabetic control occurring during the study period, principally because HbAl assays were not available.…”

Section: Discussionmentioning

confidence: 99%

The effect of insulin antibodies on insulin dose and diabetic control

1982

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Summary.In a single blind randomised cross-over study, 40 patients were changed from ordinary bovine to highly purified porcine insulins for a period of 6 months. Half were later rechallenged with bovine insulin. Sequential determinations of IgG insulin binding capacity for bovine insulin were correlated with insulin dose and diabetic control. After changing to highly purified insulins the following correlations were observed between percentage change in insulin dose and change in insulin binding capacity: at 2 months r = 0.35 (p < 0.05), at 4 months r = 0.38 (p < 0.02) and at 6 months r = 0.37 (p < 0.02). When the patients who showed substantial changes in HbA~ were removed from the analysis, the remaining 29 demonstrated a clearer relationship between these two variables (r = 0.56,p < 0.01). Removal of patients with a low initial insulin binding capacity left 18 patients with stable diabetes, and changes in insulin binding capacity and insulin dose showed an even closer correlation for this group (r = 0.77, p < 0.001). A similar degree of positive correlation was observed after rechallenge with bovine insulin. We conclude that the level of circulating insulin antibody affects the dose of insulin required to maintain stable diabetic control.Key words: Insulin, insulin antibody, diabetic control.Most patients treated with ordinary bovine insulins develop circulating insulin antibodies [1]. Higt/ly purified porcine insulins are much less immunogenic and patients changing to these insulins often experience a reduction in insulin requirement [2,3], a fall in circulating insulin binding capacity [4] and an increase in circulating levels of free insulin [5]. Although antibody mediated insulin resistance is unusual [6], injection site lipoatrophy is a common complication of the use of ordinary bovine insulins [7]. Other possible effects of insulin antibodies are less clear. Andersen [8] showed that the presence of antibodies was associated with a reduction in the honeymoon period independent of the level of diabetic control and the hypothesis that insulin antibody might 'buffer' the effect of circulating insulin [9] has not been substantiated. We report a study of the relationship between changes in insulin antibody, insulin dose and diabetic control in established diabetics changing from ordinary bovine soluble and isophane to highly purified porcine equivalents and the effects of rechallenge with the original insulins. Patients and MethodsThe practice of one hospital diabetologist was surveyed to identify all the patients aged between 16 and 65 years who had had diabetes for at least 3 years and had been treated regularly with ordinary bovine soluble and isophane insulins for at least that time. Those who were blind or pregnant or who had other serious medical or psychological illness were excluded. Fifty-nine of the 71 eligible patients consented to be studied and 40 completed the 18 month protocol. These 14 women and 26 men were aged between 16 and 64 years (mean 40 years). The age at diagnosis ranged from 2 to 5...

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Comparative Trials with Monocomponent (MC) and Monospecies (MS) Pork Insulins in the Treatment of Diabetes mellitus. Influence on Antibody Levels, on Insulin Requirement and on Some Complications

Abstract: Insuline pancreatique et plasmatiq ue chez le foetus de lapin au cours de la gestation.

Cited by 26 publications

References 3 publications

Change of insulin dosage, circulating free and bound insulin and insulin antibodies on transferring diabetics from conventional to highly purified porcine insulin

Change of insulin dosage, circulating free and bound insulin and insulin antibodies on transferring diabetics from conventional to highly purified porcine insulin

Insulin immunogenicity in pregnancy: maternal and fetal studies

The effect of insulin antibodies on insulin dose and diabetic control

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