Costs Associated With Using Different Insulin Preparations

Tylee, Tracy S.; Hirsch, Irl B.

doi:10.1001/jama.2015.7032

Cited by 27 publications

(14 citation statements)

References 5 publications

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“…There is a clear need for an alternative to insulin and insulin analogs in the treatment of diabetes. The costs for insulin treatment are becoming unaffordable, even in developed countries, and the seemingly inexorable global increase in the number of diabetes sufferers who require insulin represents a genuine crisis for many health care systems [18][19][20]. An ideal replacement would be a stable, orally administered insulin receptor agonist with no side effects.…”

Section: Discussionmentioning

confidence: 99%

“…They were not further developed for several reasons, including: cell toxicity [11], low receptor specificity [15][16][17], undesirable binding to insulin-like growth factor 1 receptor (IGF1R) [14] and activation of IGF1R [15][16][17], as well as the inhibition of protein tyrosine phosphatase 1B (PTP1B) [12]. As such the search for novel, non-toxic insulin mimetics which selectively activate INSR continues and is becoming increasingly urgent as insulin costs continue to rise beyond the realm of affordability for many diabetics [18][19][20] (http://www.cbsne ws.com/news/the-risin g-costof-insul in-horro r-stori es-every -day/, http://www.nytim es.com/2018/06/22/well/diabe tes-patie nts-at-risk-from-risin g-insul in-price s.html).…”

Section: Introductionmentioning

confidence: 99%

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Non-peptidyl small molecule, adenosine, 5′-Se-methyl-5′-seleno-, 2′,3′-diacetate, activates insulin receptor and attenuates hyperglycemia in type 2 diabetic Leprdb/db mice

Lan

Lei

Yiannikouris

et al. 2019

Cell. Mol. Life Sci.

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The pathophysiology of type 2 diabetes mellitus (T2D) is characterized by reduced or absent insulin receptor (INSR) responsiveness to its ligand, elevated hepatic glucose output and impaired glucose uptake in peripheral tissues, particularly skeletal muscle. Treatments to reduce hyperglycemia and reestablish normal insulin signaling are much sought after. Any agent which could be orally administered to restore INSR function, in an insulin-independent manner, would have major implications for the management of this global disease. We have discovered a non-peptidyl small molecule, adenosine, 5′-Se-methyl-5′seleno-, 2′,3′-diacetate [referred to as non-peptidyl compound #43 (NPC43)], which restores INSR signaling in the complete absence of insulin. Initial screening of numerous compounds in human HepG2 liver cells revealed that NPC43 significantly inhibited glucose production. The compound was potently anti-hyperglycemic and anti-hyperinsulinemic in vivo, in insulin-resistant T2D Lepr db/db mice, following either acute or chronic treatment by oral gavage and intraperitoneal injection, respectively. The compound acted at the level of INSR and activated it in both liver and skeletal muscle of Lepr db/db mice. In cell culture, the compound activated INSR in both liver and skeletal muscle cells; furthermore, it cooperated with insulin to depress glucose-6-phosphatase catalytic subunit (G6pc) expression and stimulate glucose uptake, respectively. Our results indicated that the compound directly interacted with INSRα, triggering appropriate phosphorylation and activation of the receptor and its downstream targets. Unlike insulin, NPC43 did not activate insulin-like growth factor 1 receptor in either liver or skeletal muscle. We believe this compound represents a potential oral and/or injectable insulin replacement therapy for diabetes and diseases associated with insulin resistance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-peptidyl small molecule, adenosine, 5′-Se-methyl-5′-seleno-, 2′,3′-diacetate, activates insulin receptor and attenuates hyperglycemia in type 2 diabetic Leprdb/db mice

Lan

Lei

Yiannikouris

et al. 2019

Cell. Mol. Life Sci.

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“…Greene and Riggs (46) describe how older insulins disappear from the market without generating any generic competition. In contrast to most other medicines, the price of insulin in the U.S. has increased, while in LMICs it has remained stable (7,8,25,47,48). Although intellectual property is not an issue for human insulin, and many of the current analogs are already or will shortly be off patent (49), an increase in the patents on delivery devices is a concern (50).…”

Section: The Role Of Governmentsmentioning

confidence: 99%

Why Are We Failing to Address the Issue of Access to Insulin? A National and Global Perspective

2018

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Insulin was discovered in 1921 and soon became widely available in high-income countries. However, many people currently in need of this life-saving medicine are unable to access it. This is a global phenomenon, impacting not only populations of low- and middle-income countries but low-income populations in the U.S. In the U.S., the rate of diabetic ketoacidosis remains high in certain subpopulations, the cost of insulin being the main precipitating factor. On a global level the main cause of mortality for a child with type 1 diabetes is a lack of access to insulin, and in sub-Saharan Africa the life expectancy of a child with type 1 diabetes can be as low as 1 year. One lens for considering the issue of access to health and medicines is to consider society as a three-legged stool. In this paradigm, the role of the public sector is to provide "protections" to the population it serves; the private sector is made up of "responsible businesses" that supply many of the goods and services people need; and the plural sector comprises communities and not-for-profits providing the "social affiliations" that are needed. For HIV/AIDS, each of these "legs" played a role in improving access. Civil society raised awareness of the issue and advocated for access to treatment. Governments provided funding and responses both nationally and globally. Finally, the private sector played its role, under pressure from civil society and governments, in lowering the price of medicines and developing programs to expand access. Here, we use this framework to describe the shortcomings in access to insulin from a U.S. and global perspective.

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“…This applies not just for low-and middle-income resource settings but high-income settings too, as there is the chance that expenditure on non-essential medicines in these countries may contribute to catastrophic health expenditure (35,36). Availability in public health-care settings can depend on the inclusion of the medicine on countries' National Essential Medicines Lists (NEML), and whether the NEML serves as basis for procurement, training of staff, reimbursement systems and prescription decisions.…”

Section: Access To Essential Medicines and Basic Technologiesmentioning

confidence: 99%

Effects of Supersession Prescription/Metformin Combination Therapy in Overweight and Obese Individuals with Type 2 Diabetes

Zheng¹,

Fang²,

Wang³

et al. 2017

J Obes Weight-Loss Medic

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Costs Associated With Using Different Insulin Preparations

Cited by 27 publications

References 5 publications

Non-peptidyl small molecule, adenosine, 5′-Se-methyl-5′-seleno-, 2′,3′-diacetate, activates insulin receptor and attenuates hyperglycemia in type 2 diabetic Leprdb/db mice

Non-peptidyl small molecule, adenosine, 5′-Se-methyl-5′-seleno-, 2′,3′-diacetate, activates insulin receptor and attenuates hyperglycemia in type 2 diabetic Leprdb/db mice

Why Are We Failing to Address the Issue of Access to Insulin? A National and Global Perspective

Effects of Supersession Prescription/Metformin Combination Therapy in Overweight and Obese Individuals with Type 2 Diabetes

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