国际首创丨口服胰岛素梦想照进现实!
中国制造,口服胰岛素时代即将来临。
长期外源性使用皮下胰岛素使全身胰岛素水平持续升高,导致体重增加风险[2,3];短时间内胰岛素可能出现过高浓度而发生低血糖等不良反应[4]; 糖尿病患者因担心害怕注射疼痛而导致胰岛素治疗启动延迟;且胰岛素治疗启动后,由于注射方式的不方便以及注射带来的各种不良反应,患者的依从性不理想[5]; 因为注射胰岛素可能带来的一些负面影响,所以这些患者的糖化血红蛋白(HbA1c)达标率不理想[6]。
1. 人胰岛素肠溶胶囊吸收后首先经过肝脏发挥降糖作用,其重要临床意义是什么?
图3 专家讨论
从左至右依次为:余学锋教授、李延兵教授、秦贵军教授
参考文献:
[1] MAGLIANO D J, BOYKO E J, COMMITTEE I D F D A T E S. IDF Diabetes Atlas [M]. Idf diabetes atlas. Brussels; International Diabetes Federation © International Diabetes Federation, 2021. 2021.
[2] DALY A. Use of insulin and weight gain: optimizing diabetes nutrition therapy [J]. J Am Diet Assoc, 2007, 107(8): 1386-93.
[3] KOLB H, KEMPF K, RÖHLING M, et al. Insulin: too much of a good thing is bad [J]. BMC Med, 2020, 18(1): 224.
[4] GEDAWY A, MARTINEZ J, AL-SALAMI H, et al. Oral insulin delivery: existing barriers and current counter-strategies [J]. J Pharm Pharmacol, 2018, 70(2): 197-213.
[5] ASCHNER P, GAGLIARDINO J J, ILKOVA H, et al. Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS) [J]. Diabetologia, 2020, 63(4): 711-21.
[6] JI L, BONNET F, CHEN H, et al. Early versus late intensification of glucose-lowering therapy in patients with type 2 diabetes: Results from the DISCOVER study [J]. Diabetes Res Clin Pract, 2021, 178: 108947.
[7] DRUCKER D J. Advances in oral peptide therapeutics [J]. Nat Rev Drug Discov, 2020, 19(4): 277-89.
[8] NORTON L, SHANNON C, GASTALDELLI A, et al. Insulin: The master regulator of glucose metabolism [J]. Metabolism, 2022, 129: 155142.
[9] EDGERTON D S, SCOTT M, FARMER B, et al. Targeting insulin to the liver corrects defects in glucose metabolism caused by peripheral insulin delivery [J]. JCI Insight, 2019, 5(7).
[10] MOORE M C, COATE K C, WINNICK J J, et al. Regulation of hepatic glucose uptake and storage in vivo [J]. Adv Nutr, 2012, 3(3): 286-94.
[11] NAJJAR S M, CAPRIO S, GASTALDELLI A. Insulin Clearance in Health and Disease [J]. Annu Rev Physiol, 2023, 85: 363-81.
[12] EDGERTON D S, MOORE M C, GREGORY J M, et al. Importance of the route of insulin delivery to its control of glucose metabolism [J]. Am J Physiol Endocrinol Metab, 2021, 320(5): E891-e7.
[13] CHOI S H, GINSBERG H N. Increased very low density lipoprotein (VLDL) secretion, hepatic steatosis, and insulin resistance [J]. Trends Endocrinol Metab, 2011, 22(9): 353-63.
[14] MENGE B A, GRÜBER L, JØRGENSEN S M, et al. Loss of inverse relationship between pulsatile insulin and glucagon secretion in patients with type 2 diabetes [J]. Diabetes, 2011, 60(8): 2160-8.
[15] INAISHI J, SAISHO Y, HIRAKAWA Y, et al. Association of glucose tolerance status with pancreatic β- and α-cell mass in community-based autopsy samples of Japanese individuals: The Hisayama Study [J]. J Diabetes Investig, 2020, 11(5): 1197-206.
[16] SAFADI R, SALHAB A, AMER J, et al. Enteral Insulin Attenuates Fatty Liver Signs and Symptoms in Mice on a High-Fat Diet [J]. Diabetes, 2018, 67(Supplement_1).
[17] ZHANG Y, ZHOU W, SHEN L, et al. Safety, Pharmacokinetics, and Pharmacodynamics of Oral Insulin Administration in Healthy Subjects: A Randomized, Double-Blind, Phase 1 Trial [J]. Clin Pharmacol Drug Dev, 2022, 11(5): 606-14.
[18] ELDOR R, FRANCIS B H, FLEMING A, et al. Oral insulin (ORMD-0801) in type 2 diabetes mellitus: A dose-finding 12-week randomized placebo-controlled study [J]. Diabetes Obes Metab, 2023, 25(4): 943-52.
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