Povijest i razvoj inzulinske terapije

UVOD Inzulin je peptidni hormon koji se izlučuje endogenom sekrecijom iz β stanica Langerhansovih otočića gušterače kao odgovor na povišenu koncentraciju glukoze u krvi. Cilj liječenja inzulinskom terapijom u bolesnika s dijabetesom je oponašati endogeno lučenje inzulina. Inzulinska terapija je indicirana u šećernoj bolesti tip 1 te u šećernoj bolesti tip 2 kada nije postignuta regulacija bolesti promjenom životnih navika i oralnim antidijabeticima. S vremenom su se na tržištu pojavljivale različite vrste inzulina, od najstarijih koji su bili životinjskog podrijetla, preko humanih inzulina, pa do modernih analoga humanog inzulina. CILJ ISTRAŽIVANJA Cilj ovog specijalističkog rada je dobiti bolji i sistematičniji uvid u inzulinsku terapiju, što se planira postići kronološkim pregledom razvoja inzulina i inzulinske terapije, od samih početaka do inzulina u sadašnjoj kliničkoj praksi, s osvrtom na buduću farmakoterapiju. U cilju poboljšanja farmakoterapije inzulinom, nužno je istražiti i poznavati farmakokinetička i farmakodinamička svojstva inzulina. O tome ovisi ishod liječenja i omogućuje se individualan pristup svakom bolesniku sa šećernom bolesti, što će biti u ovom radu detaljno istraženo i prikazano. Analizom dostupne literature omogućit će se cjelovitiji uvid i razumijevanje inzulinske terapije. Također će se steći uvid u nedostatke inzulina koji su dostupni na tržištu te će se ukazati na probleme koje treba riješiti razvojem inzulinske terapije u budućnosti. MATERIJAL I METODE U ovom specijalističkom radu prikazan je sustavni pregled literature, koja je pretraživana prema temi istraživanja, predmetu istraživanja, autorima i časopisima. Relevantni članci su proučavani na analitički i kritički način s obzirom na postojeća znanja o definiranom problemu. Sastavni dio rasprave ovog rada je vlastito razmatranje proučavane problematike. Elektroničkim putem su pretražene baze podataka PubMed, stranica International Diabetes Federation, smjernica Američkog dijabetološkog društva, Diabetes Care Program of Nova Scotia, hrvatskih smjernica za farmakološko liječenje šećerne bolesti tipa 2 te zajedničkih smjernica American Diabetes Association i European Association for the Study of Diabetes za liječenje hiperglikemije šećerne bolesti tipa 2. Kao izvori podataka korišteni su stručni članci, objavljeni radovi, sažetci radova, stručne knjige, baza sažetaka opisa svojstava lijeka Agencije za lijekove i medicinske proizvode (HALMED) i Europske agencije za lijekove (EMA). REZULTATI Literaturni navodi upućuju na važnost daljnjeg razvoja inzulinske terapije u smislu bolje regulacije glikemije, boljeg oponašanja endogene sekrecije inzulina, uz minimalno nuspojava i dobru adherenciju kod pacijenata sa šećernom bolesti tip 1 i tip 2. ZAKLJUČAK Razvojem i napredovanjem inzulinske terapije kroz povijest, pacijentima s T1DM I T2DM poboljšala se regulacija šećerne bolesti, kvaliteta života te produžio životni vijek. Kroz povijest razvoja inzulinske terapije radilo se na pročišćavanju ekstrakta inzulina, produljenju djelovanja inzulina, smanjenju imunogenosti, biosintezi inzulina, rekombinantnoj proizvodnji te razvoju humanih inzulina i njihovih analoga. Svaka nova generacija inzulina ima određene farmaceutske i farmakokinetske/farmakodinamske prednosti koje su se u praksi pokazale kroz bolju regulaciju šećerne bolesti i smanjen rizik od nuspojava, poglavito hipoglikemije i porasta tjelesne težine. Potrebna su daljnja istraživanja na području dijabetesa i inzulinske terapije.INTRODUCTION Insulin is a peptide hormone secreted by endogenous secretion from β cells of Langerhans's islets pancreas in response to elevated blood glucose concentrations. The goal of treating insulin therapy in diabetic patients is to imitate endogenous secretion of insulin. Insulin therapy is indicated in type 1 diabetes mellitus and in type 2 diabetes mellitus when no life-alteration or oral antidiabetic drug regulation has been achieved. Over time, different types of insulin appeared on the market, from the oldest animal origin, through human insulins to modern human insulin analogues. OBJECTIVES The aim of this research is a chronological overview of the development of insulin and insulin therapy, from the beginning to insulin in current clinical practice, with reference to future pharmacotherapy, in order to obtain a better and a more systematic insight into insulin therapy. In order to improve pharmacotherapy, further research of insulin and its pharmacokinetic and pharmacodynamic properties is a necessity. On this further research depends the success of treating diabetes in the future and the possibility of an individual approach to each diabetic patient. Analysis of available literature aims to provide a more complete insight and understanding of insulin therapy. Insights into insulin deficiencies that are available on the market will also be identified, as well as issues that need to be addressed by the development of insulin therapy in the future. MATERIAL AND METHODS This research presents a systematic overview of the literature that was searched according to research topic, research objective, authors and journals. Relevant articles have been studied in an analytical and critical manner with respect to existing knowledge of a defined problem. An integral part of the discussion of this paper is its consideration of the problems studied. The literature search was performed electronically: based on the PubMed, The American Diabetes Association's Guidelines, The Diabetes Care Program of Nova Scotia, The Croatian Guidelines for Pharmacological Treatment of Diabetes Type 2, the common guidelines of the American Diabetes Association and the European Association for the Study of Diabetes for Treatment Hyperglycemia of Type 2 Diabetes. As sources of data, the paper uses expert articles, published research, research summaries, professional books, summary descriptions of drug properties of the Agency for Medicinal Products and Medical Products (HALMED) and the European Medicines Agency (EMA). RESULTS Literature reports indicate the importance of further development of insulin therapy in terms of better regulation of glycemia, better imitation of endogenous secretion of insulin, with minimal side effects and good adherence to type 1 and type 2 diabetic patients. CONCLUSION Thanks to historical development and advancement of insulin therapy, patients with T1DM and T2DM benefit from improved regulation of diabetes, quality of life and prolonged life expectancy. The history of insulin therapy has seen developments in purifying insulin extract, prolongation of insulin action, immunogenicity reduction, insulin biosynthesis, recombinant production and development of human insulins and analogs. Each new generation of insulin has certain pharmacological and pharmacodynamic advantages which have in practice been shown to improve the regulation of diabetes and reduce the risk of side effects, especially hypoglycaemia and weight gain. Further research in the field of diabetes and insulin therapy is needed