Current status and future prospects of parenteral insulin regimens, strategies and delivery systems for diabetes treatment

A strong relationship between long term metabolic control and low frequency of chronic diabetes complications was shown in the Diabetes Control Compli cation Trial (DCCT). However, the subcutaneous intensive insulin therapy re quired to achieve the glycemic goals defined by the DCCT led to an unaccept able frequency of severe hypoglycemia and a significant weight gain. This l imits the benefits of this therapy and excludes groups of patients such as young children, the elderly or hypoglycemia prone patients. The intensive t herapy and self blood glucose monitoring (SMBG) necessary to limit hypoglyc emia represent a heavy burden for the patients and their family. Improvemen ts in parenteral insulin therapy are possible by either modifying subcutane ous insulin characteristics (analogs, adjunction of peptides such as amylin , GLP1, IGF1), or by developing better routes of administration and making SMBG easier; which is a key to intensive insulin therapy success. The ultim ate goal remains the development of an automated, glucose controlled device . (C) 1999 Elsevier Science B.V. All rights reserved.