A comprehensive systematic review by Sumeet Singh and colleagues cmaj/press/pg385.pdf. looked at outcomes associated with the use of rapid- and long-acting insulin analogues in adult and childhood type 1 and type 2 diabetes as well as gestational diabetes.
"Our results suggest that differences between conventional insulins and insulin analogues are minimal in the management of type 1, type 2 and gestational diabetes," write Mr. Singh and coauthors. They suggest that insulin analogues may be useful for some patients with problematic hypoglycemia.
In a companion research study cmaj/press/pg400.pdf looking at cost-effectiveness of insulin analogues, CADTH researchers found that the routine use of long-acting insulin analogues in adults with type 1 or type 2 diabetes or use of rapid-acting analogues in patients with type 2 diabetes is not likely to be economically viable in a health care system with finite resources.
However, for adults with type 1 diabetes, rapid-acting insulin analogues can make sense as they appear to be cost-effective over human insulin.
"In light of the increasing prevalence of this disorder, and increased acquisition costs, particularly for long-acting insulin analogues, consideration must be given to the economic burden of providing these agents to all patients with diabetes," write Chris Cameron and Heather Bennett of CADTH.
Researchers from the Medical University of Graz, Austria write in a related commentary cmaj/press/pg369.pdf that these findings are similar to other studies of insulin analogues. Based on the study by Singh and colleagues and other studies, "older conventional insulins remain effective. Therefore, the extensive promotion of insulin analogues is not justified," write Dr. Johannes Plank and coauthors. They recommend educational programs to help people manage their diabetes as they have greater impact in managing sugar levels than insulin analogues.
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What is special about the second study is that it not only investigated individual genetic markers as to their influence on the risk of myocardial infarction, but also investigated haplotypes, combinations of up to ten neighboring markers. With this method additional genetic information can be derived compared to individual genetic markers. Thus the scientists were able to identify another region, this time localized on chromosome 6, which is associated with MI risk. The LPA gene at this locus regulates the concentration of a specific lipoprotein (Lp(a)), a particle which transports lipids in the blood. This finding, too, may be useful in the future for developing new therapeutic interventions.
The third study, published in the name of the Myocardial Infarction Genetics Consortium (MIGen), was able to identify three further, previously unknown MI genes on chromosomes 2, 6 and 21. The study also shows that in individuals with not just one but several genetic markers, the MI risk is more than double. The higher the number of disease genes now identified, the higher the disease risk. This knowledge will aid in assessing the risk for myocardial infarction in order to develop preventive and early intervention strategies.
More than 750,000 people die of myocardial infarction in Europe every year. MI and the underlying coronary artery disease are among the most frequent causes of death in Germany. Besides traditional risk factors such as age, hypertension, disorders of the lipid metabolism, diabetes mellitus, smoking and overweight, genetic risk factors play a key role in the emergence of the disease.
These studies provide crucial pieces to the at present incomplete puzzle of myocardial infarction genetics. The findings indicate that there may be many mechanisms involved in myocardial infarction that are still to be discovered. New mechanisms also mean new approaches for MI prevention and treatment.
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