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European Pharmaceutical Contractor

Diabetes and the Potential of Oral Insulin

Type 2 diabetes is occurring in epidemic proportions all around the world, and this growing trend will translate into a very large increase in excess morbidity and mortality, especially from cardiovascular disease. It is now estimated that there are more than 175 million diabetics throughout the world (1). In this country the prevalence of diagnosed diabetes among adults has increased by 40 per cent in 10 years, from 4.9 per cent in 1990 to 6.9 per cent in 1999 (3, 4). Furthermore, the problem is expected to increase cumulatively by 165 per cent between 2000 and 2050 (5). For those born in the US in 2000, the lifetime risk will be roughly one in three for men and two in five for women (2). To gain control over this rising pandemic, public health issues such as obesity and sedentary lifestyle will need to be addressed, and much more widespread pharmacological intervention instituted.

In the past decade we have witnessed the introduction of a multitude of new medications, including a-glucosidase inhibitors, a biguanide, the thiazolidinediones, insulin analogues, meglitinides and D-phenyalanine derivatives. These new agents have dramatically increased the number of options available to health care providers and patients. Notwithstanding the availability of this wide and ever-increasing array of agents, the goal of attaining sustained normoglycaemia in most patients remains elusive. Recently we have seen a surge of interest in alternate routes for insulin administration, including pulmonary, nasal, buccal and oral routes. The latter, oral insulin, will be the focus of this review, together with a discussion of its potential benefits.

Type 2 diabetes is a complex metabolic disorder involving defects in insulin resistance and secretion that combine to reduce glucose uptake in insulin-sensitive tissues, as well as to impair the suppression of hepatic glucose production (see Figure 1). Increasing insulin resistance characterises the prediabetic state. As long as the beta cells (ß-cells) mass is preserved and the cells function properly, insulin resistance results in compensatory hyperinsulinemia, which maintains relatively normal glucose control. While this compensated, insulin-resistant state persists, individuals may exhibit either normal or impaired glucose tolerance (IGT), but not outright diabetes.


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By Ehud Arbit, MD, Vice President, Medical Research at Emisphere Technologies, Inc

Ehud Arbit, MD, is Vice President of Medical Research at Emisphere Technologies, Inc. Previously, Dr Arbit served as Professor at Cornell University Medical College and was Head of Division at Memorial Sloan Kettering Cancer Center in New York. Dr Arbit has served as co-Editor and is on the editorial board of several medical journals.

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Ehud Arbit
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