Información del artículo
Resumen
La introducción de los análogos rápidos de insulina en los últimos 15 años, entre ellos la insulina aspart, ha supuesto un cambio importante en las pautas de administración de insulina con generalización de la pauta de inyección múltiple. Las características farmacocinéticas de la insulina aspart (con acción mucho más corta y pico de acción más elevado que la regular) la hace especialmente adecuada para mejorar las glucemias postprandiales, con un número menor de hipoglucemias nocturnas. La tolerancia y seguridad es buena, y la presencia de lipodistrofia rara, necesitando una vigilancia clínica. En niños pequeños, con régimen de vida irregular, su administración postprandial se ha mostrado efectiva y una buena alternativa en estos casos.
Palabras clave:
Insulina aspart
Diabetes mellitus tipo 1
Terapia intensiva
Hipoglucemias
Análogos de insulina
Pediatría
Abstract
The introduction of insulin analogues 15 years ago, including insulin aspart, has represented a major change in insulin administration and has allowed intensive insulin therapy to become the treatment of choice. The pharmacokinetic properties of insulin aspart (rapid onset and shorter duration than regular insulin) improve postprandial glycemic control and reduce nocturnal hypoglycemic episodes. The tolerability and safety of insulin aspart are good and lipoatrophy is uncommon, requiring clinical monitoring. In infants and toddlers, who have unpredictable habits, postprandial administration of insulin aspart has shown effective results.
Keywords:
Insulin aspart
Insulin analogs
Type 1 diabetes
Hypoglycemia
Children
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Bibliografía
[1.]
C.C. Patterson, G. Dahlquist, E. Gyürüs, A. Green, G. Soltest.
and Eurodiab group. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–2020: a multicentre prospective registration study.
Lancet, 373 (2009), pp. 2027-2033
[2.]
S. Johnsson.
Retinopathy and nephropathy in diabetes mellitus: comparison of the effects of two forms of treatment.
Diabetes, 9 (1960), pp. 1-8
[3.]
DCCT.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
N Engl J Med, 329 (1993), pp. 977-986
[4.]
A.M. Jacobson, G. Musen, C.M. Ryan, N. Silvers, P. Cleary, B. Waberski, et al.
Long-term effect of diabetes and its treatment on cognitive function.
N Engl J Med, 356 (2007), pp. 1842-1852
[5.]
G. Musen, A.M. Jacobson, C.M. Ryan, P.A. Cleary, B.H. Wabersky, K. Weinger, et al.
Impact of diabetes and its treatment on cognitive function among adolescents who participated in the Diabetes Control and Complications Trial.
Diabetes Care, 31 (2008), pp. 1933-1938
[6.]
A. Siebenhofer, J. Plank, A. Berghold, K. Jeitler, K. Horvath, M. Narath, et al.
Short acting insulin analogs versus regular human insulin in patients with diabetes mellitus.
Cochrane Database of Systematic Reviews, (2006),
[7.]
S.R. Heller, S. Colagiuri, S. Vaaler, B.H. Wolffenbuttel, K. Koelendorf, H.H. Freberg, et al.
Hypoglycaemia with insulin aspart: a double-blind, randomised, crossover trial in subjects with type 1 diabetes.
Diabet Med, 21 (2004), pp. 769-775
[8.]
T. Danne, K. Lange, O. Kordonouri.
New developments in the treatment of type 1 diabetes in children.
Arch Dis Child, 92 (2007), pp. 1015-1019
[9.]
H.-J. Bangstad, T. Danne, L.C. Deeb, P. Jarosz-Chobot, T. Urakami, R. Hanas.
Insulin treatment in children and adolescents with diabetes.
Pediatric Diabetes, 10 (2009), pp. 82-99
[10.]
P. Home, A. Lindholm, A. Riis.
Insulin aspart vs human insulin in the management of longterm blood glucose control in type 1 diabetes mellitus: a randomized controlled trial.
Diabet Med, 17 (2000), pp. 762-770
[11.]
H.B. Mortensen, A. Lindholm, B.S. Olsen, B. Hilleberg.
Rapid appearance and onset of action of insulin aspart in paediatrics subjetcs with type 1 diabetes.
Eur J Pediatr, 159 (2000), pp. 483-488
[12.]
C.L. Acerini, T.D. Cheetham, J.A. Edge, D.B. Dunger.
Both insulin sensitivity and insulin clearance in children and young adults with type I (insulin-dependent) diabetes vary with growth hormone concentrations and with age.
Diabetologia, 43 (2000), pp. 61-68
[13.]
S.A. Amiel, R.S. Sherwin, D.C. Simonson, A.A. Lauritano, W.V. Tamborlane.
Impaired insulin action in puberty. A contributing factor to poor glycemic control in adolescents with diabetes.
N Engl J Med, 315 (1986), pp. 215-219
[14.]
R.N. Reynolds, A.N. Wagstaff.
Insulin aspart. A revision of its use in the management of type 1 or 2 diabetes.
Drugs, 64 (2004), pp. 1957-1974
[15.]
C.A. Hedman, T. Lindstrom, H.J. Arnqvist.
Direct comparison of isulin lispro and aspart shows small differences in plasma insulin profiles after subcutaneous injection in type 1 diabetes.
Diabetes Care, 24 (2001), pp. 1120-1121
[16.]
M.A. Von Mach, C. Brinkmann, T. Hansen, L.S. Weilemann, J. Beyer.
Differences in pharmacokinetics and pharmacodynamics of insulin lispro and aspart in healthy volunteers.
Exp Clin Endocrinol Diabetes, 110 (2002), pp. 416-419
[17.]
P.D. Home, A. Lindholm, A. Riis.
Insulin aspart vs. human insulin in the management of long-term blood glucose control in type 1 diabetes mellitus: a randomized controlled trial. European Insulin Aspart Study Group.
Diabet Med, 17 (2000), pp. 762-770
[18.]
T. Lauritzen.
Pharmacokinetic and clinical aspects of intensified subcutaneous insulin therapy.
Dan Med Bull, 32 (1985), pp. 104-118
[19.]
R.H. Becker, A.D. Frick, L. Nosek, L. Heinemann, K. Rave.
Dose-response relationship of insulin glulisine in subjects with type 1 diabetes.
Diabetes Care, 30 (2007), pp. 2506-2507
[20.]
L. Nosek, L. Heinemann, M. Kaiser, S. Arnolds, T. Heise.
No increase in the duration of Action with rising doses of insulin aspart [abstract].
Diabetes, 52 (2003), pp. 551-P
[21.]
P. Kurtzhals, L. Schaffer, A. Sorensen, C. Kris-Tensen, I. Jonassen, C. Schmid, et al.
Correlations of receptor binding and metabolic and mitogenic potencies of insulin analogs designed for clinical use.
Diabetes, 49 (2000), pp. 999-1005
[22.]
K. Eckardt, J. Eckel.
Insulin analogs: action profiles beyond glycaemic control.
Arch Physiol Biochem, 114 (2008), pp. 45-53
[23.]
U. Smith, E.A. Gale.
Does diabetes therapy influence the risk of cancer?.
Diabetologia, 52 (2009), pp. 1699-1708
[24.]
H. Holmberg, H. Mersebach, K. Kanc, J. Ludvigsson.
Insulin Aspart Study Group on Immunogenicity. Antibody response to insulin in children and adolescents with newly diagnosed type 1 diabetes.
Diabet Med, 25 (2008), pp. 792-797
[25.]
A. Babiker, V. Datta.
Lipoatrophy with insulin analogues in type 1 diabetes.
Arch Dis Child, 96 (2011), pp. 101-102
[26.]
I.B. Halberg, L.V. Jacobsen, U.L. Dahl.
A study on self- mixing insulin aspart with NPH insulin in the syringe before injection.
Diabetes, 48 Suppl (1999), pp. A104
[27.]
T. Danne, J. Rastam, R. Odendahl, A. Nake, U. Schimmel, R. Szczepanski, et al.
Parental preference of prandial insulin aspart compared with preprandial human insulin in a basal-bolus scheme with NPH insulin in a 12-wk crossover study of preschool children with type 1 diabetes.
Pediatr Diabetes, 8 (2007), pp. 278-285
[28.]
T.M. Nguyen, V. Renukuntla, R.A. Heptuya.
Mixing insulin aspart with detemir does not affect glucose excursion in children with type 1 diabetes.
Diabetes Care, 33 (2010), pp. 1750-1752
[29.]
W. Kaplan, L.M. Rodríguez, O.E. Smith, M.W. Haymond, R.A. Heptulla.
Effects of mixing glargine and short-acting insulin analogs on glucose control.
Diabetes Care, 27 (2004), pp. 2739-2740
[30.]
R. Fiallo-Scharer, B. Horner, K. McFann, P. Walravens, H.P. Chase.
Mixing rapid- acting insulin analogues with insulin glargine in children with type 1 diabetes mellitus.
J Pediatr, 148 (2006), pp. 481-484
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