Recombinant Human Insulin in Global Diabetes Management – Focus on Clinical Efficacy

Biosynthetic human insulin and insulin analogues are the mainstay of insulin therapy for both type 1 and type 2 diabetes although access to human insulin at affordable prices remains a global issue. The world is experiencing an exponential rise in the prevalence of diabetes presenting an urgent need to establish effective diabetes therapy in countries burdened by inadequate health care budgets, malnutrition and infectious diseases. Recombinant human insulin has replaced animal insulins and animal-based semisynthetic human insulin thereby available in sufficient quantities and at affordable prices able to provide global access to insulin therapy. In many patients, analog insulins can offer additional clinical benefit, although at a considerably higher price thus severely restricting availability in low income countries. The approval process for recombinant human insulins (i.e. biosimilars) and analogue insulins is highly variable in the developing countries in contrast to Europe and in North America, where it is well established within a strict regulatory framework. This review aims to discuss the future access to human insulin therapy in a global context with an ever increasing burden of diabetes and significant economic implications

Patterns and correlates of objectively measured free-living physical activity in adults in rural and urban Cameroon.

BACKGROUND: Urbanisation in sub-Saharan Africa is changing lifestyles and raising non-communicable disease burden. Understanding the underlying pattern of physical activity and its correlates may inform preventive interventions. We examined correlates of objectively-measured physical activity in rural and urban Cameroon. METHODS: Participants were 544 adults resident in rural (W-156, M-89) or urban (W-189, M-110) regions. Physical activity was measured using individually-calibrated combined heart rate and movement sensing over seven continuous days. Sociodemographic data were collected by self-report. Independent associations of sociodemographic correlates with physical activity energy expenditure (PAEE) or moderate-to-vigorous physical activity (MVPA) were analysed in multivariate regression models. RESULTS: Rural dwellers were significantly more active than their urban counterparts (PAEE: 58.0 vs 42.9 kJ/kg/day; MVPA: 107 vs 62 min/day; MVPA of 150 min/week in >10 min bouts: 62 vs 39%) and less sedentary (923 vs 1026 min/day); p<0.001. There was no significant seasonal difference (dry vs rainy) in activity in urban dwellers whereas in rural dwellers activity was higher during dry seasons compared to rainy seasons (p<0.001). Age, obesity and education showed significant inverse associations with activity. Urban dwellers who considered themselves adequately active were only as active as rural dwellers who thought they were not adequately active. CONCLUSIONS: This is the first study providing data on sociodemographic patterning of objectively-measured physical activity in rural and urban sub-Saharan Africa. Age, urban residence, obesity and higher educational level are important correlates of lower levels of physical activity. These suggest targets for public health interventions to improve physical activity in Cameroon.This research was supported by the Wellcome Trust (074786/Z/04/Z) and the Medical Research Council Epidemiology Unit (MC_UU_12015/3).This is the final published version. It first appeared at http://jech.bmj.com/content/early/2015/04/03/jech-2014-205154.long

Waist circumference does not predict circulating adiponectin levels in sub-Saharan women

<p>Abstract</p> <p>Background</p> <p>Because of previously reported ethnic differences in determinants and markers of obesity and related metabolic disorders, we sought to investigate circulating levels of adiponectin and their correlates in a sub-Saharan African (sSA) population.</p> <p>Subjects and Methods</p> <p>We studied 70 non-diabetic volunteers (33M/37F) living in Yaoundé, Cameroon, aged 24–69 yr, with BMI 20–42 kg/m². In all participants we measured waist circumference and total body fat by bioimpedance, and obtained a fasting venous blood sample for measurement of plasma glucose, serum insulin and adiponectin concentrations. We performed a euglycaemic hyperinsulinaemic clamp in 1/4 subjects, and HOMA_IRwas used as surrogate of fasting insulin sensitivity index since it best correlates to clamp measurements.</p> <p>Results</p> <p>Males had lower adiponectin levels than females (8.8 ± 4.3 vs. 11.8 ± 5.5 μg/L). There was no significant correlation between adiponectin and total body fat (r_s= -0.03; NS), whereas adiponectin was inversely correlated with waist circumference (r_s= -0.39; p = 0.001). Adiponectin correlated negatively with insulin resistance (r_s= -0.35; p = 0.01). In a regression analysis using fasting adiponectin concentration as the dependent variable, and age, HOMA_IR, waist circumference, and fat mass as predictors, waist circumference (β = -3.30; p = 0.002), fat mass (β = -2.68; p = 0.01), and insulin resistance (β = -2.38; p = 0.02) but not age (β = 1.11; p = 0.27) were independent predictors of adiponectin. When considering gender, these relations persisted with the exception of waist circumference in females.</p> <p>Conclusion</p> <p>Adiponectin correlates in this study population are comparable to those observed in Caucasians with the exception of waist circumference in women. The metabolic significance of waist circumference is therefore questioned in sSA women.</p

Obesity phenotypes in urban and rural Cameroonians: a cross-sectional study

BACKGROUND: Despite the increasing prevalence of diabetes and other health consequences of obesity, little is known on the metabolic profile across categories of body mass index (BMI) among African populations. We therefore assessed the prevalence and distribution of body size phenotypes among urban and rural Cameroonians. METHODS: Adults (n=1628; 41% rural dwellers) aged 24-74 years in 1994 provided data on BMI and metabolic health, defined on the basis of elevated levels of blood pressure (BP); triglycerides, fasting plasma glucose (FPG), and insulin resistance as assessed with homeostasis model assessment (HOMA). Cross-classification of BMI categories and metabolic status (healthy/unhealthy) created six groups. Metabolic measures include elevated blood pressure; elevated triglycerides ([greater than or equal to]150 mg/dL or 1.69mmo/L), elevated fasting plasma glucose ([greater than or equal to]100 mg/dl or 5.6 mmol/L or documented use of antidiabetic medications), and elevated homeostasis model assessment of insulin resistance value (HOMA-IR>90th percentile). RESULTS: A total of 25.2% of participants were overweight yet metabolically healthy (<1 abnormality) and 10.1% were obese yet metabolically healthy, whereas 1.4% were normal weight but metabolically abnormal ([greater than or equal to]2 abnormalities). Proportion of rural dwellers with abnormal metabolic phenotype across normal-weight, overweight, obese categories were 2.9%, 0.8% and 0.3%, respectively; and 0 .3%, 2.2% and 2.6% among urban dwellers. Metabolically abnormal participants increased linearly across BMI categories (p<0.001). BMI categories and metabolic status interacted to affect age, gender, BMI, FPG, triglycerides, and BP status distributions (all p<0.04). Metabolic status and residence (rural vs. urban) interacted to influence the distribution across BMI categories of diastolic BP, BMI, waist circumference, fasting and 2-hour glucose, triglycerides, HOMA-IR, and prevalent diabetes (all p<0.005), with differential occurrence of BMI categories and metabolic status among urban and rural participants. CONCLUSIONS: Metabolic healthy obesity and obesity with a favorable cardiometabolic profile are not uncommon among Cameroonians, including among rural dwellers; but the latter group tended to have a better profile

Impact of diabetes education and self-management on the quality of care for people with type 1 diabetes mellitus in the Middle East (the International Diabetes Mellitus Practices Study, IDMPS)

Aims: Self-management (self-monitoring of blood glucose, plus self-adjustment of insulin dose) is important in diabetes care, but its complexity presents a barrier to wider implementation, which hinders attainment and maintenance of glycemic targets. More evidence on self-management is needed to increase its implementation and improve metabolic outcomes. Methods: Data from 1316 participants with type 1 diabetes mellitus who were enrolled from Middle East countries into the International Diabetes Management Practices Study (IDMPS), a multinational observational survey, were analyzed to assess the impact of education on disease management and outcomes. Results: A majority (78%) of participants failed to achieve glycemic target (HbA1c < 7.0% [<53 mmol/mol]). Participants who had received diabetes education (59%) were more likely to practice self-management than those who had not (odds ratio [OR]: 2.51; 95% confidence interval [CI]: 1.7–3.69; p < 0.001), and those who practiced self-management were more likely to attain target HbA1c than those who did not (OR: 1.49; 95% CI: 1.06–2.09; p = 0.023).Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Chantelot, Jean Marc. Sanofi; FranciaFil: Domenger, Catherine. Sanofi; FranciaFil: Ramachandran, Ambady. Dr. A. Ramachandran’s Diabetes Hospitals; IndiaFil: Kaddaha, Ghaida. Dubai Health Authority; Emiratos Arabes UnidosFil: Mbanya, Jean Claude. University of Yaounde I; CamerúnFil: Shestakova, Marina. I.M.Sechenov First Moscow State Medical University; RusiaFil: Chan, Juliana. Chinese University of Hong Kong; Hong Kon

Smartphone-Assisted Glaucoma Screening in Patients With Type 2 Diabetes: a Pilot Study

We aimed to determine true and false positives of glaucoma screening, relying solely on photos of the retina, taken with a smartphone. We performed a descriptive and analytical study on patients with type 2 diabetes at the National Obesity Centre, Yaoundé, Cameroon. Participating patients had retinal photography sessions using an iPhone 5s (iOS 10.3.3; Apple, Cupertino, CA) coupled to the Make in India Retinal Camera (MIIRetCam; MIIRetCam Inc., Coimbatore, TN, India). Obtained pictures of the retina were stored and transferred via the internet to an ophthalmologist to assess glaucoma. Selected patients were then invited to undergo a conventional ophthalmological examination to confirm the diagnosis. A total of 395 patients were screened, 39 (including 20 women) were diagnosed with suspicion of glaucoma based on retinal photos, a prevalence rate of 9.87%. The following signs were found; C/D ≥0.5 in 64.1% (25/39), asymmetric C/D &gt;0.2 in 35.9% (14/39), papillary haemorrhage in 10.2% (4/39) and retinal nerve fibre deficiency in 2.5% (1/39). Only 14 of 39 patients with suspicion of glaucoma were examined, giving a lost-to-follow-up rate of 64.1%. Chronic open-angle glaucoma was confirmed in 8 patients (true positives) and absent in 6 patients (false positives). The prevalence of smartphone-detected glaucoma and lost-to-follow-up rates were high. So we need to improve this type of screening, with additional tests like transpalpebral applanation tonometer and the smartphone Frequency Doubling Technique visual field combined with better education of patients to increase their adherence to follow-up

A global perspective on the issue of access to insulin.

The discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO's framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients' abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO's Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes

Diabetes education and health insurance: How they affect the quality of care provided to peoplewith type 1 diabetes in Latin America. Data from the International Diabetes Mellitus Practices Study (IDMPS)

Aims: This study aimed to evaluate the impact of diabetes education and access to healthcare coverage on disease management and outcomes in Latin America. Methods: Data were obtained from a sub-analysis of 2693 patients with type 1 diabetes mellitus recruited from 9 Latin American countries as part of the International Diabetes Mellitus Practices Study (IDMPS), a multinational, observational survey of diabetes treatment in developing regions. Results: Results from the Latin American cohort show that only 25% of participants met HbA1c target value (< 7% [53 mmol/mol]). Attainment of this target was significantly higher among participants who had received diabetes education than those who hadn´t (28% vs. 19%, p < 0.001), and among those who practiced self-management (27% vs. 21% no self-management, p = 0.001). Multivariate analysis showed that participants who had received diabetes education were more likely to manage their diabetes (OR: 1.65 [95% CI: 1.24, 2.19]; p = 0.001), and to attain HbA1c target values (OR: 1.48 [95% CI: 1.14, 1.93]; p = 0.003). Conclusions: Given the association between uncontrolled diabetes and long-term complications, health authorities and care providers should increase efforts to ensure widespread healthcare coverage and access to self-management education to reduce the socioeconomic and humanistic burden of type 1 diabetes.Fil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Chantelot, Jean Marc. Sanofi, Paris; FranciaFil: Domenger, Catherine. Sanofi, Paris; FranciaFil: Ilkova, Hasan. Istanbul University; TurquíaFil: Ramachandran, Ambady. Dr. A. Ramachandran’s Diabetes Hospitals; IndiaFil: Kaddaha, Ghaida. Dubai Health Authority; Emiratos Arabes UnidosFil: Mbanya, Jean Claude. University of Yaounde I; CamerúnFil: Chan, Juliana. Chinese University of Hong Kong; Hong KongFil: Aschner, Pablo. Pontificia Universidad Javeriana; Colombi

Screening, prevalence, treatment and control of kidney disease in patients with type 1 and type 2 diabetes in low-to-middle-income countries (2005–2017): the International Diabetes Management Practices Study (IDMPS)

Diabetes is the leading cause of kidney disease worldwide. There is limited information on screening, treatment and control of kidney disease in patients with diabetes in low-to-middle-income countries (LMICs).Fil: Mbanya, Jean Claude. Université de Yaoundé ; CamerúnFil: Aschner, Pablo. Hospital Universitario San Ignacio; Colombia. Pontificia Universidad Javeriana; ColombiaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Ilkova, Hasan. İstanbul S. Zaim Üniversitesi; TurquíaFil: Lavalle, Fernando. Universidad Autónoma de Nuevo Leon, Facultad de Medicina; MéxicoFil: Ramachandran, Ambady. India Diabetes Research Foundation; IndiaFil: Chantelot, Jean Marc. Sanofi; FranciaFil: Chan, Juliana C. N.. Prince of Wales Hospital; Chin