Insulin

Depression is commonly found as a co-morbid condition in patients with diabetes. The co-existence of depression is associated with poor glycaemic control and low medication adherence. The objective of this study was to assess and compare the severity of depression in patients with Type II diabetes taking OHA versus Insulin. A prospective observational study conducted  among  200 diabetic patients for a period of 6 months in the general medicine department of a tertiary care hospital, with established T2DM  satisfying inclusion and exclusion criteria were evaluated for depression by  using Hamilton Depression Rating scale (HAMD) with the help of physician. Finally comparing the severity of depression among patients  taking OHA versus Insulin. Out of 200 diabetic patients, 124 (62%) patients were depressed. About 22% patients shows moderate depression  ,followed by mild depression (20%), severe (10.5%) and very severe(9.5%). Mild-Moderate level of depression is more prevalent in diabetics than in general population. Majority of the patient taking OHA had no depression ( normal, 51%) followed by mild depression (19.6%), moderate (17.6%), and only 11.8% shows severe/ very severe depression. Patients on insulin showed that 27.5% have severe or very severe depression followed by moderate (26.3%), mild (22.5%), and 23.8% have no depression. Depression is more common in patients with diabetes mellitus. Study shows that depression is more prevalent in patients taking Insulin as compared to those using OHA.

Diabetes mellitus  is a chronic disease that is characterized by inadequate pancreatic insulin secretion or poor insulin directed mobilization of glucose by target cells. Population affected with diabetes has increased from 108 million in 1980 to 422 million till date. So, it is clearly evident that the rate is alarming and diabetes has now become a global problem. Diabetes is seventh leading cause of death globally. Insulin therapy in diabetes is the commonest and the most effective therapy. Conventional methods like subcutaneous or the oral route are having several shortcomings like the pain and invasion associated with injections, oral degradation of insulin, infection, etc. Among all the demerits hypoglycemia is the major issue especially nocturnal hypoglycemia as the patient cannot monitor the level of glucose at night. To overcome these detriments there is a need for insulin delivery through novel technologies.  Many novel technologies have been proposed like the painless smart patch, Clicksoft microinjection device, pens, pumps, modified oral delivery oral delivery, inhaled insulin, etc. for the delivery of insulin.  Many other novel devices and routes are being developed. This review discusses the glimpse of these novel technologies with their pros and cons.

Even today the most preferred delivery of drugs is still through oral route but because of some inherited limitations with this route, various other routes have been explored including transdermal. Delivery and complete absorption of the drugs is the major concern these days due to various reasons including poor solubility and incomplete bioavailability, this could be due to incomplete presystemic absorption or presystemic degradation. Transdermal drug delivery system is the method by which the drug absorption occurs through the skin primarily for its systemic effect. It provides better therapeutic efficacy and safety for the administration of insulin. Most of the oral anti-diabetic drug exhibit low bioavailability and hence a poor patient compliance. Hence, it can be used as better site for delivery of numerous drugs including proteins and peptides such as insulin.

Insulin remains indispensable in the management of diabetes mellitus since its discovery in 1921. Relatively, a large percentage of world population is affected by diabetes mellitus. In today's era; insulin delivery by alternative route is an area of current interest in the design of drug delivery system. Most of the global pharmaceutical companies are showing encouraging progress in their attempts to develop alternative insulin delivery technologies. For most patients with type 1 diabetes, the tedious part of the treatment is to tolerate needle after needle, both for glucose measurement and to deliver insulin. The introduction of insulin therapy years ago has saved the lives of millions of patients with diabetes. It is growing increase in the percentage of population having diabetes mellitus due to hereditary and environmental factor.  Needle-free insulin delivery appeared to be astonishing approach and its allure rested in being comfortable and safe. The document present here encompass, in brief, the emerging technologies and discoveries that are in pipeline, including insulin inhalers, implantable insulin pumps, insulin spray, smart cells, insulin pill, insulin complement, islet cell transplant, insulin nano pump and the other promising advances in safe and comfortable insulin delivery. Therefore it will be a tripartite task for the researcher, health authorities and community pharmacist to foster the long term safety profile and to provide comfortable insulin delivery.