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Treatment of type 2 diabetes through oral delivery of insulin : best outcomes are to come yet?
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A diabetes tipo 2 é responsável pela maioria dos casos de diabetes e a sua prevalência está a aumentar em muitos países. Caracteriza-se por hiperglicemia, resistência à insulina herdada ou adquirida, defeito na secreção insulínica ou por alterações quantitativas e qualitativas na secreção de insulina. Em última análise, o tratamento para pessoas com diabetes envolve administração subcutânea de insulina, embora, em muitos casos, ainda haja controvérsia sobre quando iniciar e intensificar a terapêutica com insulina. No entanto, essa via de administração pode ser dolorosa, desconfortável e inconveniente, pois a maioria dos pessoas terá que auto administrar várias injeções subcutâneas, com maior risco de hipoglicemia, hiperinsulinemia periférica e aumento de peso. Além disso, no local de injeção é frequente haver eritema, prurido, e lipodistrofia. A administração de insulina por via oral seria a via ideal para pessoas com diabetes, devido à sua grande simplicidade e conveniência, contudo, várias limitações devem ser superadas, como a rápida degradação da insulina a nível gástrico e a sua baixa biodisponibilidade oral. Inúmeras estratégias têm sido tentadas para aumentar a absorção da insulina, como a modificação da estrutura química, polímeros mucoadesivos, adição de promotores de absorção e inibidores de enzimas. Além disso, as nanoparticulas constituem sistemas promissores para a administração de insulina, ultrapassando diversas barreiras fisiológicas.
Type 2 diabetes is responsible for most cases of diabetes and its prevalence is increasing in many countries. Characterized by hyperglycemia, inherited or acquired insulin resistance, loss of insulin function or by quantitative and qualitative changes in insulin secretion. Ultimately, the treatment for a large number of patients with diabetes involves subcutaneous insulin administration, although there is still controversy over when to initiate and intensify insulin therapy. However, this route of administration is often painful, uncomfortable, and inconvenient, as many patients will have to self-administer multiple subcutaneous injections, with a higher risk of hypoglycemia, peripheral hyperinsulinemia, and weight gain. Furthermore, erythema, pruritus, lipodystrophy, are often seen at the injection site. Although oral insulin administration is an ideal route for patients with diabetes, due to its high simplicity and convenience, several limitations must be overcome, such as the rapid degradation of insulin in the gastric fluid and the low oral bioavailability. Numerous strategies have been undertaken to improve these limited parameters, such as chemical structure modification, mucoadhesive polymers, addition of absorption promoters and enzyme inhibitors. In addition, nanoparticles are promising systems for the delivery of insulin and bypass several physiological barriers.
Type 2 diabetes is responsible for most cases of diabetes and its prevalence is increasing in many countries. Characterized by hyperglycemia, inherited or acquired insulin resistance, loss of insulin function or by quantitative and qualitative changes in insulin secretion. Ultimately, the treatment for a large number of patients with diabetes involves subcutaneous insulin administration, although there is still controversy over when to initiate and intensify insulin therapy. However, this route of administration is often painful, uncomfortable, and inconvenient, as many patients will have to self-administer multiple subcutaneous injections, with a higher risk of hypoglycemia, peripheral hyperinsulinemia, and weight gain. Furthermore, erythema, pruritus, lipodystrophy, are often seen at the injection site. Although oral insulin administration is an ideal route for patients with diabetes, due to its high simplicity and convenience, several limitations must be overcome, such as the rapid degradation of insulin in the gastric fluid and the low oral bioavailability. Numerous strategies have been undertaken to improve these limited parameters, such as chemical structure modification, mucoadhesive polymers, addition of absorption promoters and enzyme inhibitors. In addition, nanoparticles are promising systems for the delivery of insulin and bypass several physiological barriers.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Diabetes tipo 2 Administração por via oral Fisiopatologia da diabetes Nanotecnologia Insulina oral Endocrinologia