New Insulin Delivery Method on its Way

From Geriatric Pharmacy Intern Yariagna Rollan Pharm.D.(c)
University of Florida College of Pharmacy

The biggest drawback of insulin treatment is the way in which it needs to be administered. Many patients are afraid to start treatment or find it difficult to manage, especially in the elderly population; they need to be physically and mentally capable. Nicola Napoli, MD, PhD and colleagues from the Division of Endocrinology and Metabolism of the University Campus Bio-Medico di Roma in Italy, are experimenting with new routes for administering insulin in order to solve the most important problem in diabetic patients, the injections.

They are currently testing the safety and efficacy of the buccal spray insulin called Oral-Lyn, which was developed by Generex Biotechnology Corporation. Oral-Lyn offers a pain-free option to prandial insulin injections. The spray contains regular acting human DNA insulin dissolved in a buffer at a neutral pH, identical to the injection form. There are also absorption enhancers, stabilizers, and a non-CFC propellant completing the product. This buccal spray looks like an asthma inhaler and delivers insulin to the oropharyngeal mucosa, the inner lining of the mouth, with a peak of 10 minutes post administration, and complete absorption.
The spray was tested on thirty-one patients with diagnosed impaired glucose tolerance to manage their blood sugar levels. A standard 75gm oral glucose tolerance test was performed and the spray was given in, 4, 6, or 12 insulin puffs. There was no difference found in the 4 or 6 puffs group compared to placebo but on the 12 puff group there was a decrease in blood sugar level of around 29.6% compare to no treatment at all. They also noted an increase in insulin levels and no hypoglycemia was reported during the study. Other short-term trials have also been successful, but they included patients with type 1 and type 2 diabetes.

The downfall, small and short-term studies don’t warrant its use. These results need to be replicated on long-term trials in order for its endorsement on the U.S, which are already in process. The good news is that Generex has received approval for the commercial sale of Oral-Lyn in several countries already. This new method gives hope to both type 1 and type 2 diabetics for a not too far in the future non-injectable, pain free option to deliver insulin.

Shingles mingles with stroke

From Geriatric Pharmacy Intern Dana Ross Pharm.D. (c)
Palm Beach Atlantic University School of Pharmacy

Shingles, among stroke risk factors such as tobacco use, hypertension, or high blood pressure, and diabetes has shown increased chance of stroke. Investigators found shingles, an infection of herpes zoster, to be a risk factor for stroke. Shingles is caused by varicella zoster virus, which also causes chickenpox. It manifests as a painful, tingling rash that begins as a blistered rash unilaterally, or one side of the body. This rash typically scabs in about five days and clears within four weeks, sometimes two weeks. When people get the chickenpox the virus stays in the cells and for most people it does not resurface, but for some it will reoccur and cause shingles.
The study looking at 7,760 patients with a history of shingles and 23,280 patients without a history of shingles found people with a history of shingles had a risk of stroke 30% higher than those without. The risk was quadrupled when the infection was near and involving the eye. The participants with average age 47 were followed up after 12 months after treatment for shingles. It was found that 1.7% of patients with history of shingles had a stroke and 1.3% of controls (those with no history of shingles) had a stroke. Patients had a 31% greater chance to have a stroke if they had a history of shingles. It was also found that those with the infection in the eye and near the eye were 4.28 times greater chance for stroke.
These findings uncovered an emerging risk factor for stroke that is a step further for stroke prevention and management. Attention should be paid to patients with history of shingles and other stroke risk factors such as diabetes, hypertension, and tobacco use.

Other Cognitive Abilities Declining in Alzheimer's Disease

From Geriatric Pharmacy Intern, Phuong Pham, PharmD(c)
University of Florida College of Pharmacy

Researchers have been trying to identify the signs and symptoms that can lead to the diagnosis of Alzheimer's disease as early as possible. Alzheimer's disease has been commonly linked to a loss of episodic memory, in which a person fails to remember a past event that has occurred in his or her life. However, according to a study done, they found that other cognitive abilities, besides memory, may start to decline years before the diagnosis of Alzheimer is made. The study had enrolled 444 individuals without dementia between 1979 and 2006. These individuals had a clinical evaluation and a psychometric assessment done, including four cognitive factors: global cognition, verbal memory, visuospatial skill, and working memory. Visuospatial skill means the ability to process and interpret the relationship between objects and their location in space. After an average follow-up of 5.9 years, they found that 134 individuals had developed dementia and 44 with dementia died with a confirmed diagnosis of Alzheimer’s disease. When the researchers graphed the data from the psychometric assessments, they found that there was a sudden and steeper decline in the slope of the visuospatial skills three years before patients with dementia were diagnosed. The global cognition graph showed a steep decline two years before clinical diagnosis of dementia, while verbal and working memory did not show until one year before. The authors concluded, "Some of the earliest signs of preclinical disease may occur on tests of visuospatial and speeded psychomotor skills. Furthermore, the greatest rate of preclinical decline may occur on executive and attention tasks. These findings suggest that research into early detection of cognitive disorders using only episodic memory tasks, such as word lists or paragraph recall, may not be sensitive to either all of the earliest manifestations of disease or the most rapidly changing domain."

Resveratrol for Diabetes?

From Geriatric Pharmacy Intern, Dana Ross Pharm.D.(c)
Palm Beach Atlantic University College of Pharmacy

Researchers have found a possible treatment for diabetes in a substance of red grapes called resveratrol. A future study of Endocrinology, a medical journal, looked at resveratrol’s effect on diabetes. The research shows that resveratrol has anti-diabetic effects and evidence has shown the brain is responsible for mediation of these effects. Resveratrol is believed to work by activating proteins called sirtuins, which are thought to house the benefits seen with calorie restriction. Studies have shown beneficial effects on diabetes in mice when resveratrol activated sirtuins.

Sirtuins are ubiquitous in the body, found everywhere, but now evidence has shown benefits being mediated in the brain. With these findings comes a hope of targeted treatment in diabetes medications. The proteins, sirtuins, have shown expression in areas of the brain where glucose metabolism is mediated.

The study looked at mice with diabetes. The investigators directed resveratrol to the brain and saw improvement in high glucose, blood sugar, levels and improving insulin levels. Study investigators believe these findings could lead us to new treatments against type-2 diabetes. With this growing epidemic of type-2 diabetes and related disease, these are exciting findings for future medications that can target new areas of disease progression.

H1N1 (Swine Flu) and the elderly

From Geriatric Pharmacy Intern Yariagna Rollan Pharm.D(c)
University of Florida School of Pharmacy

Swine flu or H1N1 is a new combination of the swine, human, and avian virus strains. It is a serious epidemic that has been spreading rapidly because there are no antibodies for this combination of strains in people. Swine flu is a form of the influenza virus that is thought to spread, as seasonal flu, through coughing, sneezing, or contact with flu infected surfaces. Symptoms include: fever, sore throat, cough, runny or stuffy nose, headache, body aches, chills and fatigue.

Thomas Yoshikawa, MD, professor of medicine at David Geffen School of Medicine (UCLA) and also editor in chief of the Journal of the American Geriatrics Society, reports that older adults, during their lifetime, have had more chances of contact with the various flu outbreaks. This provides the elderly with partial immunity that could offer some protection against swine flu. Unless underlying health problems are present, including compromised immune system, heart or lung disease, older adults appear to have less risk of acquiring swine flu or any other type of influenza virus.

However, seasonal influenza is still a dangerous risk for many. The Center for Disease Control and Prevention (CDC) reports that during the week of October 11-17, 2009, influenza activity continued to increase in the United States compared to previous weeks. During this period of time 8,204 hospitalizations associated to influenza and 411 deaths of confirmed influenza occurred. While some protection is possible in the elderly, they can become severely ill if infected.



Therefore, is important for the elderly population to follow the necessary precautions in order to avoid contamination. The CDC recommends covering your nose and mouth with a tissue when you cough or sneeze, washing hands with soap and water, especially after coughing or sneezing, using alcohol-based hand gels, and avoiding contact with anyone presenting symptoms of the flu, and most importantly the use of yearly flu vaccination as a key to prevent infection.

The H1N1 vaccine only protects against the swine flu; to obtain protection against seasonal flu, you have to receive the seasonal flu vaccination as well. Both vaccines can be given at the same time if the shot is used. In the case of the nasal vaccination, wait three weeks between doses. The seasonal flu vaccine is readily available at pharmacies, family clinics, or even grocery stores. However, the availability of the H1N1 vaccine could be limited initially. The following groups have priority: health care personnel with direct patient contact, pregnant women, children 6 months through 4 years of age, children 5 through 18 years of age with chronic medical conditions, and people who live with or care for children 6 months of age or less. After immunization of the above groups, everyone else should receive H1N1 flu vaccine.