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Journal of Diabetes Science and... Nov 2013We review and summarize the literature on the safety and stability of rapid-acting insulin analogs used for continuous subcutaneous insulin infusion (CSII) in patients... (Review)
Review
AIM
We review and summarize the literature on the safety and stability of rapid-acting insulin analogs used for continuous subcutaneous insulin infusion (CSII) in patients with diabetes.
METHODS
Two predefined search strategies were systematically implemented to search Medline and the Cochrane Register of Clinical Trials for publications between 1996 and 2012.
RESULTS
Twenty studies were included in the review: 13 in vitro studies and 7 clinical studies. In vitro studies investigated the effects of extreme CSII conditions (high temperature and mechanical agitation) on the risk of catheter occlusions and insulin stability factors, such as potency, purity, high molecular weight protein content, pH stability, and preservative content (m-cresol, phenol). Under these conditions, the overall stability of rapid-acting insulin analogs was similar for insulin lispro, insulin aspart, and insulin glulisine, although insulin glulisine showed greater susceptibility to insulin precipitation and catheter occlusions. A limited number of clinical trials were identified; this evidence-based information suggests that the rate of catheter occlusions in patients with type 1 diabetes using CSII treatment may vary depending on the rapid-acting analog used.
CONCLUSIONS
Based on a limited amount of available data, the safety, stability, and performance of the three available rapid-acting insulin analogs available for use with CSII were similar. However, there is limited evidence suggesting that the risk of occlusion may vary with the insulin preparation under certain circumstances.
Topics: Amino Acid Sequence; Diabetes Mellitus, Type 1; Drug Stability; Humans; Infusions, Subcutaneous; Insulin; Insulin Aspart; Insulin Infusion Systems; Insulin Lispro; Insulin, Short-Acting; Molecular Sequence Data; Risk Factors; Treatment Outcome
PubMed: 24351186
DOI: 10.1177/193229681300700620 -
Environmental Health Perspectives Aug 2008Pentachlorophenol, a fungicide widely used as a wood preservative, was classified in 1999 by the International Agency for Research on Cancer as a possible human... (Review)
Review
OBJECTIVE
Pentachlorophenol, a fungicide widely used as a wood preservative, was classified in 1999 by the International Agency for Research on Cancer as a possible human carcinogen. We reviewed currently available data to determine the extent to which recent studies assist in distinguishing the effect of pentachlorophenol from that of its contaminants (e.g., dioxins and other chlorophenols).
DATA SOURCES AND EXTRACTION
We performed a systematic review of published studies pertaining to cancer risk in relation to pentachlorophenol exposure, focusing on results pertaining specifically to all cancer sites and specific hematopoietic cancers, and data pertaining to risks associated with other types of chlorophenols, dioxins, or furans.
SYNTHESIS
The pentachlorophenol studies presented considerable evidence pertaining to hematopoietic cancers, with strong associations seen in multiple studies, in different locations, and using different designs. There is little evidence of an association between these cancers and chlorophenols that contain fewer than four chlorines. The extension of a large cohort study of sawmill workers, with follow-up to 1995, provided information about risks of relatively rare cancers (e.g., non-Hodgkin lymphoma, multiple myeloma), using a validated exposure assessment procedure that distinguishes between exposures to pentachlorophenol and tetrachlorophenol. In contrast with dioxin, pentachlorophenol exposure has not been associated with total cancer incidence or mortality.
CONCLUSIONS
The updated cohort study focusing on pentachlorophenol provides increased statistical power and precision, and demonstrates associations between hematopoietic cancer and pentachlorophenol exposure not observed in earlier evaluations of this cohort. Contaminant confounding is an unlikely explanation for the risks seen with pentachlorophenol exposure.
Topics: Adult; Aged; Aged, 80 and over; Carcinogens; Case-Control Studies; Child; Chlorophenols; Cohort Studies; Dioxins; Environmental Exposure; Female; Fungicides, Industrial; Hematologic Neoplasms; Humans; Incidence; Male; Middle Aged; Pentachlorophenol; Risk Assessment
PubMed: 18709150
DOI: 10.1289/ehp.11081