Pharmacokinetics and glucodynamics of rapid-, short-, and intermediate-acting insulins: comparison of jet injection to needle syringe.

863 Dear Editor: Insulin-requiring diabetes, whether resulting from type 1 or from progression of type 2 disease, requires strict attention to glycemic control in order to reduce the incidence of microand macrovascular complications. To approach the goal of euglycemia, individualized patient treatment may demand an intensive regimen, which can negatively impact patient compliance due to the “fear factor” or inconvenience of use of needle syringes. Additionally, the hazards of needle-stick accident in institutional and private use settings have become an increasing health issue due to potential transmission of blood-borne pathogens.1,2 As an alternative to use of syringes, jet injectors were developed in the 1940s and were implemented for mass inoculations. Recently, state and federal legislation has encouraged development of safer injection products, and jet injection technology has gained momentum in multiple clinical areas as a result. The Injex device is a Food and Drug Administrationcleared needle-free jet injector. It utilizes a spring mechanism to propel 0.05–0.3 mL of solution through a 0.007-inch orifice with sufficient force to enter the subcutaneous tissue to a depth equivalent to standard needle syringe. The device utilizes a low-cost, single-use disposable cartridge, which minimizes the potential for cross-contamination. Recently, the Injex has been shown to safely and efficaciously deliver the measles, mumps, and rubella vaccine (MMRII) in a cohort of pediatric subjects.3 Despite the long history of jet injectors there have been few studies of insulin administration and fewer studies still of the pharmacokinetics of insulins delivered via jet injection. Of those studies that have been performed, there have been observations of more rapid absorption4 and increased area under the insulin concentration–time curve5 when compared with needle syringe. The present study employs the euglycemic clamp technique6,7 in a cohort of healthy volunteers as a model for insulin effects in patients with diabetes. The main objective of the study is to evaluate the pharmacokinetics and glucodynamics of various insulins delivered via needle syringe and the Injex jet injector.