Isophane Protamine Human Insulin(Novo Nordisk A/S)

Corneal injuries are common in human and veterinary ophthalmology. There are many studies which have investigated the treatment of corneal epithelial defects. This study aimed to investigate the effects of Neutral Protamine Hagedorn (NPH) insulin as an ointment for wound healing in experimental corneal defects. First, a superficial keratectomy was performed on 12 rabbits using a corneal trephine. The animals were divided into two groups, Group I (treated, n = 6) and Group II (vehicle control, n = 6). Insulin ointment was applied topically once daily in the treated group, and saline ointment was applied in the same manner in the vehicle control group. Corneal defects were observed and photographed, and changes in wound surface were recorded on days 7, 14, 21, 30, and 60. In both groups, a significant reduction in the wound surface area was noticeable on the 30th day after defect creation. Between the 30th and 60th days, while the changes in the wound surface area in Group II remained limited, the decrease continued rapidly in Group I. At the end of the study, the corneal opacity score observed was lower in Group I than in Group II. In conclusion, we determined that topical NPH insulin may accelerate corneal wound healing after superficial lamellar keratectomy. A new alternative treatment may be developed for treating corneal wounds through continuing studies on this subject.

The relative efficacy and safety of insulin neutral protamine Hagedorn (NPH) and detemir (IDet), in the management of diabetes in pregnancy remains unclear. We sought to conduct an updated systematic review and meta-analysis to study the effect of NPH versus IDet during pregnancy on clinically relevant maternal and fetal outcomes.

MEDLINE and Google Scholar were queried from inception till September 2022 for original studies comparing NPH with IDet for management of diabetes during pregnancy. Data was pooled using a random-effects model, to generate risk ratios (RR) for dichotomous outcomes and weighted mean differences (WMDs) for continuous outcomes, along with 95% confidence intervals (CIs). I² test was used to assess the magnitude of heterogeneity. Sensitivity analysis was conducted to explore the potential source of heterogeneity. As less than ten studies were included in our analysis, funnel plots were not made to evaluate publication bias. A P value of ≤0.05 was considered significant in all cases.

Our search of the literature yielded 1087 articles initially, of which seven articles comprising 1396 patients, were included in our analysis. All included articles were of reasonably high methodological quality. Our pooled analysis demonstrates no statistically significant difference between the efficacy of insulin Detemir and insulin NPH as assessed by the HbA1c values from baseline. For safety outcomes, insulin detemir was significantly associated with a greater gestational age at delivery (WMD=0.39, 95%CI: 0.07 to 0.71, P=0.02) and lower incidence of hypoglycemic events (RR=0.64, 95%CI: 0.48 to 0.86, P=0.003) in-contrast to insulin NPH.

Our findings demonstrate that both, insulin IDet and insulin NPH have a similar efficacy in reducing HbA1c from baseline. However, insulin detemir was associated with lesser incidence of maternal hypoglycemic events and greater gestational age at delivery, compared to NPH.