Control In Insulin-treated Patients Research Articles

Trends in clinical characteristics, medication use, and glycemic control in insulin-treated patients with type 1 and type 2 diabetes in Finland in 2012-2019: Nationwide real-world evidence study.

To describe the clinical characteristics and medication purchases of insulin-treated adults in Finland at index (January 1, 2012 or first insulin purchase) and December 31, 2019. Additionally, to describe basal insulin (BI) treatment patterns and associated changes in hemoglobin A1c (HbA1c) values. In this descriptive study using nationwide registries, we included adults with at least two reimbursed insulin purchases within 12 months of the first purchase between January 1, 2012 and December 31, 2019. We formed four study groups: type 1 diabetes (T1D) and type 2 diabetes (T2D)-diagnosed people who were further divided into prevalent or naïve users (start of insulin use before or after January 1, 2012). Insulin treatment patterns were estimated from medication purchase data and glycemic control from HbA1c results. Out of 145 020 people included, 34 359 had T1D and 110 661 T2D. By 2019, in parallel with the adaptation of new noninsulin medications, second-generation basal insulin (BI) analogues were adopted by 45.9% and 21.1% of prevalent T1D and T2D users. At index, HbA1c target (≤53 mmol/mol) was reached by 17% and 35% of T2D naïve and prevalent users, respectively, and by 17% of T1D prevalent users. At study end, the target was reached respectively by 41%, 34%, and 22% of insulin users. Insulin initiation improved and discontinuation worsened glycemic control in T2D, with lesser effects seen after treatment gaps or switches between BIs. Our study showed that glycemic control in insulin users has remained stable or improved between 2012 and 2019 despite aging population and in parallel with introduction of new treatment options, providing valuable insight into Finnish national diabetes care.

975-P: Clinical and Lifestyle Determinants of Continuous Glucose Monitoring Metrics in Insulin-Treated Patients with Type 2 Diabetes

Objective: There was limited evidence to evaluate the association between lifestyle habits and continuous glucose monitoring (CGM) metrics. Thus, we aimed to depict the behavioral and metabolic determinants of CGM metrics in insulin-treated patients with type 2 diabetes (T2DM). Methods: This is a prospective observational study. We analyzed data from 122 insulin-treated patients with T2DM. Participants wore Dexcom G6 and Fitbit, and diet information was identified for 10 days. Multivariate-adjusted logistic regression analysis was performed for the simultaneous achievement of CGM-based targets, defined by the percentage of time in terms of hyper, hypoglycemia and glycemic variability (GV). Intake of macronutrients and fiber, step counts, sleep, postprandial C-peptide to glucose ratio (PCGR), information about glucose-lowering medications and metabolic factors were added to the analyses. Additionally, we evaluated the impact of the distribution of energy and macronutrient during a day, and snack consumption on CGM metrics. Results: Logistic regression analysis revealed that female, participants with high PCGR, low HbA1c and daytime step count had a higher probability of achieving all targets based on CGM (odds ratios [95% confidence intervals] which were 0.24 [0.09–0.65], 0.95 [0.9–0.99], 1.34 [1.03–1.25], and 1.15 [1.03–1.29], respectively). And participants who ate snacks showed a shorter period of hyperglycemia and less GV compared to those without. Conclusions: We confirmed that residual insulin secretion, daytime step count, HbA1c, and women were the most relevant determinants of adequate glycemic control in insulin-treated patients with T2DM. In addition, individuals with snack consumption were exposed to lower times of hyperglycemia and GV. Disclosure D.Lee: None. N.Kim: None. I.Jung: None. S.Park: None. J.Yu: None. J.Seo: None. S.Park: None. N.Kim: None. Funding National Research Foundation of Korea (2019M3E5D3073102, 2019R1H1A2039682, 2020R1I1A1A01071665); National IT Industry Promotion Agency (S0252-21-1001)

A telemedicine-based approach with real-time transmission of blood glucose data improves metabolic control in insulin-treated diabetes: the DIAMONDS randomized clinical trial

PurposeTo evaluate if a web-based telemedicine system (the Glucoonline® system) is effective to improve glucose control in insulin-treated patients with type 1 and type 2 diabetes, as compared to standard of care.MethodsThis was a prospective, randomized, controlled trial, carried out at three tertiary referral centers for diabetes in Italy. Adults with insulin-treated type 1 and type 2 diabetes, inadequate glycemic control, and no severe diabetes-related complications and/or comorbidities were eligible for this study. Patients were randomized to either perform telemedicine-assisted (Group A) or standard (Group B) self-monitoring blood glucose (SMBG) for 6 months. In Group A, patients received prompt feedback about their blood glucose levels and therapy suggestions from the study staff via phone/SMS, when appropriate. In Group B, patients had no remote assistance from the study staff between planned visits.Results123 patients were included in the final analysis. After 6 months, patients achieved a significant reduction in HbA1c in Group A (−0.38%, p < 0.05) but not in Group B (+ 0.08%, p = 0.53). A significant difference in the percentage of patients with HbA1c < 7% between Group A and Group B was found after 3 months (28.6% vs 11.1%, p = 0.02). Also, fewer patients (p < 0.05) with HbA1c > 8.5% were found in Group A vs Group B, respectively, after both 3 months (14.3% vs 35.2%) and 6 months (21.8% vs 42.9%).ConclusionsThe use of the Glucoonline™ system resulted in improved metabolic control. Telemedicine services have potential to support diabetes self-management and provide the patients with remote, prompt assistance using affordable technological equipment.Trial registration This study was registered at clinicaltrials.gov (NCT01804803) on March 5, 2013.

The Effect of Coronavirus Disease-19 Pandemic Lockdown and the Overlapping Ramadan Fasting Period on Glucose Control in Insulin-Treated Patients With Diabetes: A Flash Glucose Monitoring Study.

BackgroundA strict lockdown was enforced during coronavirus disease (COVID-19) pandemic in many countries including the UAE. Lockdown period overlapped with Ramadan which is accompanied by its own drastic changes in lifestyle that include meal timings.AimsWe report the impact of COVID-19 lockdown (between 22/3/2020 and 24/6/2020) on glucose control pre- and postlockdown and during Ramadan, in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) on insulin therapy.MethodsA number of twenty-four patients (19 men, 6 women) who were monitoring their glucose levels using flash glucose monitoring (FGM) and remotely connected to the diabetes clinic in Imperial College London Diabetes Centre (ICLDC), Abu Dhabi, UAE were included. Using the international consensus on the use of continuous glucose monitoring guidelines, analyses of data were performed on glucose management indicator (GMI), time in range (TIR), time in hyperglycemia, time in hypoglycemia, low blood glucose index (LBGI) and high blood glucose index (HBGI). Variables were calculated for each period: 30 days before lockdown 14/2/2020–14/3/2020, 30 days into lockdown and pre-Ramadan 20/3/2020–18/4/2020, and 30 days into lockdown and Ramadan 24/4/2020–23/5/2020, using cgmanalysis package in R-studio software.ResultsMean average glucose (MAG) remained steady before and during lockdown, and no significant differences were observed in TIR, time in hypoglycemia, and LBGI between prelockdown and lockdown periods. However, there was a statistically significant difference in GMI and percentage of time in hyperglycemia (>10.0 mmol/L) between Ramadan and pre-Ramadan during the lockdown period in p = 0.007, 0.006, and 0.004, respectively. Percentage of TIR (3.9–10.0 mmol/L) was significantly lower in Ramadan as compared to pre-Ramadan (50.3% vs. 56.1%; p = 0.026). Mean absolute glucose (MAG) (182.0 mmol/L vs. 166.6 mmol/L, p = 0.007) and HBGI (10.2 (6.8, 14.8) vs. 11.9 (7.9, 17.8), p = 0.037) were significantly higher in Ramadan compared to pre-Ramadan period. There was no statistically significant difference in percentage of time in hypoglycemia (<3.9 mmol/L) and LBGI between Ramadan and pre-Ramadan periods.ConclusionThe lockdown period had no significant effects in the markers of glycemic control in the population studied. However, Ramadan fasting period embedded within this time was associated with several changes that include increase in GMI, HBGI, and glycemic variability similar to what has been reported in other Ramadan studies.

Continuous Glucose Monitor with Siri Integration Improves Glycemic Control in Legally Blind Patients with Diabetes.

Continuous glucose monitoring (CGM) is safe and effective in improving glycemic control in insulin-treated patients with diabetes. However, the safety of CGM use in legally blind patients with diabetes is unknown. This is a retrospective study of seven legally blind patients with diabetes on intensive insulin therapy who were using Dexcom G6 with voice-enabled Apple's Siri feature. CGM metrics, hemoglobin A1c, and frequency of severe hypoglycemia were measured for 12 months. There was a significant reduction in A1c after 3, 6, and 12 months of Dexcom G6 with Apple Siri use (P < 0.0001). Time-in-range increased at 12 months (50.9% ± 5.5% at 3 months vs. 56.8% ± 5.5% at 12 months, P = 0.029) without increase in time spent in hypoglycemia. There was a significant reduction in severe hypoglycemia requiring medical assistance for 12 months. Voice-enabled CGM use improved glycemic control and reduced severe hypoglycemia in legally blind patients with diabetes on intensive insulin therapy.

A Study of Seasonal Variation in the Effect of Add-On Sitagliptin on Blood Glucose Control in Insulin-Treated Patients With Type 2 Diabetes.

BackgroundThere are several reports of seasonal variation in hemoglobin A1c (HbA1c) in patients with type 2 diabetes (T2DM), but no reports of seasonal variation in the effect of add-on drugs on blood glucose control in insulin-treated patients.MethodsUsing data collected from 630 patients in a multicenter study, we compared the amount of change in HbA1c after 1, 3, 6, 9, and 12 months of add-on administration of sitagliptin in insulin-treated patients divided into four groups based on the month when sitagliptin was started.ResultsA significantly larger decrease in HbA1c at 6 months from baseline was observed in the group that started add-on sitagliptin in February to April than in the other three groups. However, the amount of change in HbA1c at 12 months did not differ among the groups.ConclusionsThe consideration of seasonal variation enables more accurate evaluation of a drug’s short-term effect on blood glucose control.

711-P: Factors Associated with Insulin Adherence in Patients Initiating Insulin Therapy: A Three-Month Prospective Study

Background: Insulin therapy is the most effective treatment to achieve optimal glycemic control in patients with type 2 diabetes (T2DM), while insulin adherence is crucial to achieve optimal glycemic control in insulin-treated patients. Understanding factors associated with insulin adherence in patients initiating insulin therapy will help to improve long-term insulin adherence. Method: This study was a 3-month prospective study. One hundred and twenty-six (63 males and 63 females) patients with T2DM who were initiating insulin therapy were recruited. At baseline, when patients accepted receiving insulin therapy, demographic data (age, sex, duration of diabetes), psychosocial factors (health literacy, diabetes distress, quality of life, perceived benefits of insulin therapy, and perceived barriers of insulin therapy) were measured by self-reported questionnaires. Clinical data (HbA1c levels, body mass index) were collected from medical records. Adherence to insulin injection was measured by the 8-item Moriskey Medication Adherence Scale (MMAS) after 3 months of initiating insulin therapy. Higher score MMAS indicated poorer insulin adherence. Results: The mean age of participants was 59.11 years (SD: 13.30). Baseline diabetes distress (r=0.202, p=0.024), quality of life(r=-0.227, p=0.010), and perceived benefit of insulin therapy (r=-0.189, p=0.035) significantly correlated with 3-month insulin adherence. Age, sex, baseline HbA1c levels, duration of diabetes, body mass index, health literacy, and perceived barriers of insulin injection did not significantly associate with insulin adherence. Conclusion: Baseline psychosocial factors rather than demographic data and clinical data are associated with insulin adherence 3 months later. To improve insulin adherence, healthcare providers should address the diabetes distress, QoL, and perceived benefit of insulin therapy when educating patients initiating insulin therapy. Disclosure S. Ma: None. R.H. Wang: None. C. Lee: None. H. Hsu: None. T. Lee: None. S. Chen: None.

Modeling patient empowerment and health literacy to glycemic control in insulin-treated patients: A prospective study

ObjectiveTo model the pathways of patient empowerment (PE) and health literacy (HL) to glycemic control specific to insulin-treated patients by prospective design. MethodsInsulin-treated patients with type 2 diabetes (T2DM) (N = 185) were recruited by convenience sampling. Data of personal characteristics, PE, and HL were collected by questionnaires at baseline and 9 months later. The 9-month glycosylated hemoglobin (HbA1c) levels of each participant were collected from medical records. Structural equation modeling was used to test a hypothesized model. ResultsBaseline and 9-month communicative HL and critical HL significantly and negatively correlated with 9-month HbA1c levels. Structural equation modeling supported that baseline and 9-month PE significantly affected HL at corresponding time points. Baseline PE indirectly affected 9-month HL through 9-month PE. The 9-month HL directly affected 9-month HbA1c. Baseline HL indirectly affected 9-month HbA1c through 9-month HL. ConclusionCommunicative HL and critical HL rather than functional HL were crucial in improving glycemic control. PE is essential to improve HL in insulin-treated patients. Practice ImplicationsHealthcare providers could apply the empowerment approach to educate insulin-treated patients. Through reciprocal dynamic process of PE, insulin-treated patients with T2DM might improve their communicative and critical HL; and finally, glycemic control could be improved.

Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes: Empowerment Perceptions and Diabetes Distress as Important Determinants.

The purpose of this cross-sectional study was to explore the determinants of hemoglobin A1c (HbA1c) levels in insulin-treated patients with Type 2 diabetes mellitus (T2DM) based on demographic and disease characteristics, self-reported regimen adherence factors (adherence in insulin regimen and self-monitoring of blood glucose), and psychosocial factors (decisional balance for insulin injection, health literacy, self-efficacy for insulin injection, diabetes distress, and empowerment perceptions). Via convenience sampling, 255 insulin-treated patients with T2DM were recruited from two endocrinology clinics in Taiwan. A self-report questionnaire was used to collect demographic and disease characteristics, regimen adherence factors, and psychosocial factors. The first HbA1c level measured after completion of the questionnaire was the dependent variable. The last HbA1c level measured before patients started insulin therapy as well as body mass index (BMI) was collected from medical records. Results indicated that adherence in insulin regimen was relatively good. Regimen adherence factors did not significantly correlate with HbA1c levels, but empowerment perception, decisional balance for insulin injection, health literacy, and diabetes distress did. The hierarchical multiple regression models indicated that BMI, the last HbA1c levels before starting insulin therapy, empowerment perception, and diabetes distress were important determinants of HbA1c levels. Nurses could periodically assess the diabetes distress of insulin-treated patients with T2DM and refer to mental health professionals when needed. Furthermore, applying empowerment approaches such as enhancing self-awareness of improved glycemic control and sharing more decision-making power with insulin-treated patients with T2DM might have benefits for their glycemic control.

Use of Continuous Glucose Monitoring Data for Defining Glucose Control in Insulin-Treated Patients

Glycated haemoglobin (HbA1c) and self-monitoring of blood glucose (SMBG) are usually used to define glucose control in diabetic patients, but in many cases they are insufficient to present overall control. Continuous Glucose Monitoring (CGM) is used for adjustment of insulin doses but derived data could help to define glucose control. We assess the use of CGM data for defining control in subgroup of patients treated with insulin. We studied 75 diabetic patients (43 men, 32 women; age 55.23±8.99 years, disease duration 12.84±7.02 years) - 33 with type 2 diabetes on pre-mixed insulin, 21 with type 2 on multiple insulin injection (MII), 21 with type 1 on MMI. Patients did multiple daily blood glucose measurements of fasting and prandial blood glucose for three month period. HbA1c was measured and CGM by using iProTM for seven days was performed at the end of this period. Based on HbA1c assessment 36.36% of patients on premixed insulin, 19.05% of type 2 patients on MII and 9.52% of type 1 patients on MII were with good control. After estimation of results from SMBG these percentage were respectively 28.14%, 12.11%, 4.51%. CGM defined 27.27% of patients on premixed insulin, 23.80% of type 2 patients on MII and 2.38% of type 1 patients on MII as well controlled. In addition CGM gave information about insulin excursion - they were with no significant difference in the three groups (17.09±7.01, p=0.231). CGM was more informative than SMBG in presenting hypoglycemic episode (p=0.01) including night hypoglycemia and especially their duration (p=0.001). No difference was found in different groups with no dependence on type of diabetes or insulin regimen. Nevertheless of short observed period CGM data could give much information about overall glucose control that is comparable to three month blood glucose measurement and are better than other methods in estimating hypoglycemic episodes. Performing of CGM should be included in recommendations for assessment of glucose control. Disclosure T. Totomirova: None. I. Daskalova: None. M. Arnaudova: None.

Noradrenergic Activity in the Human Brain: A Mechanism Supporting the Defense Against Hypoglycemia.

Hypoglycemia, one of the major factors limiting optimal glycemic control in insulin-treated patients with diabetes, elicits a brain response to restore normoglycemia by activating counterregulation. Animal data indicate that local release of norepinephrine (NE) in the hypothalamus is important for triggering hypoglycemia-induced counterregulatory (CR) hormonal responses. To examine the potential role of brain noradrenergic (NA) activation in humans during hypoglycemia. A hyperinsulinemic-hypoglycemic clamp was performed in conjunction with positron emission tomographic imaging. Nine lean healthy volunteers were studied during the hyperinsulinemic-hypoglycemic clamp. Participants received intravenous injections of (S,S)-[11C]O-methylreboxetine ([11C]MRB), a highly selective NE transporter (NET) ligand, at baseline and during hypoglycemia. Hypoglycemia increased plasma epinephrine, glucagon, cortisol, and growth hormone and decreased [11C]MRB binding potential (BPND) by 24% ± 12% in the raphe nucleus (P < 0.01). In contrast, changes in [11C]MRB BPND in the hypothalamus positively correlated with increments in epinephrine and glucagon levels and negatively correlated with glucose infusion rate (all P < 0.05). Furthermore, in rat hypothalamus studies, hypoglycemia induced NET translocation from the cytosol to the plasma membrane. Insulin-induced hypoglycemia initiated a complex brain NA response in humans. Raphe nuclei, a region involved in regulating autonomic output, motor activity, and hunger, had increased NA activity, whereas the hypothalamus showed a NET-binding pattern that was associated with the individual's CR response magnitude. These findings suggest that NA output most likely is important for modulating brain responses to hypoglycemia in humans.

Influence of Non-Palpable Subcutaneous Tissue Changes on the Glycemic Control in Insulin-Treated Patients With Diabetes

Influence of Non-Palpable Subcutaneous Tissue Changes on the Glycemic Control in Insulin-Treated Patients With Diabetes

Use of a Combined Blood-Glucose- and ß-Ketone-Measuring Device Improves Glycemic Control in Insulin-Treated Patients With Diabetes: The Gold Plus Study.

Using self-measurements of blood glucose (SMBG) is daily routine for patients with insulin-treated diabetes, however measuring ß-ketones in blood is not widespread. How the use of a combined device, which can measure both, is accepted in daily routine by patients and will lead to better glycemic control is not well studied. This multicenter, prospective, noninterventional study assessed the impact of routine use of the GlucoMen® LX Plus on patient acceptance, usage and glycemic control among insulin-treated patients with diabetes mellitus type 1 and type 2. A1c and self-reported frequency of SMBG were evaluated at baseline and also postprandial SMBG, ß-ketone measurements, and use of reminders after 3 and 6 months of use. A total of 631 patients, 254 type 1/350 type 2 (27 no type specified), with mean (SD) baseline A1c 8.5% (1.5), age 54.6 (15.6) years, and 47.3% female were studied. Frequent use of SMBG at baseline led to a higher decrease in A1c at 6 month (V3): -0.3% if SMBG measured up to 1/day versus -0.9% in 4-6/day. Increase of SMBG frequency during the study showed also a negative correlation to A1c, 9.2% at V1 versus 7.6% at V3. Postprandial SMBG was done by 77.7% and ß-ketone measurements by 45.5% of all patients; the reminders were used by 33.4% and led to an increased frequency of SMBG at 6 months. A combined device for SMBG and ß-ketone measurements is well accepted by patients with insulin-treated diabetes and can lead through the avoidance or detection of ketoacidosis/increased frequency of SMBG and increased awareness of the patients to an improved glycemic outcome.

Effects of MK-0941, a Novel Glucokinase Activator, on Glycemic Control in Insulin-Treated Patients With Type 2 Diabetes

OBJECTIVETo assess the efficacy and safety of MK-0941, a glucokinase activator (GKA), when added to stable-dose insulin glargine in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSIn this double-blind study, 587 patients taking stable-dose insulin glargine (±metformin ≥1,500 mg/day) were randomized (1:1:1:1:1) to MK-0941 10, 20, 30, or 40 mg or matching placebo t.i.d. before meals (a.c.). This study included an initial 14-week, dose-ranging phase followed by a 40-week treatment phase during which patients were to be uptitrated as tolerated to 40 mg (or placebo) t.i.d. a.c. The primary efficacy end point was change from baseline in A1C at Week 14.RESULTSAt Week 14, A1C and 2-h postmeal glucose (PMG) improved significantly versus placebo with all MK-0941 doses. Maximal placebo-adjusted least squares mean changes from baseline in A1C (baseline A1C 9.0%) and 2-h PMG were −0.8% and −37 mg/dL (−2 mmol/L), respectively. No significant effects on fasting plasma glucose were observed at any dose versus placebo. By 30 weeks, the initial glycemic responses noted at 14 weeks were not sustained. MK-0941 at one or more doses was associated with significant increases in the incidence of hypoglycemia, triglycerides, systolic blood pressure, and proportion of patients meeting criteria for predefined limits of change for increased diastolic blood pressure.CONCLUSIONSIn patients receiving stable-dose insulin glargine, the GKA MK-0941 led to improvements in glycemic control that were not sustained. MK-0941 was associated with an increased incidence of hypoglycemia and elevations in triglycerides and blood pressure.

Adherence to insulin and its association with glycaemic control in patients with type 2 diabetes

Good glycaemic control improves outcomes in patients with type 2 diabetes, but the extent to which this depends on adherence to insulin treatment is uncertain. To investigate the association between adherence to insulin and glycaemic control in insulin-treated patients with type 2 diabetes. Observational records-based study. We studied all patients with type 2 diabetes who were resident in Tayside, Scotland from 1 January 1995 to 30 September 2001, and who were treated with insulin. Adherence to insulin treatment was measured as the annual number of days of insulin coverage on the recommended dose, calculated from the amount of drug dispensed at community pharmacies and the recommended dose level for each patient. The association between glycaemic control (HbA1c), and adherence was determined, as was the influence of covariates, including age, sex, duration of diabetes and number of injections per day. A total of 1099 people were studied: 574 (52%) males and 525 (48%) females, mean +/- SD age 62 +/- 12 years, diabetes duration 10 +/- 7 years. Median time in the study (time for which insulin was dispensed) was 1107 (range 366-2446) days. Insulin prescribed was 58.0 +/- 33.3 IU/day and insulin collected from pharmacies was 53.6 +/- 27.1 IU/day. Mean adherence to insulin was thus 70.6%+/-17.7%. Adherence to insulin (p = 0.0021), BMI (p = 0.0001) and diabetes duration (p = 0.0314) were all significant predictors of HbA1c. Adherence to insulin appears poor in these type 2 diabetes patients, and there was a significant relationship between adherence and long-term metabolic control.

Subcutaneous insulin: pharmacokinetic variability and glycemic variability

The therapeutic goal in insulin-treated diabetic patients is to maintain on the long-term a tight glucose control (HbA1, < 6.5-7% or less) through an insulin regimen which "mimic" the physiological insulin profile: a basal insulin secretion to maintain glucose homeostasis and an acute post-prandial secretion in response to meal intake. Such goal represents a challenge for the clinician as conventional human insulins have major drawbacks: slow absorption and too late peak with regular insulins, delayed peak and often occuring at an unwanted time with intermediate and long-acting insulins. Furthermore, these insulins are characterised by a large within- and between-subjects variability, which complicate patients' task to self-adapt their daily doses, even for those well educated and compliants. These limitations and unpredictable variations in insulin action are responsible for an increased risk of hypoglycemic events, between meals as well as during the night period. As a consequence, glucose control is frequently insufficient in type 1 diabetic patients, and these limitations may contribute also to the delayed initiation of insulin therapy in type 2 diabetics when oral antidiabetic agents fail. This variability and the non-reproducibility of the conventional insulin pharmacodynamics are explained by several exogenous and endogenous factors describe in this review. Availability of new short-acting (lispro, aspart and glulisine) and long-acting analogs (glargine, detemir) of human insulin, with improved pharmacokinetic characteristics, and a lesser variability and better reproducibility, should facilitate a tight glucose control in insulin-treated patients. The main pharmacokinetic and pharmacodynamic characteristics of these new insulin analogs are presented and discussed in the light of there intra- and inter-individual variability. Their reduced variability should permit to reinforce near "physiological" insulin regimen such as "basal-bolus" technique and to consider new approaches and therapeutic strategies in type 1 and type 2 diabetic patients.

Troglitazone improved glycemic control in insulin-treated patients with type 2 diabetes mellitus

Source Citation Schwartz S, Raskin P, Fonseca V, Graveline JF, for the Troglitazone and Exogenous Insulin Study Group. Effect of troglitazone in insulin-treated patients with type II diabetes melli...

The challenges of maintaining good diabetes control in insulin-treated patients during ramadan

Practical Diabetes InternationalVolume 15, Issue S1 p. S11-S12 ArticleFree Access The challenges of maintaining good diabetes control in insulin-treated patients during ramadan Abdul F Lakhdar, Abdul F Lakhdar Medical Directorate, Royal Preston Hospital, Preston, UKSearch for more papers by this author Abdul F Lakhdar, Abdul F Lakhdar Medical Directorate, Royal Preston Hospital, Preston, UKSearch for more papers by this author First published: 14 December 2005 https://doi.org/10.1002/pdi.1960150911Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Barber SG, Fairweather S, Wright AD, et al. Muslims, Ramadan and diabetes. Brit Med J 1979; i: 46. 2 Ebbing RN. Muslims, Ramadan and diabetes mellitus. Brit Med J 1979; ii: 333– 334. 3 Davidson JC. Muslims, Ramadan and diabetes mellitus. Brit Med J 1979; ii: 1511– 12. 4 Cahill GF, Herrera MG, Morgan AP, et al. Hormone-fuel interrelationships during fasting. J Clin Invest 1966; 45: 1751– 69. 5 Owen OE, Morgan AB, Kemp HG, et al. Brain metabolism during fasting. J Clin Invest 1967; 46: 1589– 95. 6 Sherwin R, Felig P. Pathophysiology of diabetes mellitus. Med Clin N Amer 1978; 63: 695– 711. 7 Bolli GB, Dimitriadis GB, Pehling GB, et al. Abnormal glucose counter-regulation after subcutaneous insulin in insulin-dependent diabetes mellitus. N Eng J Med 1984; 310: 1706– 1711. 8 Chandalia HB, Bhargaav A, Kataria V. Dietary pattern during Ramadan fasting and its effect on the metabolic control of diabetes. Pract Diabet 1987; 4: 287– 40. 9 Khoghers Y, Sulaiman MI, Al-Fayez SF. Ramadan fasting in diabetes — safety and state of control. Ann Saudi Med 1987; 7: 5– 6. 10 Tang C, Rolfe M. Clinical problems during the fast of Ramadan. Lancet 1989; i: 1396. 11 Kruszynska YT, Home PD, Hanning I, Alberti KGMM. Basal and 24 h C-peptide and insulin secretion in normal man. Diabetologia 1987; 30: 16– 21. 12 Al-Nakhi A, Al-Arouj M, Kandari A, Murad M. Multiple insulin injection during Ramadan fasting in IDDM patients. Diabetologia 1997; 40 (suppl 1). Citing Literature Volume15, IssueS1Supplement: Management of Diabetes Mellitus During the Holy Month of RamadanJanuary/February 1998Pages S11-S12 ReferencesRelatedInformation

Effect of BMI, insulin dose and number of injections on glycaemic control in insulin-using diabetic patients

Background: Strict glucose control is essential to the prevention of diabetic complications. The level of glycaemic control in insulin-treated patients with diabetes mellitus (DM) in a routine clinical setting is not known.Methods: In a cross-sectional survey comprising 8 hospitals in the Rijnmond area, The Netherlands, age, body mass index (BMI), insulin dose, number of injections, and HbA1c were scored in 712 patients with insulin-dependent DM (IDDM) and 462 patients with non-insulin-dependent DM (NIDDM).Results: In IDDM and NIDDM patients, respectively, age (mean ± SD) was 40 ± 17 and 65 ± 12 years, BMI was 24.1 ± 3.5 and 27.3 ± 4.1 kg/m2, daily insulin dose was 49 ± 18 and 44 ± 18 U (P < 0.001). Intensive therapy (≥ 4 injections or continuous subcutaneous insulin infusion) was used in 59% of IDDM and 13% of NIDDM patients. HbA1c below the upper normal limit was achieved in 11% of the patients, and within 20% above the upper normal limit in 37%. Obesity was positively associated with HbA1c in NIDDM patients (P < 0.01). A higher insulin dose was associated with higher HbA1c in both IDDM and NIDDM patients (P < 0.01).Conclusions: Good glycaemic control was established in 37% of our patients. Intensive insulin treatment and higher insulin dose did not improve glucose regulation. Obesity is a risk factor for poor glycaemic control.

Basal and Tolbutamide‐induced Plasma Somatostatin in Healthy Subjects and in Patients with Diabetes and Impaired Glucose Tolerance

Peripheral levels of basal and tolbutamide-induced somatostatin have been measured in patients with diabetes or impaired glucose tolerance (IGT) and compared with those in normal individuals. Basal somatostatin was significantly higher in patients with Type 1 diabetes than in age-matched control subjects. This increase was most pronounced at diagnosis, and appeared to be related to metabolic control in insulin-treated patients. No increase was noted in patients with Type 2 diabetes or with IGT. Intravenous bolus injection of tolbutamide enhanced peripheral somatostatin levels in healthy volunteers in a biphasic manner. Patients with IGT also exhibited a biphasic response but the amplitude of the first phase was higher. No secretory response was detected in 27/29 Type 1 diabetic patients at diagnosis; a somatostatin response to tolbutamide became detectable again in Type 1 patients with normalization of their basal somatostatin levels but was then paradoxically related to poor blood glucose control. In Type 2 diabetes, basal somatostatin levels were similar to age-matched control subjects, but decreased upon intravenous tolbutamide administration.