Insulin Dose In Patients Research Articles

Relationship Between Lipohypertrophy, Glycemic Control, and Insulin Dosing: A Systematic Meta-Analysis.

Background: Lipohypertrophy is a common complication in patients with diabetes receiving insulin therapy. There is a lack of consensus regarding how much lipohypertrophy affects diabetes management. Our study aimed to assess the potential correlation between lipohypertrophy and glycemic control, as well as insulin dosing in patients with diabetes. Methods: We performed a systematic review followed by a meta-analysis to collect data about glycemic control and insulin dosing in diabetic patients with and without lipohypertrophy. To identify relevant studies published in English, we searched medical databases (MEDLINE/PubMed, Embase, and CENTRAL) from 1990 to January 20, 2023. An additional hand-search of references was performed to retrieve publications not indexed in medical databases. Results of meta-analyses were presented either as prevalence odds ratios (pORs) or mean differences (MDs) with 95% confidence intervals (95% CIs). This study was registered on PROSPERO (CRD42023393103). Results: Of the 5540 records and 240 full-text articles screened, 37 studies fulfilled the prespecified inclusion criteria. Performed meta-analyses showed that patients with lipohypertrophy compared with those without lipohypertrophy were more likely to experience unexplained hypoglycemia (pOR [95% CI] = 6.98 [3.30-14.77]), overall hypoglycemia (pOR [95% CI] = 6.65 [1.37-32.36]), and glycemic variability (pOR [95% CI] = 5.24 [2.68-10.23]). Patients with lipohypertrophy also had higher HbA1c (MD [95% CI] = 0.55 [0.23-0.87] %), and increased daily insulin consumption (MD [95% CI] = 7.68 IU [5.31-10.06]). Conclusions: These results suggest that overall glycemic control is worse in patients with lipohypertrophy than in those without this condition.

Effectiveness of insulin degludec/liraglutide versus insulin degludec/insulin aspart in Japanese patients with type 2 diabetes.

To evaluate and compare the effectiveness of once-daily insulin degludec/liraglutide (IDegLira) to that of once-daily insulin degludec/insulin aspart (IDegAsp) after switching from basal insulin therapy at 6months by assessing changes in hemoglobin A1c (HbA1c), body weight, and insulin doses in patients with type 2 diabetes (T2D). A total of 91 patients with T2D with HbA1c levels exceeding 7.0% were included in this study. Adjusted least square mean changes in HbA1c, body weight, and total insulin doses were compared between the IDegLira group and IDegAsp group. Subgroup analyses were performed, stratified by median values of HbA1c (< 8.5 and ≥ 8.5%), obesity (body mass index < 25 and ≥ 25kg/m2), and basal insulin doses (< 14 and ≥ 14 units) at baseline to assess treatment interaction by subgroup. The IDegLira group showed a greater reduction in HbA1c levels than the IDegAsp group (-0.17 vs -0.79%, p = 0.003) with comparable body weight changes. The analyses of adjusted mean changes of total insulin doses showed that the IDegAsp group had a larger increase than the IDegLira group (3.64 vs 1.30 unis, p = 0.016). The effect of IDegLira on HbA1c levels was superior to that of IDegAsp in patients with high HbA1c. There were no inter-group differences in the rate of hypoglycemic episodes. Once-daily IDegLira had greater effects on HbA1c and a lesser increase in insulin doses than IDegAsp when patients are switched from basal insulin therapy. Moreover, the effect on HbA1c was enhanced in patients with high HbA1c levels at baseline.

Increased Insulin Requirements in Severe Cases of Covid-19 are Higher Than in Moderate Cases.

Despite the low overall death rate of coronavirus disease 2019 (COVID-19), no study has examined the association between COVID-19 severity and the total daily insulin dose required for glycemic control. The aim of this study was to determine the maximum total daily insulin dose required according to COVID-19 severity, and the number of days required to reach the maximum insulin dose in patients with COVID-19 who used insulin during hospitalization. This retrospective cohort study included participants aged 20-90 years with a confirmed diagnosis of COVID-19 who used insulin during hospitalization at Kyoto Prefectural University of Medicine Hospital between March 4, 2020, and May 31, 2021. Factors associated with maximum insulin dose during hospitalization were evaluated using linear regression analyses. The maximum insulin doses were 31.8, 76.8, and 230.7 U/day, and the numbers of days between COVID-19 diagnosis and the need for maximum insulin were 15.6, 17.1, and 13.7 days in patients without ventilator management, with ventilator management, and with ventilator and extracorporeal membrane oxygenation management, respectively. Multivariate linear regression analyses revealed that hemoglobin A1c level (β = 15.87, P = 0.001), use of a ventilator (β = 50.53, P < 0.001), and use of extracorporeal membrane oxygenation (β = 150.36, P < 0.001) were independent determinants of maximum insulin dose. Patients with severe COVID-19 required a significantly higher maximum insulin dose than did those with moderate COVID-19. The maximum insulin dose was reached approximately 2weeks after onset. Furthermore, the hemoglobin A1c level on admission and the use of a ventilator or extracorporeal membrane oxygenation during hospitalization were associated with the need for maximum insulin dose.

Efficacy of Vijayasaradi capsule as add-on management in insulin-dependent type 2 diabetes – A randomized standard controlled clinical trial

BACKGROUND: In patients with hyperglycemia, the resistance to oral antihyperglycemic drugs may lead to insulin therapy. Insulin therapy has some limitations, such as the cost of medicine, dose monitoring, and the risk of hypoglycemia. The classical text of Ayurveda has described several formulations for treating diabetes. The role of Ayurveda antidiabetic formulations needs to be studied for controlling hyperglycemia and reducing the dose and frequency of insulin administration. Vijayasaradi capsule is an antidiabetic herbal formulation mainly utilized to treat hyperglycemia. Objective: This study aimed to evaluate the clinical efficacy of Vijayasaradi capsule as add-on management in the cases of insulin-dependent type 2 diabetes. MATERIALS AND METHODS: Seventy-nine patients of either sex with insulin-dependent diabetes mellitus (T2-IDDM) between 18 and 70 years were studied. The intervention for the control group (n = 38) was hypoglycemic drugs with insulin injections. The trial group (n = 41) was treated with the Vijayasaradi capsule, two capsules (500 mg each) thrice daily before food, hypoglycemic medicine, and insulin injection. The duration of the study was 3 months, and follow-ups were done weekly. Percentage changes of reduction in the units of insulin therapy, fasting and postprandial blood sugar levels, and hemoglobin A1c before and after the treatment and the associated subjective symptoms of type 2 diabetes were the primary outcome measures. RESULTS: The trial drug significantly decreased fasting blood sugar (P = 0.02) and postprandial blood sugar (P = 0.0001). The average insulin dose was also reduced from 33.27 ± 19 to 28.8 ± 80 units. A significant reduction (P = 0.001) in hemoglobin A1c was observed after the treatment. After the treatment, reduction in the maximum average insulin dose was also observed. CONCLUSION: Vijaysaradi capsule can be used as an add-on therapy to manage hyperglycemia and reduce insulin doses in patients with T2-IDDM.

Glycemic Outcomes of Hospitalized Patients on Ambulatory Humulin-R U-500 Insulin

ObjectiveManaging hospitalized patients on ambulatory U-500 insulin is challenging because of limited guidance on how to safely adjust insulin doses during admission. We sought to evaluate glycemic outcomes in relation to inpatient insulin doses in patients receiving U-500 prior to hospitalization. MethodsRetrospective study of hospitalized patients on ambulatory U-500 seen consecutively from January 2015 to December 2019. Primary outcomes were inpatient hypoglycemia, hyperglycemia, and normoglycemia at different insulin dosages expressed as weight-based (unit/kg/d) inpatient total daily dose (TDD) and ratio of inpatient to outpatient TDD. ResultsWe identified 66 admissions of 46 unique patients. The median (interquartile range) body mass index was 41.0 kg/m2 (35.1, 46.8), home TDD 212 units (120, 300), and home insulin dose 1.6 units/kg/d (1.1, 2.2). The median (interquartile range) inpatient insulin dose was 0.7 unit/kg/d (0.3, 1.0) and the ratio of inpatient to outpatient TDD was 0.4 (0.2, 0.8). Hyperglycemia persisted throughout the hospitalization. For the outcomes of hyperglycemia and normoglycemia, we found no association between increased levels of insulin dosages. For the outcome of hypoglycemia, significantly higher odds were observed when non-fasting patients received an inpatient TDD that was either > 40% of their home TDD or > 0.6 unit/kg/d of insulin. ConclusionPatients on ambulatory U-500 have significant hyperglycemia during admission. Inpatient insulin doses of 40% of home TDD or ≤ 0.6 unit/kg were not associated with increased hypoglycemia risk. Further prospective studies are needed to determine effective doses in these high-risk patients.

Efficacy of the mHealth application in patients with type 2 diabetes transitioning from inpatient to outpatient care: A randomized controlled clinical trial

IntroductionNo studies have assessed the efficacy of telemedicine using a platform for recording and adjusting insulin doses in patients with diabetes mellitus type 2 (DM2) transitioning from inpatient to outpatient care. This study aimed to assess, in a population of patients with DM2, discharged from a tertiary referral hospital, whether treatment based on the use of an mHealth application was associated with better glycemic control at the 3-month follow-up, than standard care. MethodsThis open, randomized, controlled clinical trial included adult DM2 patients who were transitioning from inpatient to outpatient care. The efficacy and safety of patient management with and without mHealth was compared at the 3-month follow-up. The primary outcome was the change in the Glycosylated hemoglobin (HbA1c) levels. The secondary outcomes were the rates of hypoglycemic and hyperglycemic events and treatment satisfaction measured using the Insulin Treatment Satisfaction Questionnaire (ITSQ). ResultsIn total, 86 patients (41 using mHealth) were included in the clinical trial. HbA1c levels showed a significant decrease in both groups. The mean HbA1c level was significantly lower in the mHealth group. Patients using mHealth showed decreased incidence rate ratios of hypoglycemia 3.0 mmol/L [<54 mg/dl], hypoglycemia ranging from 3.0 to 3.8 mmol/L [54 to 70 mg/dl] and severe hypoglycemia. The level of satisfaction assessed using the ITSQ was higher in the mHealth group. ConclusionUsing mHealth in patients with DM2 transitioning from inpatient to outpatient care improves metabolic control and may reduce the hypoglycemia rates.

Association of serum fibroblast growth factor 21 with diabetic complications and insulin dose in patients with type 1 diabetes mellitus.

IntroductionFibroblast growth factor (FGF) 21 is an important regulator of glycemic control, but the association between circulating FGF21 and diabetic complications is poorly understood. Moreover, basal FGF21 secretion, especially in response to insulin dose, in patients with type 1 diabetes mellitus (T1DM), has not been well examined. Therefore, this study aimed to determine the association of circulating FGF21 levels with diabetic complications and insulin dosage in middle-aged and elderly patients with T1DM.Materials and methodsA total of 127 middle-aged and elderly patients with T1DM, including 68 patients with diabetic complications, and 106 non-diabetic individuals were analyzed in this cross-sectional study. Information on demographic characteristics and T1DM was extracted from their electronic medical records. Serum FGF21 levels were determined using ELISA.ResultsSerum FGF21 levels were significantly lower in T1DM patients (75.2 [37.4–135.1] pg/mL) than in non-diabetic participants (151.6 [92.0–224.6] pg/mL; P < 0.001). No diabetic complications were associated with serum FGF21 concentrations. Both basal and bolus insulin doses were significantly and positively correlated with serum FGF21 levels (P < 0.05). Stepwise multiple regression analysis showed that FGF21 level was associated with age and body mass index (P < 0.05), while the basal insulin dose was an independent positive predictor of serum FGF21 levels (β = 0.197, P = 0.032).ConclusionsCirculating FGF21 levels are reduced in patients with T1DM; however, they are not associated with diabetic complications. In addition, aging, obesity, and insulin dosage are positive determinants of circulating FGF21.

Sex differences over time for glycemic control, pump use and insulin dose in patients aged 10–40 years with type 1 diabetes: a diabetes registry study

IntroductionTo evaluate sex differences in people with type 1 diabetes concerning changes in glycemic control and trends in insulin pump use and insulin dose over two decades in adolescents and...

Comparative efficacy and safety of glucose-lowering drugs as adjunctive therapy for adults with type 1 diabetes: A systematic review and network meta-analysis.

To assess the efficacy and safety of glucose-lowering drugs used as an adjunct to insulin therapy in adults with type 1 diabetes. We searched Medline, Embase and the Cochrane Central Register of Controlled Trials up to 24 January 2020 for randomized controlled trials. Our primary outcome was change in HbA1c. We additionally assessed eight efficacy and six safety secondary endpoints. We performed random effects frequentist network meta-analysis to estimate mean differences (MDs) and odds ratios (ORs), alongside 95% confidence intervals (CIs). We assessed risk of bias and evaluated confidence in the evidence for the primary outcome. We included 58 trials comprising 13 216 participants. Overall, sodium-glucose co-transporter (SGLT) inhibitors, liraglutide, glibenclamide, acarbose and metformin reduced HbA1c compared with placebo (MDs ranging from -0.46% [95% CI -0.64% to -0.29%] for empagliflozin to -0.20% [-0.35% to -0.06%] for metformin). SGLT inhibitors, exenatide daily, liraglutide and metformin reduced body weight and total daily insulin dose, while liraglutide and SGLT inhibitors reduced blood pressure. Diabetic ketoacidosis and genital infections were more frequent with SGLT inhibitors, while exenatide, liraglutide, pramlintide and metformin increased the incidence of nausea. No drug increased the incidence of severe hypoglycaemia. Confidence in evidence was mainly moderate to very low. Specific drugs may improve glycaemic control and reduce body weight, blood pressure and total daily insulin dose in patients with type 1 diabetes. However, low quality of evidence and an increased risk of diabetic ketoacidosis, genital infections or gastrointestinal adverse events should be taken into consideration by healthcare providers and patients. Future long-term trials are needed to clarify their benefit-to-risk profile and elucidate their role in clinical practice.

Application of Artificial Intelligence Techniques for the Estimation of Basal Insulin in Patients with Type I Diabetes.

Artificial intelligence techniques have been positioned in the resolution of problems in various areas of healthcare. Clinical decision support systems developed from this technology have optimized the healthcare of patients with chronic diseases through mobile applications. In this study, several models based on this methodology have been developed to calculate the basal insulin dose in patients with type I diabetes using subcutaneous insulin infusion pumps. Methods. A pilot experimental study was performed with data from 56 patients with type 1 diabetes who used insulin infusion pumps and underwent continuous glucose monitoring. Several models based on artificial intelligence techniques were developed to analyze glycemic patterns based on continuous glucose monitoring and clinical variables in order to estimate the basal insulin dose. We used neural networks (NNs), Bayesian networks (BNs), support vector machines (SVMs), and random forests (RF). We then evaluated the agreement between predicted and actual values using several statistical error measurements: mean absolute error (MAE), mean square error (MSE), root-mean-square error (RMSE), Pearson's correlation coefficient (R), and determination coefficient (R2). Results. Twenty-four different models were obtained, one for each hour of the day, with each chosen technique. Correlation coefficients obtained with RF, SVMs, NNs, and BNs were 0.9999, 0.9921, 0.0303, and 0.7754, respectively. The error increased between 06:00 and 07:00 and between 13:00 and 17:00. Conclusions. The performance of the RF technique was excellent and got very close to the actual values. Intelligence techniques could be used to predict basal insulin dose. However, it is necessary to explore the validity of the results and select the target population. Models that allow for more accurate levels of prediction should be further explored.

Determinants of High-Dose Insulin Usage and Upper Extremity Muscle Strength in Adult Patients With Type 2 Diabetes

ObjectivesIn this study, we aimed to determine the association between upper extremity muscle strength and insulin dose in patients with type 2 diabetes. MethodsA total of 236 patients with type 2 diabetes under insulin treatment for at least 1 year were included in this cross-sectional study. Patients were divided into 3 groups based on their total daily insulin dose (TDID): group 1, TDID >2 U/kg/day or >200 units/day; group 2, TDID 1 to 2 U/kg/day or 51 to 199 U/day; and group 3, TDID <0.5 U/kg/day or 50 U/day. High-dose insulin use was defined as total daily insulin dose >2 U/kg or >200 U/day. Muscle strength was measured using a handgrip dynamometer. ResultsHigh-dose insulin users were younger and had higher measures of generalized and central obesity and glycated hemoglobin. There was no significant difference in muscle strength between the groups. Low muscle strength was seen in 26.7% of all patients. Patients with low muscle strength were older, had lower insulin dose treatment and had better glycemic control than patients with normal muscle strength. Handgrip strength was inversely correlated with age, body mass index and duration of diabetes, but not with TDID. ConclusionsPatients with type 2 diabetes with high-dose insulin use had similar upper extremity muscle strength measurements with standard-dose insulin users. Studies with more patients are needed to determine the relationship between muscle mass, muscle strength and high-dose insulin use.

Kistik Fibrozis ile İlişkili Diyabet: Bir Olgu Sunumu

Kistik fibrozis ile ilişkili diyabet (KFİD), kistik fibrozisin (KF) yaygın bir komplikasyonudur. Kistik fibrozis ile ilişkili diyabetin temel nedeni hastalarda yıllar içerisinde pankreas hasarının artması ile beraber pankreas adacık hücrelerinin kaybı ve insülin eksikliğinin gelişmesidir. Tedavideki amaç çocuk ve adolesanlarda normal büyüme ve gelişmenin ve kan glukoz regülasyonunun sağlanmasıdır. Tedavinin temelini insülin tedavisi ve tıbbi beslenme tedavisi oluşturur. İnsülin tedavisi, KFİD hastalarında akciğer fonksiyonunu stabilize eder ve beslenme durumunu iyileştirir. Kistik fibrozis ile ilişkili diyabetli hastalara yüksek enerji, yüksek yağ ve yüksek tuz içeren bir beslenme planı önerilmektedir. Karbonhidrat sayımı, insülin tedavisi alan hastalarda öğün öncesi insülin dozunun belirlenmesinde yararlıdır. Bu yazıda kliniğimizde izlenen KFİD’li bir çocuk olgunun medikal ve tıbbi beslenme tedavisi literatür derlemesi eşliğinde sunulmuştur.

1042-P: Insulin Requirement during Total Parenteral Nutrition in Patients with Diabetes Mellitus

Glycemic control in patients with diabetes mellitus receiving total parenteral nutrition (TPN) can be challenging due to multiple factors. These patients often have a high burden of illness and receive medications that raise blood glucose (BG) levels. Moreover, TPN delivers a large amount of glucose directly into the systemic circulation without the benefit of incretin effect. Therefore, relatively large amounts of insulin are expected to be required for glycemic control. However, there are no studies to guide insulin dosing in patients with diabetes being started on TPN. We conducted a retrospective study including all patients with diabetes admitted to our hospital over a 1-year period who received TPN for ≥ 3 days. The goal of this study was to estimate a safe starting dose of insulin for TPN. Patients receiving enteral nutrition along with TPN were excluded. Insulin doses and blood glucose levels on the last day of TPN were used for data analysis. We found 25 patients who fulfilled our inclusion/exclusion criteria. All patients had type 2 diabetes and were receiving antidiabetic drugs before hospitalization. Mean age was 68 ± 7 years, 56% were men, 80% were White, 44% had microvascular and 44% had macrovascular complications. Mean BMI was 26.7 ± 6.7 kg/m2, systolic BP 131 ± 27 mmHg, diastolic BP 65 ± 15 mmHg, HbA1c 7.7 ± 2.3% and serum creatinine 2.7 ± 3.3 mg/dl. The mean daily BG on TPN was 212 ± 47 mg/dl. Out of 171 BG values available on the last day of TPN, 116 (68%) were &amp;gt;180 mg/dl, 4 (2%) were &amp;lt;70 mg/dl and 0 were &amp;lt;40 mg/dl. Only two patients suffered mild hypoglycemic episodes while all others remained hyperglycemic. Average total daily insulin dose was 17 ± 20 units before starting TPN and 53 ± 54 units on the last day of TPN. Patients received an average of 0.7 Units/kg total daily dose of insulin on the last day of TPN. With this dose, they had minimal risk of hypoglycemia but the glucose levels were often high. Our study shows that the majority of patients with diabetes need more than 0.7 units/kg insulin when receiving TPN. Disclosure R. Garg: None. A. Arunachalam: None. L.E. Bermudez: None. M. Ramirez: None.

The Effect of In Vitro-digestion on Mammalian Milks’ Insulin and IGF-1

Abstract Objectives This study investigated the impact of in vitro-digestion and spray-dry processing on insulin concentration and insulin growth factor-1 (IGF-1) in milk from several species. Diabetes is a growing health problem in the U.S. and worldwide, predicted to affect 642 million people by 2040. To date, insulin therapy is considered to be the best treatment due to its low side effects. However, insulin treatment in type-2 diabetes can lead to insulin resistance. Natural alternatives are used to treat diabetes in many regions of the world, and mechanisms of action need investigating. Literature shows that daily camel milk consumption led to a decrease in insulin dose in patients with type 1 diabetes and can improve glucose control in type-2 diabetes. The presence of bioactive insulin has been hypothesized as a mechanism for this effect. Methods Human Insulin and Bovine IGF-1 immunoactivity were measured in milk from Human, Bovine, Goat, and Camel and spray dried milk from goat and camel by ELISA (RayBioTech) with microplate reader. Raw and pasteurized samples subjected to in vitro digestion were also measured. Results Raw goat and camel milk showed insulin immunoreactivity with approximately 31, and 20 µIU/mL, respectively. Spray-dried goat and camel milk from different animals showed insulin immunoreactivity of approximately 26, and 20 µIU/mL, respectively. Insulin immunoactivity in bovine and human milk was 16 and 20 µIU/mL. In vitro digestion did not decrease insulin levels in either goat or camel milk, but significantly reduced human and bovine milk insulin immunoactivity. Bovine IGF1 did not cross react with this anti-human insulin antibody. IGF-1 immunoactivity was present in goat milk at very low concentration but not detected in other samples. Conclusions Goat and camel milk (fresh and spray dried) had high insulin concentrations. There was no impact of in vitro-digestion and spray dried processing on insulin levels. IGF-1 was only present in raw goat milk. IGF-1 was not detected in camel milk samples suggesting that the antidiabetic effects of camel milk is due to its insulin concentration and the ability of the insulin to survive gastric and intestinal digestion, as well as pasteurization. Funding Sources NIFA; NCSU.

Open-Label Study to Assess the Efficacy of Ipragliflozin for Reducing Insulin Dose in Patients with Type 2 Diabetes Mellitus Receiving Insulin Therapy.

Background and ObjectiveTo avoid insulin-induced hypoglycemia and weight gain, the minimum dose of insulin should be used. In this study, therefore, we examined insulin dose reduction by ipragliflozin add-on therapy in Japanese patients with type 2 diabetes mellitus treated with long-acting basal insulin.MethodsIn this multicenter, open-label study, patients received one ipragliflozin 50-mg tablet once daily in combination with basal insulin for 24 weeks. The primary efficacy endpoint was the change and percent change in insulin dose from baseline to Week 24. Secondary efficacy endpoints included changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), glycoalbumin, cholesterol, leptin, adiponectin, C-peptide, glucagon, body weight, and blood pressure, and number of patients achieving withdrawal of insulin at the end of treatment (EOT). Treatment-emergent adverse events (TEAEs) were evaluated for safety.ResultsIn total, 114 patients were screened, 103 were registered, and 97 completed the study. The mean age was 59 years and 72.8% of patients were male. The mean change in insulin dose from baseline at Week 24 was − 6.6 ± 4.4 units/day (p < 0.001); the mean percent change was − 29.87%. HbA1c, FPG, glycoalbumin, glucagon levels, body weight, and blood pressure significantly decreased from baseline to EOT (p < 0.05). Cholesterol, leptin, and adiponectin were unaffected. One patient was able to stop insulin treatment at Week 16. The incidence of TEAEs was 60.2%. Hypoglycemia (10.7%) and pollakiuria (13.6%) were the most common drug-related TEAEs. Conclusions Once-daily 50-mg ipragliflozin enabled a 30% dose reduction of insulin by Week 24 compared with baseline. No major safety concerns were raised.Clinical Trial RegistrationClinicalTrials.gov (NCT02847091)Electronic supplementary materialThe online version of this article (10.1007/s40261-019-00851-z) contains supplementary material, which is available to authorized users.

Research progress of exercise therapy on type 1 diabetes mellitus

Type 1 diabetes mellitus (T1DM) is mostly an autoimmune disease. The combined effects of genetic and environmental factors lead to progressive islet beta cell functional failure and lifelong dependence on exogenous insulin therapy. Numerous studies have shown that regular physical exercise may reduce the daily insulin dose in patients with T1DM and patients need to be clear how to safely increase their physical activity, and incorporate more independent physical activity into daily life. At the same time, they should master the contraindications in order to avoid the risks of movement. Currently a recommendation for all T1DM patients is engaging in at least 150 min/week of moderate to vigorous intensity aerobic exercise, sustainability or high-intensity interval training, combined with resistance training such as resistance machines and bands, as well as other stretching and balance exercises such as yoga, tai chi, for 3 to 7 times per week, which is depended on the physical condition of patients and the exercise intensity, besides resistance training can be performed on nonconsecutive days. Key words: Diabetes mellitus, type 1; Insulin; Exercise prescription; Exercise therapy

Addition of canagliflozin to insulin improves glycaemic control and reduces insulin dose in patients with type 2 diabetes mellitus: A randomized controlled trial.

The aim of this study was to evaluate the efficacy of canagliflozin in reducing the required insulin dose and the risk of hypoglycaemia in type 2 diabetes (T2D). This study was conducted in patients with T2D treated with insulin. They were randomly assigned to the control (n = 17) and canagliflozin (n = 17, plus 100 mg/day canagliflozin) groups. In both groups, a defined insulin dose adjustment protocol was applied to achieve the same level of glycaemic control. The change from baseline in daily insulin dose was significantly smaller in the canagliflozin group (3.9 units/day) than in the control group (13.4 units/day; P = 0.040). Low blood glucose index and predicted % of blood glucose (BG) <70 mg/dL, which are hypoglycaemia-related variables, worsened significantly in the control group but both remained unchanged in the canagliflozin group. The standard deviation for night-time BG levels improved significantly only in the canagliflozin group. Supplementation of insulin therapy with 100 mg canagliflozin in patients with T2D reduced the required insulin dose and hypoglycaemic risk and flattened night-time glycaemic fluctuations while maintaining the same level of glycaemic control.

1230-P: Addition of Canagliflozin to Insulin Improves Glycemic Control and Reduces Insulin Dose in Patients with Type 2 Diabetes Mellitus: A Study Based on Continuous Glucose Monitoring

Background and Aims: No studies have compared insulin dose or hypoglycemic risks between type 2 diabetes mellitus (T2DM) treated with and without Sodium glucose cotransporter-2 (SGLT2) inhibitors using defined criteria for insulin dose adjustment to achieve the same level of glycemic control. The aim of this study was to evaluate the efficacy of canagliflozin in reducing the required insulin dose and the risk of hypoglycemia in T2DM. Materials and Methods: This randomized, two-group comparative study was conducted in 34 patients treated with insulin alone or combined with oral hypoglycemic agents. They were randomly assigned to the control (n=17, insulin) and canagliflozin (n=17, insulin plus 100 mg/day) groups and wore a continuous glucose monitoring (CGM, ipro2®) for 14 days. In both groups, a defined insulin dose adjustment protocol was applied to achieve the same level of glycemic control. Results: The change from baseline in daily insulin dose was significantly smaller in the canagliflozin group (3.9 units/day) than control group (13.4 units/day; p = 0.040). Low blood glucose index (LBGI) and predicted % of blood glucose (BG) &amp;lt;70 mg/dL, which are hypoglycemia-related parameters, worsened significantly in the control group, but both remained unchanged in the canagliflozin group. The SD for nighttime BG levels improved significantly only in the canagliflozin group. Participants’ body weight (BW) decreased in both groups, but the change in BW showing a significant decrease in the canagliflozin group. Conclusion: Supplementation of insulin therapy with 100 mg canagliflozin in patients with T2DM reduced the required insulin dose and hypoglycemic risk and flattened nighttime glycemic fluctuations while maintaining the same level of glycemic control. The addition of SGLT2 inhibitors may provide several benefits to patients on insulin therapy, enabling them to maintain strict glycemic control. Disclosure K. Torimoto: None. Y. Okada: None. Y. Sato: None. Y. Tanaka: None.

Lag Time Remains with Newer Real-Time Continuous Glucose Monitoring Technology During Aerobic Exercise in Adults Living with Type 1 Diabetes.

Background: Real-time continuous glucose monitoring (CGM) devices help detect glycemic excursions associated with exercise, meals, and insulin dosing in patients with type 1 diabetes (T1D). However, the delay between interstitial and blood glucose may result in CGM underestimating the true change in glycemia during activity. The purpose of this study was to examine CGM discrepancies during exercise and the meal postexercise versus self-monitoring of blood glucose (SMBG).Methods: Seventeen adults with T1D using insulin pump therapy and CGM completed 60 min of aerobic exercise on three occasions. A standardized meal was given 30 min postexercise. SMBG was measured during exercise and in recovery using OmniPod® Personal Diabetes Manager (PDM; Insulet, Billerica, MA) with built-in glucose meter (FreeStyle; Abbott Laboratories, Abbott Park, IL), while CGM was measured with Dexcom G4® with 505 algorithm (n = 4) or G5® (n = 13), which were calibrated with subjects' own PDM.Results: SMBG showed a large drop in glycemia during exercise, while CGM showed a lag of 12 ± 11 (mean ± standard deviation) minutes and bias of −7 ± 19 mg/dL/min during activity. Mean absolute relative difference (MARD) for CGM versus SMBG was 13 (6–22)% [median (interquartile range)] during exercise and 8 (5–14)% during mealtime. Clarke error grids showed CGM values were in zones A and B 94%–99% of the time for SMBG.Conclusion: In summary, the drop in CGM lags behind the drop in blood glucose during prolonged aerobic exercise by 12 ± 11 min, and MARD increases to 13 (6–22)% during exercise as well. Therefore, if hypoglycemia is suspected during exercise, individuals should confirm glucose levels with a capillary glucose measurement.

A Pragmatic Clinical Trial to Compare the Real-World Effectiveness of V-Go versus Standard Delivery of Insulin in Patients with Advanced Type 2 Diabetes.

BackgroundMany patients with type 2 diabetes mellitus (T2DM) do not have adequate glycemic control, leading to poor patient outcomes and high healthcare costs.ObjectiveThis prospective pragmatic clinical trial evaluated V-Go, a wearable insulin delivery device, compared with standard treatment optimization (STO) among insulin-treated patients with T2DM in a real-world, community-based practice setting.MethodsStudy sites, rather than individual patients, were randomized to V-Go or STO via cluster randomization. Patients were treated according to routine clinical practice and followed up to 4 months. T2DM medications and supplies were purchased utilizing usual insurance and co-pay systems. The primary analysis was an unadjusted treatment group comparison of glycosylated hemoglobinA1c (HbA1c) change from baseline to end of study (EOS). A cost of therapy analysis was completed on patients who had received comparable baseline T2DM treatment with multiple daily basal-bolus insulin injections (MDI).ResultsAnalysis included 415 patients (169 V-Go, 246 STO) enrolled from 52 US sites. Mean baseline HbA1c (9.6%) was higher in V-Go (9.9%, range 8.0% – 14.2%) than STO (9.3%, range 7.9% – 13.9%, p <.001). HbA1c decreased from baseline to EOS in both V-Go (−1.0%, p<.001) and STO (−0.5%, p<.001); V-Go had significantly larger decrease (p=.002). V-Go had a significant reduction (p<.001) in mean insulin total daily dose (TDD; 0.76 U/kg baseline, 0.57 U/kg EOS), not seen in STO (0.72 U/kg baseline and EOS). The MDI group included 95 (56.2%) V-Go and 113 STO (45.9%) patients. Mean baseline HbA1c was significantly higher in V-Go (9.9%) than STO (9.4%). V-Go also experienced larger decrease in HbA1c from baseline (−1.0%) than STO (−0.36%) (p=.006) with a decrease in TDD, while STO TDD remained unchanged. EOS mean per patient per day cost of diabetes treatment was lower for V-Go ($30.59) vs STO ($32.20) (p=.006). V-Go was more cost effective than STO ($24.02 per 1% drop in HbA1c vs $58.86, respectively).ConclusionsThis pragmatic clinical trial demonstrated improved HbA1c levels, lower cost, and decreased insulin dose in patients with T2DM initiating V-Go vs STO in a real-world community-based practice setting. Observed baseline HbAlc indicated use of V-Go in more difficult to manage diabetes patients.