Long-term Continuous Subcutaneous Infusion Research Articles

Evaluation of Glycaemic Control, Glucose Variability and Hypoglycaemia on Long-Term Continuous Subcutaneous Infusion vs. Multiple Daily Injections: Observational Study in Pregnancies With Pre-Existing Type 1 Diabetes.

IntroductionWe evaluated the effectiveness of long-term continuous subcutaneous insulin infusion (CSII) compared with multiple daily insulin (MDI) injections for glycaemic control and variability, hypoglycaemic episodes and maternal/neonatal outcomes in pregnant women with pre-existing type 1 diabetes (pT1D).MethodsOur observational cohort study included 128 consecutive pregnant women with pT1D, who were treated from 1 January 2010 to 31 December 2017. Of 128 participants, 48 were on CSII and 80 were on MDI. Glycaemic control was determined by glycated haemoglobin (HbA1c) (captured in preconception and each trimester of pregnancy). Glucose variability (GV) was expressed as the coefficient of variation (CV) [calculated from self-monitoring of blood glucose (SMBG) values], and hypoglycaemia was defined as glucose values < 3.9 mmol/l. The data on maternal and neonatal outcomes were collected from obstetrical records.ResultsDuration of the treatment was 8.8 ± 5.3 years in the CSII and 12.6 ± 8.0 years in the MDI group. The CSII lowered HbA1c in preconception (7.1 ± 0.1 vs. 7.9 ± 0.2%, p = 0.03) and the first (6.9 ± 0.1 vs. 7.7 ± 0.2%, p = 0.02), second (6.6 ± 0.1 vs. 7.2 ± 0.1%, p = 0.003) and third (6.5 ± 0.1 vs. 6.8 ± 0.1%, p = 0.02) trimesters significantly better than MDI. Significantly lower CV was observed only for fasting glycaemia in the first trimester (17.1 vs 28.4%, p < 0.001) in favour of CSII. Moreover, the CSII group had significantly lower mean hypoglycaemic episodes/week/patient only during the first trimester (2.0 ± 1.7 vs 4.8 ± 1.5, p < 0.01). In early pregnancy, the majority of women on CSII had less hypoglycaemia than on MDI (0–3: 79.1 vs. 29.1%; 4–6: 18.8 vs. 65.8%; ≥ 7: 2.1 vs. 5.1%, p < 0.01, respectively). We found no difference in the incidence of adverse maternal/neonatal outcomes.ConclusionsTreatment with CSII resulted in a favourable reduction of HbA1c in the preconception period and each trimester in pregnancy. Moreover, long-term CSII treatment demonstrated more stable metabolic control with less GV of fasting glycaemia and fewer hypoglyacemic episodes only during early pregnancy.Electronic supplementary materialThe online version of this article (10.1007/s13300-020-00780-7) contains supplementary material, which is available to authorized users.

Long-term Continuous Subcutaneous Infusion of Ketoprofen Combined With Morphine: A Safe and Effective Approach to Cancer Pain

According to international guidelines, nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids are the cornerstone drugs for cancer pain. In clinical practice, severe cancer pain often requires 3 step analgesics and alternative routes of administration, thus NSAIDs are usually abandoned. Our aim was to evaluate feasibility, safety, and efficacy of ketoprofen combined with opioids in long-term continuous subcutaneous infusion (CSI) for cancer pain in a prospective observational open-label pilot study. Ketoprofen was added to morphine CSI in 172 consecutive patients (study group, SG). Concomitantly, 48 received opioids CSI without ketoprofen for contraindication to NSAIDs (control group, CG). CSI was delivered through a single-use elastomeric pump refilled weekly. Safety was evaluated according to the number of adverse events and their severity. The measures of efficacy were pain relief (NRS, Numerical Rating Scale), percentage of patients that needed to increase morphine dosage, and median relative increase between weeks 2 and 4. Toxicity typically attributable to NSAIDs were recorded in 4.1% of patients after 3 months of treatment and the combination of NSAIDs and corticosteroids seems not to influence the risk of gastrointestinal adverse effects. The local side effects related to the CSI regimen were negligible in both the groups. By the fourth week, pain was well controlled (NRS 0 to 2) in 80% of patients receiving ketoprofen compared with 46% of patients without ketoprofen (P<0.01.) Moreover, the percentage of patients needing to increase the morphine dosage (40.5% vs. 68.7% P<0.01) and the relative dose increase (12% vs. 25% P<0.005) were significantly lower in the SG. Ketoprofen CSI in combination with opioids is a feasible, safe, and effective approach to cancer pain.

The pharmacological therapeutic management of levodopa-induced dyskinesias in patients with Parkinson's disease.

The clinical management of levodopa-induced dyskinesia is difficult. Once present, dyskinesias are only partially improved by lowering the daily dose of levodopa and co-administering a D2 dopamine agonist. Therefore it appears to be necessary to use an NMDA-antagonist, such as amantadine, as an antidyskinetic agent. Clozapine may also improve dyskinesia without worsening akinesia, but it requires strict haematological monitoring. A long-term continuous subcutaneous infusion of apomorphine significantly reduces the dose of levodopa required, thereby markedly reducing dyskinesia, but this is difficult from a practical point of view. If none of these pharmacological strategies is successful, surgery should then be considered. Since the management of established levodopa-induced dyskinesia is difficult and often disappointing, efforts should be encouraged to try to prevent the occurrence of dyskinesia, before levodopa priming. This seems to be best achieved by the use of D2 dopamine agonists in the early stages of the disease, before, or in combination with, levodopa.

The Effect of Long-Term High-Dose Naloxone Infusion in Experimental Blunt Spinal Cord Injury

The effect of long-term continuous subcutaneous infusion of naloxone on blunt spinal cord injury in the rat was assessed using four tests of neurological function, seven histological categories, and two electrophysiological measures. All four neurological function tests showed a trend toward improvement in naloxone-treated animals: the degree of improvement was statistically significant in two of the four categories. A significant reduction in myelin sheath edema was found in the naloxone-treated animals. Although there was a decrease in corticomotor-evoked potentials complexity following injury, there was no significant difference in naloxone-treated animals. Somatosensory-evoked potentials were significantly increased in amplitude and latency in naloxone-treated animals. This increase was most apparent at 60 min: no difference was found by 3 weeks postinjury. These results confirm earlier reports that naloxone can ameliorate the functional neurological deficits of spinal cord injury. Naloxone also produces alterations in the somatosensory-evoked responses in the early phase of treatment and significantly reduces myelin sheath edema.