Multiple Insulin Injections Research Articles

Influence of Timing of Insulin Initiation on Long-term Glycemic Control in Japanese Patients with Type 2 Diabetes: A Retrospective Cohort Study.

Objective Delays in insulin initiation can lead to the development of complications in the management of type 2 diabetes. Methods In this study, the effects of the timing of insulin initiation on glycemic control in patients with type 2 diabetes were evaluated retrospectively. Changes in the HbA1c levels of 237 patients were analyzed after insulin initiation. Results The patients were divided into 4 groups according to the duration of diabetes at the time of insulin initiation: ≤3 years, 4 to 6 years, 7 to 9 years, or ≥10 years. Patients with a diabetes duration of ≤3 years were more frequently hospitalized at the time of insulin initiation, had a higher HbA1c level before insulin initiation and a lower HbA1c level at 1 year after insulin initiation and exhibited significant decreases in HbA1c at 1, 3, or 5 years after insulin initiation than those in the other 3 groups with longer durations of diabetes. In the group receiving 4 insulin injections per day, the reduction in HbA1c after 5 years of treatment was larger in patients with a diabetes duration at the time of insulin initiation of ≤3 years than in those with a duration of 7 to 9 years or ≥10 years. Conclusion Our results suggested that an earlier initiation of insulin therapy was crucial for sustaining glycemic control in Japanese patients with type 2 diabetes, particularly in those with a history of obesity or receiving multiple insulin injections daily.

Combination use of liraglutide and insulin to Japanese patients with multiple insulin injection: efficacy and cost.

The introduction of liraglutide in the treatment of patients with type 2 diabetes already taking insulin is still subject to discussion in terms of timing and benefits. Gradually intensive insulin therapy is hastily prescribed. Switching from multiple insulin injection (MII) to insulin and liraglutide is evaluated in this study. We studied 92 patients with type 2 diabetes previously under MII, C-peptide ≥ 1.5ng/ml, divided into a group with reasonable glycemic control [RC: HbA1c < 8% (64mmol/mol)] and another with a poor control [PC: HbA1c ≥ 8%, (64mmol/mol)] after introduction of liraglutide and insulin therapy. Except for HbA1c, there were no statistical differences between RC and PC groups. Basal insulin doses were adjusted to achieve the fasting plasma glucose of 90-120mg/dl. HbA1c was significantly improved in both groups, from 9.6% ± 1.6 (81mmol/mol) and 7.0% ± 0.6 (53mmol/mol) to 8.0% ± 1.5 (64mmol/mol) and 6.8 ± 0.5% (51mmol/mol). Reduction of body weight was significant only in RC (from 70 ± 16kg to 68 ± 16kg, p < 0.01). All patients from RC group and 58% of PC group reached HbA1c < 8% without hypoglycemia. This observation persuades us to propose the liraglutide and insulin combination to patients with C-peptide ≥ 1.5ng/ml, regardless of the HbA1c.

Impact of sensor-augmented pump therapy with predictive low-glucose management on hypoglycemia and glycemic control in patients with type 1 diabetes mellitus: 1-year follow-up

AimsTo describe real-life experience with sensor-augmented pump therapy with predictive low-glucose management (SAPT-PLGM), in terms of hypoglycemia and glycemic control after one year of follow-up in T1D patients with hypoglycemia as the main indication of therapy. MethodsRetrospective cohort study under real life conditions. Baseline and one-year follow-up variables of glycemic control, hypoglycemia and glycemic variability were compared. ResultsFifty patients were included, 31 on prior treatment with SAPT with low-glucose suspend (LGS) feature and 19 on multiple dose insulin injections (MDI). Mean HbA1c decreased in the MDI group (8.24%–7.08%; p = 0.0001). HbA1c change was not significant in the SAPT-LGS group. Area under the curve (AUC) below 70 mg/dl improved in both SAPT-LGS and MDI groups while AUC, %time and events below 54 mg/dl decreased in SAPT-LGS group. Glycemic variability improved in the MDI group. Less patients presented severe hypoglycemia with SAPT-PLGM in both groups, however the change was non-significant. ConclusionsUnder real life conditions, SAPT-PLGM reduced metrics of hypoglycemia in patients previously treaded with MDI and SAPT-LGS without deteriorating glycemic control in SAPT-LGS patients, while improving it in patients treated with MDI.

Minimizing postprandial hypoglycemia in Type 1 diabetes patients using multiple insulin injections and capillary blood glucose self-monitoring with machine learning techniques

Background: Diabetic patients treated with intensive insulin therapies require a tight glycemic control and may benefit from advanced tools to predict blood glucose (BG) concentration levels and hypo/hyperglycemia events. Prediction systems using machine learning techniques have mainly focused on applications for sensor augmented pump (SAP) therapy. In contrast, insulin bolus calculators that rely on BG prediction for multiple daily insulin (MDI) injections for patients under self-monitoring blood glucose (SMBG) are scarce because of insufficient data sources and limited prediction capability of forecasting models.Methods: We trained individualized models that can predict postprandial hypoglycemia via different machine learning algorithms using retrospective data from 10 real patients. In addition, we designed and tested a hypoglycemia reduction strategy for a similar in silico population. The system generates a bolus reduction suggestion as the scaled weighted sum of the predictions. We evaluated the general and postprandial glycemic outcomes of the in silico population to assess the systems capability of avoiding hypoglycemias.Results: The median [IQR] sensitivity and specificity for hypoglycemia cases where the BG level was below 70 mg/dL were 0.49 [0.2–0.5] and 0.74 [0.7–0.9], respectively. For hypoglycemia cases where the BG level was below 54 mg/dL, the median [IQR] sensitivity and specificity were 0.51 [0.4–0.6] and 0.74 [0.7–0.8], respectively.Conclusions: The results indicated a decrease of 37% in the median number of postprandial hypoglycemias median decrease of 44% for hypoglycemias of 70 mg/dL and 54 mg/dL, respectively. This dramatic reduction makes this method a good candidate to be integrated into any Decision Support System for diabetes management.

1103-P: Glucose-Responsive Insulin: An Unprecedented Cleavable Linker Concept

Achieving the optimal combination of multiple glucose measurements and insulin injections provides a complex daily situation for most insulin-dependent diabetes patients with currently available insulin products. To date, several fast-acting and long-acting insulins have been developed. However, while the pharmacokinetic profiles have been optimized, it has remained an elusive goal for decades to develop a Glucose Responsive Insulin (GRI), which can be responsive to the fluctuations in blood glucose concentrations during the day. Here we present an unprecedented GRI concept. The concept is based on the hydrolysis of a cleavable linker that is covalently bound to insulin. The chemical nature of this central linker is designed to rapidly release active insulin when glucose rises above euglycemia (5 mM), and this release of active insulin will increase with increasing blood glucose concentration. The second element of the concept is an albumin-mediated inactivation of the GRI by lipidation. After injection, the GRI will bind to albumin and circulate as a depot, resulting in a slow release of insulin like seen with other basal insulins such as insulin Detemir. At the linker level, we have tested three concentrations of glucose, and glucose responsiveness was demonstrated by a decrease in reaction time with increasing glucose concentration. Moreover, fully conjugated GRI molecules were tested in 90% pancreatectomized rats, a model of type 1 diabetes, demonstrating significant and long-lasting glucose lowering effect as compared to control. Overall, we have demonstrated the feasibility of providing a GRI approach, which combines the properties of a basal insulin with that of a bolus insulin. With the circulating depot approach the concept also holds a promise for liver preference. Ultimately our approach could provide a safe insulin for the treatment of insulin-dependent diabetes with very low risk of side effects. Disclosure K. Mannerstedt: Employee; Self; Gubra. E. Engholm: Employee; Self; Gubra. N.K. Mishra: Employee; Self; Gubra. M. Lundh: Employee; Self; Gubra. N. Buch-Månson: None. L.N. Fink: Employee; Self; Gubra. Stock/Shareholder; Self; Novo Nordisk A/S. S.L. Pedersen: None. P.J. Pedersen: Employee; Self; Gubra. P. Le-Huu: Employee; Self; Gubra, Novo Nordisk A/S. Employee; Spouse/Partner; Novo Nordisk A/S. J. Lai: Employee; Self; Gubra. K.J. Jensen: Consultant; Self; Gubra. Stock/Shareholder; Self; Gubra. K. Fosgerau: Stock/Shareholder; Self; Gubra.

200-LB: Pregestational Diabetes and Pregnancy Outcomes

Pre-gestational diabetes, type 1 diabetes (T1DM) and type 2 diabetes (T2DM) are associated with adverse outcomes: miscarriage, stillbirth, macrosomia and increased rates of emergency cesarean sections (EMCS). We reviewed 175 women with pre-gestational diabetes who attended the National Maternity Hospital in Dublin, Ireland between 2015 to 2017. Fifty women (28.6%) had T2DM and 125 women (71.4%) had T1DM. The mean age for T1DM group was (34 ± 4.7years) and T2DM (35.5 ± 3.8 years). Most of our patients were of European descent (85%) others were mostly of Asian and North African origin (15%). Mean duration of diabetes was 5.4 years in T2DM and 15.7 years in T1DM. Structured pre-pregnancy planning attended by 38.3% of our patients. Pre-pregnancy folic acid was used by 45.7% of patients for at least one month prior to booking. Forty women (29%) of T1DM were on Continuous Subcutaneous Insulin Infusion (CSII). Patients with T2DM were treated with Metformin (20%) only, Metformin and multiple dose insulin (MDI) injection combined (44%), MDI (28%) and diet control alone (2%). Mean BMI for T2DM was 32.6 ± 8.1 kg/m2 at booking and for T1DM 26.2 ± 4.5 kg/m2. Diabetic Retinopathy was more frequent in T1DM. The HBA1C in CSII group was 53.5 mmol/mol in the first trimester and improved to 42.9 mmol/mol in the third. T1DM group on MDI had HBA1C of 56.9 mmo/mol at booking and 44.7 mmol/mol in the third trimester. The mean HBA1C in T2DM at booking was 44.5 mmol/mol and 37.5 mmol/mol in the third trimester. Cesarean section (CS) was common in T1DM 48% with mostly EMCS 32%. In T2DM rate of CS was 38%. The most neonatal ICU (NICU) admission was due to hypoglycemia; in the T1DM group was 16.5% and 10% in T2DM group. Total neonatal birth weights above 4.0 Kg in our cohort was 21.7%. Our cohort with pre-gestational diabetes were overweight, older with long standing diabetes. Initial inadequate diabetes control in T1DM was better in patients with CSII with a significant improvement during pregnancy in all patients. With appropriate multidisciplinary treatment we minimized adverse outcomes. Disclosure D.S.A. Ali: None. M. Hatunic: None.

Association of diabetes treatment with long-term glycemic patterns in patients with type 2 diabetes mellitus: A prospective cohort study.

AimThis study aimed to analyze diabetes treatment and treatment changes in association with long‐term glycemic patterns in an Asian population with diabetes.Materials and methodsThis was a prospective cohort study of 6218 patients with type 2 diabetes managed in public primary care clinics in Singapore. Clinical data from 2011 to 2016 were extracted from electronic medical records, including serial HbA1c measurements and dispensed antidiabetic medication records. Patterns of longitudinal HbA1c trajectories were identified using latent class growth analysis, and patients' annual treatment plans were compared between subgroups with different HbA1c patterns.ResultsWe identified four distinct HbA1c patterns. Eighty‐one percent of patients were classified in the low‐stable group, where monotherapy and dual therapy with oral agents were the most common treatments. We also identified three groups with poorer control, with moderate‐stable (14%), moderate‐increase (3%), and high‐decrease (2%) HbA1c patterns. Insulin treatment was most prevalent in these groups, with 61% to 72% of subjects receiving insulin treatment in 2016. More than 60% of subjects in poorer control groups had experienced treatment intensification during follow‐up. Addition of multiple insulin injections was the most common intensification in moderate‐increase and high‐decrease groups.ConclusionsTreatment reflected and was appropriate to the extent of dysglycemia in this population. A small group of patients had deteriorating glycemic control, in spite of being treated with multiple insulin injections, suggesting non‐response or non‐adherence to treatment. Further investigation is needed to identify reasons for the deteriorating control observed and design effective interventions for these patients.

Effects of flash glucose-sensing technology-based continuous glucose monitoring on compliance of patients with type 2 diabetes mellitus: study protocol for a randomized controlled trial

Background and objectives: Multiple insulin injection therapy has been widely used in the intensive treatment of diabetes mellitus and enabled more patients to obtain good glycemic control. Intensive insulin treatment such as multiple insulin injection every day had been proven to have effects on the protection of islet and delay the onset of diabetic complications. However, during the insulin intensive therapy, severe hypoglycemia must be avoided by intensive glucose monitoring because it can increase the risks of stroke and cardiovascular disease. Conventional invasive intensive blood glucose monitoring is limited in clinical practice because it can cause patient pain and inconveniences. Patient's poor compliance in blood glucose monitoring would restrict the application of insulin intensive therapy in patients outside the hospital. The latest method of flash glucose-sensing technology-based continuous glucose monitoring (CGM) made insulin intensive therapy safer and less painful for a patient with diabetes mellitus. However, little is reported on the effects of flash glucose-sensing technology based CGM in patients receiving multiple daily injections of insulin. This study will provide evidence to validate whether flash glucose-sensing technology-based CGM can increase the behavioral self-monitoring and compliance with self-management of a Chinese patient with diabetes mellitus receiving multiple daily injections of insulin compared with conventional invasive blood glucose monitoring. Subjects and methods: This is a prospective, single-center, open-label, randomized controlled trial. Forty patients with type 2 diabetes mellitus who receive multiple daily injections of insulin at the Department of Endocrinology, Northern Jiangsu People's Hospital, Yangzhou University, China between August 2018 and December 2019 are included in this study. These patients are randomly divided to undergo conventional blood glucose monitoring (n = 20) or a flash glucose-sensing technology-based CGM group (n = 20). Patient recruitment began in August 2018 and will end in June 2019. Analysis of primary outcome measure will be completed in June 2019. The study will end in December 2019. Study protocol: 1.0. The protocol was approved by the Medical Ethics Committee of Northern Jiangsu People's Hospital (approval No. 2018045) and is performed in strict accordance with the Declaration of Helsinki formulated by the World Medical Association. All participants provide written informed consent. Outcome measures: The primary outcome measure is the compliance of glycemic monitoring. The secondary outcome measures include the time taken for reaching the goal of glycemic control, HbA1c, self-management scores, the number of hypoglycemia attacks, and Hamilton Anxiety Scale score. Discussion: This study will provide evidence to validate whether flash glucose-sensing technology can increase patient's compliance of intensive insulin treatments, control blood glucose, and improve quality of life. Trial registration: This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017456) on July 31, 2018.

Hypoglycaemic effects of glimepiride in sulfonylurea receptor 1 deficient rat.

Sulfonylureas (SUs) have been suggested to have an insulin-independent blood glucose-decreasing activity due to an extrapancreatic effect. However, a lack of adequate in vivo evidence makes this statement controversial. Here, we aimed to evaluate whether glimepiride has extrapancreatic blood glucose-lowering activity in vivo. Sulfonylurea receptor 1 deficient (SUR1-/- ) rats were created by means of transcription activator-like effector nucleases (TALEN)-mediated gene targeting technology. Type 2 diabetic models were established by feeding a high-fat diet and administering a low-dose of streptozotocin. These rats were then randomly divided into four groups: glimepiride, gliclazide, metformin and saline. All rats were treated for 2weeks. Glimepiride decreased blood glucose levels and increased insulin sensitivity without elevating insulin levels. Gliclazide showed similar effects as glimepiride. Both agents were weaker than metformin. Further mechanistic investigations revealed that glimepiride increased hepatic glycogen synthesis and decreased gluconeogenesis, which were accompanied by the activation of Akt in the liver. Moreover, glimepiride increased both total and membrane glucose transporter 4 (GLUT4) levels in muscle and fat, which might be attributed to insulin receptor-independent IRS1/Akt activation. Glimepiride possesses an extrapancreatic blood glucose-lowering effect in vivo, which might be attributed to its direct effect on insulin-sensitive tissues. Therefore, the combination of glimepiride with multiple insulin injections should not be excluded per se.

Efficacy and safety of adding single dose insulin glargine in patients with type 2 diabetes uncontrolled by oral hypoglycemic drugs

Abstract:&#x0D; Unfortunately, a Significant number of type 2 diabetic patients on oral hypoglycemic agents are not achieving the desired and recommended target of glycemic control in terms of reduction of HbA1c and fasting plasma glucose, this is largely because most of them are reluctant to use insulin injections for many reasons, mainly the painful injection, fear of hypoglycemia or inability to adapt to a complex regimen of multiple insulin injections. it has been recommended by many diabetes associations ( the American diabetes association(ADA) and the European association for the study of diabetes(EASD) ), in their algorithm of management of hyperglycemia in patients with uncontrolled diabetes (HbA1c &lt; 7 %) to add a basal ( long acting) insulin to their oral drug regimen as a more simple initial step of adding insulin that is acceptable by most patients and capable of achieving target glycemic levels. insulin glargine is the preferred long acting insulin analogue for its pharmacodynamic properties (peakless action profile with low incidence of hypoglycemia and longer duration of action) , furthermore, its pen formulary makes it less painful than conventional human insulin syringe injections.

Effect of Socioeconomic Status and Ethnicity on Glycemic Control in Arab and Jewish Youth with Type 1 Diabetes Mellitus.

ObjectivesResearch and theory suggests that socioeconomic status may affect diabetes control. We investigated the effect of socioeconomic status and ethnicity on glycated hemoglobin (HbA1c) in Arab and Jewish children with type 1 diabetes mellitus in northern Israel.MethodsData were collected from medical records of 80 Arab and 119 Jewish children attending a pediatric diabetes clinic in a tertiary health care center. Multivariate regression analysis was used to assess factors independently affecting HbA1c level.ResultsMean age was 12.9±4.7 years. Arab families had more children compared to Jewish families (3.7±1.5 versus 2.9±1.2, respectively, P=0.0007). Academic education was significantly less common in Arab families (25% versus 66.2%, respectively, P=0.0001). Income of Jewish parents was significantly higher compared to that of Arab parents (7,868±2,018 versus 5,129±906 NIS/month, respectively, P=0.0001). Mean age at diagnosis of diabetes was 9.6±4.6 years and disease duration was 3.4±2.3 years in both groups. Half of Arab and Jewish children were treated with multiple insulin injections and half with insulin pumps. Mean number of self-glucose testing/day was higher in Jewish children than in Arab children (4.7±2.5 versus 4.0±1.5, respectively, P=0.033). Mean HbA1c was above recommendations, 9.5% (12.6 mmol/L) in Arab children and 8.7% (11.3 mmol/L) in Jewish children (P=0.004). In multivariate analysis, disease duration (P=0.010) and ethnicity (P=0.034 for Arabs versus Jews) were independently associated with HbA1c.ConclusionsBoth Arab and Jewish children failed to meet HbA1c goals, but this effect was significantly greater for Arabs. Ethnicity remained a predictor of failure even following adjustment for potential confounders.

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.

Human insulin — is there still a place for it in everyday practice?

Type 2 diabetes is a progressive disease where in case of unsuccessful behavioral modifications and metformin monotherapy treatment needs to be intensified by adding some other oral agents and/or GLP-1 agonists and/ /or basal insulin. After some years of treatment with increasing defect of beta cells, there is a necessity to start or intensify insulin therapy with prandial insulin, premixed insulin, basal-bolus regimen or multiple injections of insulin. Patient’s treatment should be individualized but there are no direct recommendations which type of insulin to choose — human or analogue one. This article summarizes clinical situations in which one could consider using human insulin. When selecting a suitable insulin, the type of dietary habits, especially eating snacks, the presence of gastroparesis and economic issues should be taken into account. It turnes out that for patients with type 2 diabetes both human and analogue insulins are equally safe and efficient in terms of risk of severe hypoglycaemia. Undoubtedly, analogue insulin has uncontestable advantages, but in some clinical cases human insulin seems to be a better option.

Type 1 Diabetes in Children and Adolescents.

Type 1 Diabetes in Children and Adolescents.

New-onset insulin-dependent diabetes due to nivolumab.

SummaryNivolumab, a monoclonal antibody against programmed cell death-1 receptor, is increasingly used in advanced cancers. While nivolumab use enhances cancer therapy, it is associated with increased immune-related adverse events. We describe an elderly man who presented in ketoacidosis after receiving nivolumab for metastatic renal cell carcinoma. On presentation, he was hyperpneic and laboratory analyses showed hyperglycemia and anion-gapped metabolic acidosis consistent with diabetic ketoacidosis. No other precipitating factors, besides nivolumab, were identified. Pre-nivolumab blood glucose levels were normal. The patient responded to treatment with intravenous fluids, insulin and electrolyte replacement. He was diagnosed with insulin-dependent autoimmune diabetes mellitus secondary to nivolumab. Although nivolumab was stopped, he continued to require multiple insulin injection therapy till his last follow-up 7 months after presentation. Clinicians need to be alerted to the development of diabetes mellitus and diabetic ketoacidosis in patients receiving nivolumab.Learning points:Diabetic ketoacidosis should be considered in the differential of patients presenting with metabolic acidosis following treatment with antibodies to programmed cell death-1 receptor (anti-PD-1).Autoimmune islet cell damage is the presumed mechanism for how insulin requiring diabetes mellitus can develop de novo following administration of anti-PD-1.Because anti-PD-1 works by the activation of T-cells and reduction of ‘self-tolerance’, other autoimmune disorders are likely to be increasingly recognized with increased use of these agents.

Real-Time Continuous Glucose Monitoring and Multiple Insulin Injections Are Effective for Glycemic Control

Hypoglycemia, a barrier to glycemic control in patients with type 1 diabetes, is more likely to occur in patients with impaired hypoglycemia awareness

Severe Hypercortisolism with Hypokalemic Alkalosis Mimicking Ectopic Cushing Syndrome in a Patient with Cushing Disease Due to Pituitary Microadenoma.

Severe Hypercortisolism with Hypokalemic Alkalosis Mimicking Ectopic Cushing Syndrome in a Patient with Cushing Disease Due to Pituitary Microadenoma.

Способ введения инсулина и перинатальные исходы у беременных с сахарным диабетом 1 типа

Изучено влияние способа введения инсулина на перинатальные исходы у беременных с сахарным диабетом 1 типа (СД 1) при одинаковом уровне гликированного гемоглобина. В проспективное сравнительное исследование включена 31 беременная с СД 1. В зависимости от способа введения инсулина на протяжении всей гестации пациенток разделили на 2 группы. В 1-й группе (n = 13) инсулин вводили постоянной подкожной инфузией инсулина (ППИИ), во 2-й группе (n = 18) применяли режим множественных инъекций инсулина (МИИ). Группы беременных не отличались между собой по возрасту, социальному положению, паритету, индексу массы тела до беременности, уровню артериального давления, длительности СД 1, наличию сосудистых осложнений СД, уровню гликированного гемоглобина. Преждевременные роды чаще наблюдались у пациенток на МИИ (66,7 % против 46,2 %, p &gt; 0,05). Макросомия чаще встречалась у новорожденных от матерей на МИИ (77,8 % против 30,8 %, p = 0,025). Гипербилирубинемию чаще регистрировали у детей от матерей на МИИ (72,2 % против 23,0 %, p = 0,02). Диабетическая фетопатия выявлена у 38,5 % новорожденных в группе ППИИ и у 83,3 % в группе МИИ (p = 0,048). В интенсивной терапии нуждались 92,3 % новорожденных от матерей на ППИИ и 100 % детей от матерей на МИИ (p &gt; 0,05). На второй этап реабилитации переведены 76,9 % детей от матерей на ППИИ и 94,4 % детей от матерей на МИИ (p &gt; 0,05). При одинаковом уровне гликированного гемоглобина у беременных с СД 1 при использовании ППИИ уменьшается частота преждевременных родов, макросомии и гипербилирубинемии у новорожденных, диабетической фетопатии, по сравнению с режимом МИИ. Дети от матерей на ППИИ реже нуждались в интенсивной терапии и переводе на второй этап реабилитации, раньше выписывались домой, чем дети от матерей на МИИ.

Basal and Bolus Insulin Dose Changes after Switching Basal Insulin to Insulin Degludec in Patients with Type 1 DiabetesMellitus: A Pilot Study.

Ultra-long-acting insulin degludec (DEG) has a longer duration of action and less daily variability relative to other basal insulin (BI), and thus may benefit patients with type 1 diabetes mellitus (T1DM). We examined the impact of switching BI to DEG on glycemic control and insulin dose in T1DM. T1DM patients (n=22; six male; mean age: 64.5±12.6years) receiving basal-bolus insulin therapy were included. Initially, the BI dose was replaced with DEG in a 1:1 ratio; 80-100% of the total dose was replaced with DEG for multiple basal insulin injections. DEG was titrated according to study protocol. Changes in HbA1c, daily insulin dose, glycemic self-monitored blood glucose variations, and hypoglycemia frequency were evaluated for 24weeks. Once-daily DEG significantly decreased HbA1c levels when switched from once-daily BI (7.9±0.8 vs. 7.5±0.9%, p=0.020) and maintained HbA1c when switched from twice-daily BI (8.5±1.6 vs. 8.4±1.2%, p=0.457). The BI dose decreased by -7.8±13.9% (p=0.017) and -16.6±16.9% (p=0.050) when switched from once-daily BI and twice-daily BI, respectively. The total bolus insulin dose significantly decreased when switched from once-daily BI (21.7±8.3 to 19.3±8.8 U/day, p=0.016) especially in the injection before breakfast and evening meal. Body weight and hypoglycemia frequency was not significantly different. DEG improved glycemic control when switched from once-daily BI and maintained glycemic control when switched from twice-daily BI without increasing hypoglycemia.

Prevalence of Dental Caries in Patients with Type 1 Diabetes Mellitus Treated with Multiple Insulin Injections and that of Individuals without Diabetes

In addition to macro and microvascular complications that are associated with the disease, hyperglycaemia is also a risk factor for several oral complications. The aim of this study is to establish a relationship between dental caries in patients with type 1 diabetes mellitus treated with multiple insulin injections and that of individuals without diabetes. It is also an aim to characterize the oral hygiene habits of this population. An observational clinical study of analytical and cross-sectional nature was conducted. Thirty patients with type 1 diabetes mellitus and 30 individuals without diabetes were observed and questioned about information regarding their medical history. Oral examination was conducted according to the standards of the World Health Organization and ICDAS was used for caries detection. Statistical analysis was performed and the significance level was set at 5%. Patients with diabetes mellitus showed similar caries levels to that of individuals without diabetes. Patients with diabetes mellitus had a higher dental plaque index. Only 10% of the patients having episodes of nocturnal hypoglycaemia brush their teeth after glucose intake. Although there's some controversy in the literature regarding the prevalence of caries in patients with diabetes mellitus, the results are in agreement with a great number of studies. However, patients with diabetes mellitus have a higher plaque index which can be associated with a higher risk for developing certain oral pathologies. No statistically significant association was found between type 1 diabetes mellitus and dental caries.