Starting Insulin Treatment Research Articles

Myths and beliefs about insulin therapy in patients with diabetes mellitus and their family caregivers from a hospital in northern Peru, 2020.

To analyze and explore the myths and beliefs about insulin therapy in patients with diabetes mellitus and their family caregivers from a general hospital in northern Peru in 2020. This qualitative study used a thematic analysis model, following the interpretative paradigm. Sociodemographic and clinical data were obtained from medical records. Patients with diabetes that used some type of insulin for at least three months prior to the study were interviewed, as well as their family caregivers. Patients participated in a focus group and in-depth interviews; family caregivers participated only in in-depth interviews. Twelve patients with diabetes (11 with type 2 diabetes mellitus) were included; six in the focus group and six in the in-depth interviews. Seven family caregivers were included. After analysis, we obtained four categories: 1) beliefs related to starting insulin treatment: treatment of choice after failure of other drugs, cures diabetes, regulates sugar, fear of injectables; 2) beliefs related to treatment adherence: decompensation for not using insulin, insulin is necessary to live; 3) beliefs related to alternative therapies and cost: use of alternative therapies, high cost of insulin; and 4) myths related to the use of insulin: generates dependence, dependence for insulin administration, negative effects of insulin. The beliefs and myths of patients treated with insulin arise from the beginning of treatment, remain throughout the course of treatment, and are often reinforced by the worldview of family members.

Difference in the early clinical course between children with type 1 diabetes having a single antibody and those having multiple antibodies against pancreatic β-cells

Islet-cell associated antibodies are predictive and diagnostic markers for type 1 diabetes. We studied the differences in the early clinical course of children with type 1 diabetes with a single antibody and those with multiple antibodies against pancreatic β-cells. Sixty-seven children with type 1 diabetes aged less than 15 years diagnosed between 2010 and 2021 were included in the study and subdivided into two subgroups: children who were single positive for either glutamic acid decarboxylase (GAD) antibodies (n = 16) or insulinoma-associated antigen-2 (IA-2) antibodies (n = 13) and those positive for both antibodies (n = 38) at diagnosis. We compared the patients' clinical characteristics, pancreatic β-cell function, and glycemic control during the 5 years after diagnosis. All clinical characteristics at diagnosis were similar between the two groups. One and two years after diagnosis, children who tested positive for both antibodies showed significantly lower postprandial serum C-peptide (CPR) levels than those who tested positive for either GAD or IA-2 antibodies (p < 0.05). In other periods, there was no significant difference in CPR levels between the two groups. There was a significant improvement in glycosylated hemoglobin (HbA1c) levels after starting insulin treatment in both groups (p < 0.05), but no significant difference in HbA1c levels between the groups. Residual endogenous insulin secretion may be predicted based on the number of positive islet-cell associated antibodies at diagnosis. Although there are differences in serum CPR levels, optimal glycemic control can be achieved by individualized appropriate insulin treatment, even in children with type 1 diabetes.

Supporting people with type 2 diabetes who need insulin

Abstract The year 2022 marks 100 years since the first person with diabetes received an insulin injection and supporting people with insulin self‐management is a core role for diabetes nurses. Janet Kinson was a diabetes nurse and author. She developed the first diabetes education programme for nurses and the topic of insulin was central to the curriculum. This article will honour the contribution she made by focusing on diabetes education for people with type 2 diabetes who need insulin. It will start by tracing why and when people with type 2 diabetes should start insulin treatment followed by an exploration of the barriers to starting insulin at the level of the individual, the health care professional and the health system. We know that around 50% of people with type 2 diabetes delay starting insulin for seven years when it is clinically indicated. We also know that around a third of people with type 2 diabetes who are insulin treated remain hyperglycaemic or experience frequent hypoglycaemia. Therefore, there is a need for interventions that address delay, optimise starting insulin as well as consider how we best support people with type 2 diabetes to persist with and intensify their insulin over the diabetes journey. This article presents the current literature on interventions to support people with type 2 diabetes with insulin and identify gaps in support that may be addressed in future research. Copyright © 2022 John Wiley &amp; Sons..

PSUN238 COVID 19 induced Type 1 Diabetes Mellitus

Abstract Introduction There have been some case reports where patients presented with uncontrolled hyperglycemia without previous diagnosis of diabetes but very limited literature supporting the fact that COVID 19 infection can lead to the development of new onset Type 1 diabetes. Clinical Case A 30-year-old African American man presented to the office with a diagnosis of new onset DM towards the end of March 2021. He did not have any significant medical history other than prediabetes with a prior HbA1c of 6% and COVID 19 infection in 2020. He had no family history of DM. He was very sick with the COVID 19 infection and lost 20 pounds of weight around that time. He did not get hospitalized and did not have any blood work done. A couple of months after recovery from his COVID 19 illness he developed leg cellulitis. He decided to seek help for this problem and was started on some antibiotics and antifungals, but they did not help much. His leg swelling and pain did not improve so he went to the ER. At that time his work-up showed a HbA1c of 15.5%. Patient was also having polydipsia and polyuria by that time. He was given a new set of antibiotics and was discharged to follow-up with a primary care provider. His PCP started him on Metformin and Lantus insulin for new onset DM2. He was then referred to Endocrinologist for further management. At the time of his endocrine office visit his symptoms of polyuria and polydipsia had improved a lot.His Anti GAD 65 antibodies were positive with a value of 41 (neg &amp;lt;5). C-peptide level was 1.9 which was in the range (1.1-4.4). IAA–2 autoantibodies were positive with a value of more than 120 (neg&amp;lt;7.5). ZNT 8 antibodies and Insulin antibodies were negative. An increase in the number of antibodies is associated with a higher likelihood of type 1 DM. Only less than 3% of type 2 diabetics have positive antibodies. As per the laboratory interpretation our patient had type 1 diabetes. After starting insulin treatment, the HbA1c improved to 6.6% from 15.5%. Patient is currently on continuous glucose monitoring with insulin therapy and has a good glycemic control. Conclusion Our case highlights the importance that SARS-CoV-2 infection is an independent risk factor for the development of new onset type 1 DM and increased risk of complications in preexisting diabetics. There have been studies showing that patients who presented with DKA precipitated by COVID-19 infection had worse outcomes than patient's presenting with DKA without COVID-19 infection. Mortality was higher for COVID-19 in diabetic patients as well. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Evaluation of the effect of training given according to Pender's Health Promotion Model on psychological insulin resistance

This study was conducted to evaluate the effect of training given to individuals with Type 2 Diabetes Mellitus (Type 2 DM) according to Pender's Health Promotion Model on attitudes towards insulin treatment. A randomized controlled design was conducted with a pretest-posttest control group in the endocrinology outpatient clinic of a university hospital in Northern Cyprus with 68 individuals with Type 2 DM who started insulin treatment. The training content was prepared according to Pender's Health Promotion Model and the suitability of the training was ensured by obtaining expert opinions as necessary. Within the scope of the study, individuals were randomly assigned to intervention (n = 34) and control (n = 34) groups. The experimental group received three sessions of training and was followed up for three months. A Patient Enquiry Form and the Insulin Treatment Appraisal Scale were used. An informed consent form was obtained from the patients and all data were collected by the researcher using the face-to-face interview method. To conduct the research, the necessary institutional permission and ethics committee approval were obtained and ethical principles were followed. This study, in which education was given according toPender's Health Promotion Model was evaluated, found that there was no significant difference between the groups in terms of the sociodemographic characteristics and the disease and insulin treatment characteristics of the experimental and control groups (p > 0.05), and both groups were found to be homogenous. The training given according toPender's Health Promotion Model led to a significant improvement in some metabolic control variables and attitudes towards insulin treatment in the experimental group during the three months (p > 0.05). The education provided according to Pender's Health Promotion model helped patients develop a positive attitude towards insulin treatment and it is thus an applicable and reliable resource.

Association between Smoking and the Switching to Insulin Therapy in Type 2 Diabetes Patients

A total of 532 type 2 diabetes mellitus patients, who started insulin treatment due to the inability to achieve glycemic control with maximum oral anti-diabetic treatment, were included in the study. The patients were divided into three groups according to their smoking status at the beginning of insulin therapy: smokers (n = 114), ex-smokers (n = 178), and non-smokers (n = 240). Demographic and metabolic data, treatment regimens, and insulin start times were evaluated.

Does Smoking Speed up Switching To Insulin Therapy in Type 2 Diabetes Patients?

Objectives: Since no studies have been published on how active smoking affects switching to insulin therapy, we aimed to investigate the role of smoking on switching to insulin therapy in type 2 diabetes mellitus patients. Methods: A total of 617 type 2 diabetes mellitus patients, who started insulin treatment due to the inability to achieve glycemic control with maximum oral anti-diabetic treatment, were included in the study. The patients were divided into three groups according to their smoking status at the beginning of insulin therapy: smokers (n=143), ex-smokers (n=189), and non-smokers (n=285). Demographic and metabolic data, treatment regimens, and insulin start times were evaluated. Results: The age of onset of diabetes was lower in smokers than non-smokers. Non-smoker duration of diabetes (p=0.001) and switching to insulin treatment (p&lt;0.001) were statistically higher than smokers. HbA1c values of non-smokers were statistically similar to the other two groups. Conclusions: Diabetes onset age and switching to insulin therapy is shorter in smokers than in non-smokers. These results reveal that glycemic control is impaired with smoking and patients have to switch to insulin treatment in a shorter time. Smoking cessation programs should also be offered to the diabetic population. Keywords: Smoking, Type 2 Diabetes Mellitus, Diabetic Complications, Insulin Treatment, HbA1c.

Endometrial Cancer After Pancreas-After-Kidney Transplantation: A Case Report and Review of the Literature

As the number of long-term survivors after organ transplantation increases, malignancy has become a problem as a late complication. We herein report a case of endometrial cancer during the follow-up of pancreas transplantation after kidney transplantation. A 49-year-old woman was diagnosed with endometrial cancer. The patient had developed type 1 diabetes at 8 years old and started insulin treatment, and at 29 years old, she started hemodialysis for diabetic nephropathy. At 31 years old, she received living donor kidney transplantation and withdrew from dialysis. Hypoglycemia unawareness began to occur frequently from around 36 years old, and at 48 years old, the patient underwent deceased donor pancreas transplantation after kidney transplantation and achieved insulin independence. At 49 years old, she was diagnosed with endometrial cancer. Surgical treatment (total abdominal hysterectomy with left salpingo-oophorectomy) was performed. The pathologic diagnosis was confirmed as stage 1A uterine endometrioid carcinoma grade 1. The postoperative course was uneventful. She was discharged from our hospital on postoperative day 8. There has been no evidence of recurrence and/or metastasis of endometrial cancer for 16 months since the surgery. Carcinogenesis after pancreas transplantation may be a lethal late complication. It is important to carry out regular screening examinations with carcinogenesis in mind.

Severe hyperglycemia in an insulin-deficient patient with type 2 diabetes responding well to oral antidiabetic therapy

Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease characterized by a steady decline in beta-cell function and insulin resistance. As a result, most patients with T2DM may require treatment with insulin after 15–20 years of diagnosis. Various pathophysiological defects were identified leading to hyperglycemia, including reduced insulin secretion due to beta-cell failure. They reduced beta-cell mass and a defect in insulin secretion, which leads to a relative insulin deficiency in these patients requiring insulin treatment. Most international guidelines recommend starting insulin treatment in patients with poor glucose control, mainly if the glycated hemoglobin (HbA1c) is above 9% with the presence of symptoms, especially in relatively newly diagnosed patients with T2DM. We present a 45-year-old patient with T2DM of 5 years duration who attended our center with severe hyperglycemia with evidence of insulin deficiency both clinically and biochemically, who responded well to oral antidiabetic agents achieving adequate glycemic control.

Recommendations for Glycemic Treatment for Patients Receiving Dexamethasone for Treatment of COVID-19

Abstract Introduction: SARS-CoV-2 infects not only cells of the upper respiratory system. Overproduction of proinflammatory cytokines results in cytokine storm, leading to hyper permeability, multiorgan failure, and death. The cytokine storm is more likely to develop in patients with uncontrolled diabetes. Dexamethasone reduces mortality in patients with COVID-19, but insulin resistance and hyperglycemia are common adverse effects which are also associated to worse outcomes. Methods: We analyze and recommend treatment with insulin in patients with hyperglycemia treated with dexamethasone. Articles for review were selected including information with hyperglycemia caused by steroids. After analyzing the information and adhering to endocrinology guidelines, we propose an algorithm for treating patients hospitalized with COVID-19 and hyperglycemia (with or without diabetes) and require steroid treatment. Results: It is important to consider the characteristics of each patient, specially weight, nutritional status, age, and renal function. Due to an increased insulin resistance, good control requires more bolus doses. A good approach is to start 50/50% of basal/bolus insulins. Discussion: Steroids are the best treatment for patients with important inflammation. There are important factors to consider in these hospitalized patients to start insulin treatment, but also for discharge. Hyperglycemia in these patients can be approached by provision of insulin via basal and bolus insulin. Keywords: COVID-19; dexamethasone; hyperglycemia; diabetes; insulin

Immunogenicity and Efficacy of Insulin Glargine Biosimilar Ezelin versus Originator Insulin Glargine in Patients with Type 2 Diabetes.

PurposeTo compare the immunogenicity and efficacy of insulin glargine biosimilar Ezelin (EZL) versus originator insulin glargine Lantus (LAN) as a reference basal insulin in patients with type 2 diabetes (T2D).Patients and MethodsThis was a randomized, multicenter, open-label, 24-week study in insulin-naïve patients with T2D, with HbA1c of >7.0%. We randomly assigned 133 eligible patients to receive either EZL or LAN. Baseline characteristics, including insulin autoantibody (IAA), zinc transporter 8 (ZnT8) antibody, HbA1C, fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPPG), AST, ALT, BUN, eGFR, and oral antidiabetic drugs, were obtained before starting insulin treatment. After starting treatment, insulin dose was titrated to achieve FPG target along with oral antidiabetic drugs. Patients were given home glucometer and assisted to record plasma glucose measurement and adverse event (AE). Every month, patients came to the diabetes clinic and performed a regular physical examination and intensifying treatment if needed. Out of the 133 randomized patients, only 122 completed the study and can be examined for their IAA and ZnT8 after 6 months of treatment. The study was registered in clinicaltrials.gov, NCT03352674.ResultsThere is a similar proportion of patients with changes of IAA from baseline: 1 out of 58 (1.7%) patients receiving EZL versus 1 out of 64 (1.6%) patients receiving LAN (p = 1.000). One patient in the EZL group (1.7%) versus none in the LAN group experienced a change of ZnT8 antibody from baseline. Similar glucose control in EZL versus LAN was determined by the change in HbA1c, FPG, and 2hPPG (−2.0%, −67.46 mg/dL, and −76.51 mg/dL in the EZL group versus −1.7%, −58.11 mg/dL, and −70.03 mg/dL in the LAN group). There were six events of documented hypoglycemia in the EZL group versus five events in the LAN group. No patients experienced diabetic ketoacidosis during the study.ConclusionOverall, insulin glargine biosimilar EZL and originator insulin glargine LAN have shown a similar immunogenicity profile, as well as efficacy in providing glucose control and safety findings in T2D populations.

Bilateral diabetic papillopathy developed after starting insulin treatment. Potential toxic effect of insulin? A case report.

Diabetic papillopathy is a complication of diabetes. It presents with edema, uni or bilateral and vascular alteration of the anterior optic nerve. Often this complication is observed in patients with severe diabetic retinopathy, but is rarely observed in isolated form. Some authors believe that diabetic papillitis is a particular form of non-arteritic anterior ischemic optic neuropathy (NAION). But there is important evidence that confers an inflammatory component to diabetic papillopathy. We report in this work a rare case of isolated acute bilateral diabetic papillopathy developed in a diabetic patient after adding the insulin to the oral hypoglycemic therapy. Male patient, 49-years-old, diabetic type 2, with altered glycemia at follow up, with clinical history of HbA1c 8% to 12% in the last 2 years, on oral hypoglycemic therapy for 10 years. He never had a history of diabetic retinopathy. At the last check-up, this patient presented bilateral papillopathy, without reduction of visual acuity bilaterally. The patient reports he added 10 days before the insulin therapy to the oral hypoglycemic therapy, under medical supervision. Hematochemical and serological tests were requested, which excluded the presence of inflammatory and infectious diseases. The brain magnetic resonance imaging (MRI) with gadolinium excluded the hypothesis of optic neuritis or intracranial hypertension. Cardio-circulatory tests were normal. Fluorescein angiographic examinations and optical coherence tomography (oct) confirmed the bilateral edema and the thickening of optic nerve without other retinal damage. Therefore he was diagnosed with bilateral diabetic papillopathy. Then, diabetologists added pump insulin treatment to the oral hypoglycemic therapy. After 2 months, his blood sugar levels and HbA1C improved and papillopathy regressed. We have reported a rare case of bilateral acute diabetic papillopathy associated with the addition of insulin to the oral hypoglycemic therapy. A randomized control study with diabetic patients, would be useful to verify the possible injuries of the optic nerves during the delicate transition to insulin therapy.

Delay in starting insulin therapy in patients with type 2 Diabetes Mellitus

Amaç: Diabetes mellitus hastalarında gerekmesine rağmen insülin başlatılmasıyla ilgili birçok sorun vardır. Bu çalışmanın amacı hastaların niçin zamanında insülin tedavilerini alamadıklarını saptamak ve bu sorunlara değinmektir. Yöntemler: Tek merkezde kesitsel yapılan bu çalışma için etik kurul’dan izin ve gönüllülerden onam alındı. 18 yaşından büyük, tip 2 diyabetes mellituslu hastalar çalışmaya dahil edildi. Hamileler, 18 yaşından küçükler, dekompanse karaciğer hastalığı olanlar, psikiyatrik bozukluğu olanlar, Tip 1 diyabeti olanlar çalışmaya alınmadı. Veri toplanması için anket kullanıldı. İstatistiksel analiz SPSS 18.0'da yapıldı. Bulgular: Toplam 1062 hasta çalışmaya alındı. Hastaların %34’ü regüle idi. İnsülin kullanması gerektiği halde kullanmayan hasta sayısı 105’di. 105 hastadan 34 hastaya hekimler hiç insülin tedavisi önermemişken 33 hasta enjeksiyon korkusu nedeniyle insülin istememiş ve 32 hasta ise insülin hakkında yanlış bilgileri olduğu için insülin kullanmaya başlamamıştı. İnsülin kullanırken insülin tedavisine son veren 36 hasta sorgulandığında 8 hastanın insülin tedavisi hekimleri tarafından durdurulmuştu. Kalan 28 hasta ise insülin tedavilerini en sık enjeksiyon zorluğu ve insülin hakkında duyduğu yanlış bilgiler nedeni ile kendileri bırakmıştı. Sonuçlar: Hasta hekim diyalogunu artıran poliklinik şartlarının sağlanması, enjeksiyon kaleminin ve iğnesinin bizzat hasta tarafından görülüp denenmesi, yanlış bilgi edinilmesinden kaçınmak için hastalara ve doktorlara yönelik konferanslar diyabetes mellitus’ta insülinin geç başlanmasına çözüm olabilir.

Diabetes mellitus in dogs attending UK primary-care practices: frequency, risk factors and survival

BackgroundDiabetes mellitus (DM) is an important endocrine disorder of dogs. The objectives of this study were to estimate prevalence and incidence of DM in dogs, and to explore risk factors for DM and the survival of DM cases in primary-care clinics in the UK.ResultsA case-control study nested in the cohort of dogs (n = 480,469) aged ≥3 years presenting at 430 VetCompass clinics was used to identify risk factors for DM, using multivariable logistic regression. Overall 409 new and 863 pre-existing DM cases (total 1272) were identified in 2016, giving an apparent annual prevalence of 0.26% (95% confidence interval (CI): 0.25–0.28%), and an annual incidence risk of 0.09% (95%CI: 0.08–0.09%) in dogs aged ≥3 years. Factors associated with increased odds for DM diagnosis were all age categories > 8 years, female entire dogs (odds ratio (OR): 3.03, 95% CI 1.69–5.44, p < 0.001) and male neutered dogs (OR: 1.99, 95% CI 1.18–3.34, p = 0.010) compared to male entire dogs, Border Terriers (OR: 3.37, 95% CI 1.04–10.98, p = 0.043) and West Highland White Terriers (WHWT) (OR: 2.88, 95% CI 1.49–5.56, p = 0.002) compared to crossbreeds. Dogs that had received previous glucocorticoid treatment (OR: 2.19, 95% CI 1.02–4.70, p = 0.044) and those with concurrent conditions (documented obese, pancreatitis, hyperadrenocorticism) also had increased odds for DM diagnosis.Cox regression modelling was used to evaluate factors associated with survival in the 409 incident DM cases in 2016. Increased hazard of death following diagnosis of DM was shown in dogs that were ≥ 10 years age, Cocker Spaniels (HR: 2.06, 95% CI 1.06–4.01, p = 0.034) compared to crossbreeds, had a blood glucose (BG) level at diagnosis > 40 mmol/L (HR: 2.73, 95% CI 1.35–5.55, p = 0.005) compared to < 20 mmol/L at diagnosis, or had received previous glucocorticoid treatment (HR: 1.86, 95% CI 1.21–2.86, p = 0.005). Dogs at reduced hazard of death included neutered dogs (HR: 0.58, 95% CI 0.42–0.79, p = 0.001), Border Collies (HR: 0.39, 95% CI 0.17–0.87, p = 0.022) and those starting insulin treatment (HR: 0.08 95% CI 0.05–0.12, p < 0.001).ConclusionsCertain breeds and concurrent health conditions are associated with an increased risk of DM. In addition to certain signalment factors, a high BG level at diagnosis and prior glucocorticoid treatment were adversely associated with survival of dogs with DM.

Achieving Effective and Efficient Basal Insulin Optimal Management by Using Mobile Health Application (APP) for Type 2 Diabetes Patients in China.

AimTo evaluate the effectiveness of the mobile health application (APP) education in basal insulin optimal management program for insulin-naive type 2 diabetes (T2D) patients in China.MethodsThe basal insulin optimal management program was launched in 297 hospitals in China, throughout the six main regions of China. A total of 17,208 insulin-naive patients with T2D who started to use basal insulin were screened. The mobile health APP was downloaded in each recruited patient’s mobile phone and the doctor’s mobile phone. Then, according to the instructions and education materials in the APP, these patients began their self-management of insulin dosage titrations and contacted their doctors by APP if they need help.ResultsOverall, 12,530 patients with T2D were finally included in the analysis. The average age was 51.97±12.76 years, and 58% of them were males. The average body mass index is 24.46±3.83 kg/m2, and the average HbA1c at baseline was 8.33±2.11% with 24% of the subjects reaching the target of HbA1c<7.0% at baseline. After 3 months of treatment and educations through the APP, HbA1c decreased significantly from baseline (−1.02±1.72%), with 59% of the patients reaching HbA1c<7.0%. After 6 months, the glycemic control of HbA1c also decreased from baseline significantly (−1.01±1.67%). Dosage of insulin daily was 0.23±0.09 IU/kg at baseline, and 0.23±0.23 IU/kg after 6 months of treatment. Regarding the profiles of hypoglycemia treatment, 3145 patients received basal insulin in combination with mono oral anti-diabetic drug (OAD), 1204 patients with dual OADs, 208 patients with triple OADs, and 17 patients with quarter OADs.ConclusionPatients could benefit from the basal insulin optimal management program in self-management by using mobile health APP educations. For T2D patients who are going to start insulin treatment, mobile health APP can help them to reach the target of glycemic control with appropriate dosage of insulin.

Grado de conocimiento de insulinización por los médicos de atención primaria y su repercusión en el control de la diabetes

ObjectiveTo determine the level of knowledge and current management of starting insulin treatment by Primary Care physicians, and its impact on metabolic control. Materials and methodsA mainly qualitative exploratory sequential study, with a phenomenological approach, followed by a quantitative phase. The study included 37 primary care physicians from the Andalusian Health Service. Socio-demographic and clinical care variables were analysed. Univariate and bivariate analyses were performed. ResultsThere was a wide variability between Primary Care physicians in the level of knowledge of treatment with insulins (low knowledge: 13.5%; medium knowledge: 59.5%; high knowledge: 27.0%). There was a direct relationship between the level of knowledge and the attainment of HbA1c goals (as the level of knowledge increased, the metabolic control improved). The most common basal insulins prescribed were insulin glargine U-100 (56.8%), followed by insulin glargine U-300 (29.7%), and neutral protamine hagedorn (NPH) insulin (8.1%). There was a trend to show a different prescription pattern with basal insulins (as the level of knowledge decreased, the prescription of mixed and NPH insulins increased). More than one-third (35.1%) of primary care physicians did not know more complex patterns of treatment with insulins. ConclusionsOnly 27% of Primary Care physicians had a high knowledge about treatment with insulins. There was a direct relationship between the level of knowledge about insulins and glycaemic control. It is necessary to improve the knowledge about insulin therapy in order to optimise metabolic control and reduce the risk of complications.

Key factors for overcoming psychological insulin resistance: an examination of patient perspectives through content analysis

ObjectiveTo understand participant perceptions about insulin and identify key behaviors of healthcare professionals (HCPs) that motivated initially reluctant adults from seven countries (n=40) who had type 2 diabetes (T2D) to...

Predicting short- and long-term glycated haemoglobin response after insulin initiation in patients with type 2 diabetes mellitus using machine-learning algorithms.

AimTo assess the potential of supervised machine‐learning techniques to identify clinical variables for predicting short‐term and long‐term glycated haemoglobin (HbA1c) response after insulin treatment initiation in patients with type 2 diabetes mellitus (T2DM).Materials and methodsWe included patients with T2DM from the Groningen Initiative to Analyse Type 2 diabetes Treatment (GIANTT) database who started insulin treatment between 2007 and 2013 and had a minimum follow‐up of 2 years. Short‐ and long‐term responses at 6 (±2) and 24 (±2) months after insulin initiation, respectively, were assessed. Patients were defined as good responders if they had a decrease in HbA1c ≥ 5 mmol/mol or reached the recommended level of HbA1c ≤ 53 mmol/mol. Twenty‐four baseline clinical variables were used for the analysis and an elastic net regularization technique was used for variable selection. The performance of three traditional machine‐learning algorithms was compared for the prediction of short‐ and long‐term responses and the area under the receiver‐operating characteristic curve (AUC) was used to assess the performance of the prediction models.ResultsThe elastic net regularization‐based generalized linear model, which included baseline HbA1c and estimated glomerular filtration rate, correctly classified short‐ and long‐term HbA1c response after treatment initiation, with AUCs of 0.80 (95% CI 0.78–0.83) and 0.81 (95% CI 0.79–0.84), respectively, and outperformed the other machine‐learning algorithms. Using baseline HbA1c alone, an AUC = 0.71 (95% CI 0.65–0.73) and 0.72 (95% CI 0.66–0.75) was obtained for predicting short‐term and long‐term response, respectively.ConclusionsMachine‐learning algorithm performed well in the prediction of an individual's short‐term and long‐term HbA1c response using baseline clinical variables.

Insulin protects against type 1 diabetes mellitus-induced aortopathy associated with the inhibition of biomarkers of vascular injury in rats

Background We sought to investigate the protective effect of insulin against type 1 diabetes mellitus (T1DM)-induced aortic injury (aortopathy) associated with the inhibition of biomarkers of vascular injury. Material and methods T1DM was induced in rats by streptozotocin (STZ) (65 mg/kg), and the protection group started insulin treatment 2 days post diabetic induction and continued until being sacrificed at week 8. Results Aortopathy was developed in the diabetic rats as demonstrated by profound alterations to the aorta ultrastructure, which was substantially protected by insulin. In addition, insulin significantly inhibited diabetes-induced dyslipidaemia, soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1), oxidative stress, and inflammation. However, blood levels of these biomarkers in the insulin-treated group were still significant (p < .05) compared with the control group, whereas insulin treatment returned blood glucose and triglyceride to control levels. Conclusions We demonstrate effective protection by insulin against T1DM-induced aortopathy in rats, which is associated with the inhibition of vascular injury biomarkers.

Effects of a Mediterranean Eating Plan on the Need for Glucose-Lowering Medications in Participants With Type 2 Diabetes: A Subgroup Analysis of the PREDIMED Trial.

OBJECTIVETo examine the effects of two Mediterranean eating plans (Med-EatPlans) versus a low-fat eating plan on the need for glucose-lowering medications.RESEARCH DESIGN AND METHODSFrom the Prevención con Dieta Mediterránea (PREDIMED) trial, we selected 3,230 participants with type 2 diabetes at baseline. These participants were randomly assigned to one of three eating plans: Med-EatPlan supplemented with extra-virgin olive oil (EVOO), Med-EatPlan supplemented with mixed nuts, or a low-fat eating plan (control). In a subgroup (15%), the allocation was done in small clusters instead of using individual randomization, and the clustering effect was taken into account in the statistical analysis. In multivariable time-to-event survival models, we assessed two outcomes: 1) introduction of the first glucose-lowering medication (oral or injectable) among participants on lifestyle management at enrollment and 2) insulin initiation.RESULTSAfter a median follow-up of 3.2 years, in multivariable analyses adjusting for baseline characteristics and propensity scores, the hazard ratios (HRs) of starting a first glucose-lowering medication were 0.78 (95% CI 0.62–0.98) for Med-EatPlan + EVOO and 0.89 (0.71–1.12) for Med-EatPlan + nuts, compared with the control eating plan. After a median follow-up of 5.1 years, the adjusted HRs of starting insulin treatment were 0.87 (0.68–1.11) for Med-EatPlan + EVOO and 0.89 (0.69–1.14) for Med-EatPlan + nuts compared with the control eating plan.CONCLUSIONSAmong participants with type 2 diabetes, a Med-EatPlan + EVOO may delay the introduction of new-onset glucose-lowering medications. The Med-EatPlan did not result in a significantly lower need for insulin.