Subcutaneous Insulin Injection Research Articles

Hypoglycemic Agents in the Management of Type 2 Diabetes Mellitus

Type 2 diabetes is increasing in prevalence and causes a significant health care burden due to associated microvascular and macrovascular complications. Type 2 diabetes is diagnosed by clinical findings of hyperglycemia and laboratory confirmation of elevated plasma glucose. Initial therapy includes diet and exercise, followed by the use of oral hypoglycemic agents and potentially subcutaneous insulin injections. Of the oral hypoglycemic agents currently available, metformin is the first-line choice. Recently, new adjunct therapies have been introduced that can improve glycemic control, although the long term effects on modifying the disease outcome in terms of diabetes complications remain to be seen. A review of the mechanism of action of current, non-insulin therapies will be presented. This review article will also discuss recent patents related to the field.

Impact of dose adjustment for normal eating in Australia (OzDAFNE) on subjective wellbeing, coping resources and negative affects in adults with type 1 diabetes: A prospective comparison study

AimThis prospective study examined the impact of a structured education program (OzDAFNE) on subjective wellbeing, coping resources, and negative affects in adults with type 1 diabetes. Participants completing the OzDAFNE program were compared to those using continuous subcutaneous insulin (CSII) and multiple daily injections (MDI) over the same time period. MethodsParticipants in the OzDAFNE group (N=144) were recruited from diabetes centres throughout Australia. The comparison groups were recruited from Diabetes Australia-Victoria's membership database and comprised 383 people using MDI and 64 people using CSII. All participants completed self-report questionnaires at baseline and 12-months later. Additional assessments for OzDAFNE participants were conducted at the end of the education program and at three and six-months following the training. ResultsThe results demonstrated that participants completing the OzDAFNE program experienced improved subjective wellbeing (p<.01), a greater sense of mastery and control in managing their diabetes (p<.001), and reduced diabetes-related distress (p<.001) compared to the CSII and MDI groups. However, the CSII group recorded a significant drop in self-esteem (p<.001) over the duration of the study. Conclusions/InterpretationsThe OzDAFNE program provides a powerful mastery experience for participants, positively influencing subjective wellbeing and diabetes-related distress.

98 THE FETAL AND POSTNATAL EFFECTS OF PERICONCEPTIONAL HYPERGLYCEMIA USING A RABBIT MODEL

The objective of this study was to analyse the effects of maternal hyperglycemia during the periconception period on fetal and postnatal development using a rabbit model. Diabetes was induced in adult New Zealand female does by a single intravenous alloxan injection (group D). Glycemia was maintained between 3 and 5 g L–1 with 2 daily subcutaneous insulin injections. Does from group D and contemporary controls (group C) were naturally mated 1 wk after induction of diabetes in group D animals, without superovulation, and embryos collected after sacrifice on Day 4 post-coitum. In Expt. 1, embryos from D (n = 11) and C (n = 13) groups were transferred respectively to the right and left horns of 3 female recipients, which were killed on Day 28. In Expt. 2, 17 D and 16 C females were mated naturally. 68 D and 98 C embryos were collected and transferred to 26 non-diabetic recipients (6–7 embryos per doe). 17 females were pregnant with no difference between C and D recipients. Fetal development was monitored by ultrasound. At birth, litters were equilibrated in number. 15 D and 7 C pups (from 4 D and 2 C litters) were killed at weaning (1 month of age). The remaining 13 D and 26 C pups (4 D and 7 C litters) were allocated to 1 of 2 feeding groups: control or obesogenic diet. The obesogenic diet was based on the control diet supplemented with animal fat (suet, 200%) and glucose (200%). Bodyweight, adiposity, and glucose metabolism were monitored until sacrifice at 5 months of age. Data were analysed by ANOVA using litter (fetuses), litter and sex (weaning), and litter and diet (5 months) as co-factors. Sex effects at 5 months were not analysed due to small numbers of animals. Fetal development was not different between D and C groups. Fetal, placental, and fetal organ weights did not differ at Day 28, except for brain weight, which was significantly lower in D fetuses (0.86 ± 0.1 v. 1.05 ± 0.08 g; P &lt; 0.05). There was no difference in litter size at birth (3.3 ± 0.3 v. 3.6 ± 0.5 pups for D and C groups, respectively; P = 0.5), but birthweight was significantly increased in D offspring (211 ± 6 v. 194 ± 6 g; P &lt; 0.05). There was no difference in weight after 14 days. At 1 month of age, adiposity, plasma insulin and leptin concentrations were not different between groups. In contrast, in male D offspring, fasting glycemia was significantly lower (1.7 ± 0.2 v. 2.1 ± 0.02 g L–1; P &lt; 0.01), plasma insulin-like growth factor 1 was significantly increased (P &lt; 0.05) and kidney/bodyweight ratio was significantly reduced (0.41 ± 0.03 v. 0.45 ± 0.04; P &lt; 0.01). From 12 wk of age, bodyweight became significantly different between D and C groups and according to diet (P &lt; 0.005), with D individuals being lighter than C individuals for each dietary group. Finally, fasting glycemia was significantly higher in the animals fed the obesogenic diet (1.35 ± 0.05 v. 1.19 ± 0.05 g L–1; P &lt; 0.04), regardless of group. These data suggest that maternal hyperglycemia during the periconceptional period affects glucose metabolism and organ development in offspring with sexual dimorphism.

Enhancement of insulin-induced cutaneous vasorelaxation by exercise in rats: A role for nitric oxide and K Ca2+ channels

Insulin is a potent vasoactive hormone which induces vasodilatation at physiological concentrations. Aerobic exercise is known to improve insulin vasodilatory activity in humans and experimental animals. Since both insulin and physical training is known to activate K ATP and K Ca2+ channels and increase nitric oxide (NO) synthesis, we hypothesized that insulin and exercise might use a common mechanism in mediating their vascular effect. The present study was carried out to investigate the role of NO, K ATP and K Ca2+ channels in enhancement of insulin-induced cutaneous vasorelaxation by exercise in rats. Male Wistar rats were submitted to exercise training for 8 weeks on a treadmill. Cutaneous microvascular response to insulin was recorded from soles skin using a laser Doppler flowmeter. Systemic arterial blood pressure and heart rate were measured using a tail-cuff during assessment of cutaneous blood flow. Subcutaneous injection of insulin induced a dose-dependent increase in skin blood flow in control rats which was significantly higher in exercised animals. Local inhibition of NO synthesis ( l-NAME, 10 − 4 M) was associated with a marked inhibitory effect on insulin-induced vasodilatation and this inhibition was significantly greater in exercised rats. Likewise, a selective K Ca2+ channel blocker (iberiotoxin, 10 − 9 M) inhibited insulin-induced vasodilatation and this inhibition was significantly exaggerated in exercised animals. Local K ATP blockade (glybenclamide, 10 − 5 M) showed an identical response in sedentary and exercised animals. Insulin induced a marked vasodilatation in cutaneous microcirculation following aerobic exercise in rats. Both NO and K Ca2+ channels might be involved in the genesis of this effect.

Haemorrhagic shock induced by subcutaneous insulin injection.

Sir—A number of chronic kidney disease patients with diabetes receive intensive insulin therapy nowadays, and many of them are also treated for several comorbidities. The combination of insulin therapy and other comorbidities could result in an unexpected complication.

Contribution of glimepiride to basal–prandial insulin therapy in patients with type 2 diabetes

Aim To investigate the efficacy of continuing glimepiride in combination with basal–prandial insulin therapy in type 2 diabetes. Methods An open crossover study was performed with arms of discontinuation and continuation of glimepiride in 25 subjects with mean diabetes duration of 17 years and 5 years of insulin treatment combined with glimepiride plus metformin. At entry and at the end of each 3-month arm, meal tolerance tests were performed for measurements of blood glucose and C-peptide. Results In terms of between-treatment differences (discontinuation vs. continuation arm of glimepiride) during meal tolerance tests performed at the ends of arms, significant increases in plasma glucose were seen on the discontinuation arm at 0-, 30-, and 60-min, while significant decreases in serum C-peptide were observed at 60- and 120-min. A1C values of the discontinuation arm significantly increased (from 6.6 ± 0.6 at baseline to 7.7 ± 0.8 at 3-months, p < 0.0001). Increases in A1C were closely correlated with decreases in area under the curve of meal-stimulated serum C-peptide ( r = −0.61, p < 0.0001). Conclusions Since endogenous insulin secretion is more physiological than subcutaneous insulin injection, continuing glimepiride may remain beneficial, partly through enhancing insulin secretion, in individuals with a long duration of diabetes and basal–prandial insulin therapy.

Is Continuous Insulin Infusion 1st Line Rx for Diabetes Mellitus?

Research Article| October 01 2010 Is Continuous Insulin Infusion 1st Line Rx for Diabetes Mellitus? AAP Grand Rounds (2010) 24 (4): 46. https://doi.org/10.1542/gr.24-4-46 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Is Continuous Insulin Infusion 1st Line Rx for Diabetes Mellitus?. AAP Grand Rounds October 2010; 24 (4): 46. https://doi.org/10.1542/gr.24-4-46 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP News Search Advanced Search Topics: diabetes mellitus, diabetes mellitus, type 1, infusion procedures, insulin, prescriptions, drug, subcutaneous insulin delivery, insulin administration Source: Sulmont V, Souchon P-F, Gouillard-Darnaud C, et al. Metabolic control in children with diabetes mellitus who are younger than 6 years at diagnosis: continuous subcutaneous insulin infusion as a first line treatment? J Pediatr. 2010; 157(1): 103– 107; doi: https://doi.org/10.1016/j.jpeds.2009.12.034Google Scholar Investigators from Reims, France studied the long-term metabolic outcomes of children with type 1 diabetes mellitus diagnosed prior to their 6th birthday with a treatment duration of at least five years. The participants fell into two groups: Group A consisted of 34 children who were initially treated with multiple daily subcutaneous insulin injections (MDI) and Group B consisted of 32 children who were treated by continuous subcutaneous insulin infusion (CSII) from the time of initial diagnosis. Children assigned to Group A received MDI treatment initially... Copyright © 2010 by the American Academy of Pediatrics2010 You do not currently have access to this content.

The importance of anti-insulin antibody in patients with type 1 diabetes mellitus treated with continuous subcutaneous insulin infusion or multiple daily insulin injections therapy

To investigate the influence of two insulin administration modalities, continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDI) therapy with insulin analogues, on the development of insulin antibodies (IAs) in patients with type 1 diabetes mellitus and to assess the impact of IAs on glucose control and hypoglycaemia. 96 patients with type 1 diabetes mellitus treated with CSII (n=48) or MDI (n=48) were included in the study. Age, duration of diabetes, A1c, preprandial and postprandial blood glucose and hypoglycaemic events were compared between IA positive and negative patients. IA levels were higher in the CSII group (% 24.6±14.2) than the MDI group (% 13.2±9.9). Duration of diabetes and age were not associated with IA positiveness. While A1c, preprandial blood glucose and the frequency of hypoglycaemic events were similar in two groups, postprandial blood glucose was lower in IA positive group (P=0.03). Patients with type 1 diabetes mellitus treated with CSII with insulin analogues had higher IA levels when compared to MDI therapy. However, the development of IAs did not impair the glycaemic control.

Nursing and observation on spinal tuberculosis patients complicated with diabetics treated with insulin pump during perioperative period

Objective To compare the curative effect of the insulin with different routes of administration in spinal tuberculosis patients complicated with diabetics during perioperative period and to summarize nursing experience. Methods A total of 60 cases of spinal tuberculosis complicated with diabetics before surgical treatment were divided into two groups:experimental group treated with insulin pump and control group treated with insulin subcutaneous injection. The conditions of blood glucose, insulin dosage, incidence of hypoglycemia, wound healing were compared between two groups. Results Blood glucose in two groups were controlled well but experimental group was superior to control group. experimental group had lower incidence of hypoglycemia,fewer hospital stay than control group. Wound infection in two groups was similar and no one appeared complications. Conclusions In controlling blood glucose, the insulin pump is superior to insulin subcutaneous injection.Enhancing psychology nursing, skin nursing, health education, blood glucose monitoring and complication prevention can ensure therapeutic effectiveness. Key words: Diabetics; Spinal tuberculosis; Insulin pump; Nursing

Clinical analysis of inpatients with hyperglycemia in the medical intensive care units——Data of Shanghai Renji Hospital from 2002 to 2009

Objective To analyze the association of the morbidity,the management of blood glucose,and the prognosis of patients with hyperglycemia in the medical intensive care units(ICU).Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System,and the data were retrospectively analyzed.Results(1)2631 subjects were included in the present study,blood glucose was determined at least once during hospitalization in 2168 of them.The incidence of hyperglycemia was 26.3%,in which 12.9% presented a known history of diabetes and 13.4% without.In the patients with diabetes history,93.2% of them received anti-diabetic treatment during hospitalization.mainly with oral anti-hyperglyeemic agents (53.0%)or subcutaneous insulin injection(24.9%).However,in the patients without diabetes history,84.4% were not treated against hyperglycemia.The mortality was increased in the latter group(30.4% vs13.9%,P 10 mmol/L was higher than those with blood glucose≤7.0 mmol/L(20.5% vs 9.9%,P 7.0 mmol/L(P<0.01).(3)Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death(OR=1.26).Conclusions The ICU patients showed a high prevalence of hyperglycemia,the management of hyperglycemia should be emphasized.Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality. Key words: Intensive care units; Hyperglycemia; Glyeemic management

Skin and subcutaneous adipose layer thickness in adults with diabetes at sites used for insulin injections: implications for needle length recommendations

Objective:During subcutaneous insulin therapy, inadvertent intramuscular (IM) injections may increase pain and/or adversely affect glucose control. The most appropriate needle length for patients depends on skin thickness (ST) and the distance to muscle fascia. ST and subcutaneous adipose layer thickness (SCT) were measured in adults with diabetes.Research design and methods:A total of 388 US adults with diabetes (in three BMI subgroups: <25, 25–29.9, and ≥30 kg/m2) with diverse demographic features were evaluated. Each subject had ultrasound measurements of ST and SCT at four injection sites.Results:Subjects had BMI 19.4–64.5 kg/m2, age 18–85 years; 40% Caucasian, 25% Asian, 16% Black, 14% Hispanic; 28% type 1 diabetes. Mean ST (±95% CI) was: arm 2.2 mm (2.2, 2.3), thigh 1.9 mm (1.8, 1.9), abdomen 2.2 mm (2.1, 2.2) and buttocks 2.4 mm (2.4, 2.5). Multivariate analyses showed body site, gender, BMI, and race are statistically significant factors for ST but effects were small. Thigh ST was <0.6 mm thinner than the buttocks. Differences of 10 kg/m2 account for 0.2 mm ST variation. Mean SCT was: arm 10.8 mm (10.2, 11.3), thigh 10.4 mm (9.8, 10.9), abdomen 13.9 mm (13.2, 17.7) and buttocks 15.4 mm (14.7, 16.2). Females had 5.1 mm greater SCT. Differences of 10 kg/m2 account for 4 mm SCT variation.Adverse events:A few mild hypo- or hyperglycemia events, unrelated to study procedure, were detected and treated before subject discharge from study visits.Limitations:Only adults in the US were studied; some measurements could not be obtained on every subject, at every injection site.Conclusions:Injection site ST does not differ by clinically significant degrees in demographically diverse adults with diabetes; SCT has a wider range. Needles ≥8 mm, inserted perpendicularly, may frequently enter muscle in limbs of males and those with BMI <25 kg/m2. With 90° insertion, needles 4–5 mm enter the subcutaneous tissue with minimal risk of IM injection in virtually all adults. These data will assist recommending appropriate length needles for subcutaneous insulin injections in adults.

Feasibility Study of Vertical Subcutaneous Injection of Insulin with an Insulin Pen Injector in Diabetic Patients with Normal Body Mass Index

This study explored the feasibility of vertical insulin injection with an insulin pen injector in 40 Chinese diabetic outpatients with a normal body mass index. The patients, who received insulin in the hospital clinic, were assessed for abdominal subcutaneous fat thickness and distribution at four abdominal points using ultrasonography. Abdominal subcutaneous fat thickness and distribution were found to be heterogeneous and to differ significantly at these four points. Abdominal subcutaneous fat thickness was < 5 mm in nine of the 40 patients. In patients with abdominal subcutaneous fat thickness of < 5 mm, vertical insulin injection risks injecting into the muscle layer and is, therefore, not desirable. Vertical injection into pinched skin with a rotary syringe is safe and effective in such patients.

Metabolic Control in Children with Diabetes Mellitus Who are Younger than 6 Years at Diagnosis: Continuous Subcutaneous Insulin Infusion as a First Line Treatment?

To assess long-term metabolic outcomes in children with diabetes mellitus that was diagnosed when they were <6 years old. A cohort of 66 children with diabetes mellitus that had a duration of at least 5 years and was diagnosed before they were 6 years old. Thirty-four children were treated at diagnosis with multiple daily subcutaneous insulin injections (MDI), and all these children, except 3, were switched to continuous subcutaneous insulin infusion (CSII; group A). Thirty-two children received CSII as initial treatment (group B). Hemoglobin A1c values were significantly lower in patients receiving CSII than MDI during all the 8 years of follow-up except one (year 1: 6.9%+/-0.9% versus 7.6%+/-1%, P=.011 ; year 4: 7.4%+/-0.8% versus 8.1%+/-0.9%, P=.006; year 7: 7.6%+/-0.5% versus 8.3%+/-0.8%, P=.001). The incidence of severe hypoglycemia was greatly decreased for the CSII group (9.8 versus 22.3 episodes/100 patient-years, P=.016). In group A, hemoglobin A1c values increased during the study period, and in group B, they increased only during the first 2 years and remained constant thereafter. Only 9.1% of patients did not use or abandoned CSII. CSII in children<6 years of age enables better long-term metabolic control and lowers the risk of severe hypoglycemia better than MDI, especially when initiated at diagnosis.

Continuous subcutaneous insulin infusion providing better glycemic control and quality of life in Type 2 diabetic subjects hospitalized for marked hyperglycemia

Intensive glycemic control is effective in prevention of diabeticcomplications [1–3]. Continuous subcutaneous insulin infusion(CSII) therapy provides a continuous and stable delivery ofinsulin by an external pump. It has been reported that CSII helpslower plasma glucose and prevents hypoglycemia in Type 1 dia-betic patients attempting to improve glycemic control [4]. On theother hand, the majority of Type 2 diabetic patients receive oralanti-diabetic drugs for glycemic control. However, the treatmentmay gradually fail because of deterioration of b-cell functionand/or glucotoxicity [5,6]. Previous studies indicated that inten-sive insulin treatment by CSII is more effective in glycemiccontrol in Type 2 diabetes than conventional insulin therapy[7].Acute hyperglycemia may result in many pathophysiologicaldisorders, such as immune dysfunction, endothelial dysfunctionand neural damage [8–10]. Transient CSII applications in ambu-latory diabetes cases are helpful for glucose control [11–13].However, it is not known whether use of CSII provides betterglycemic control and improvement of quality of life as comparedwith conventional subcutaneous insulin injection and intravenousinsulin infusion in hospitalized Type 2 diabetic subjects withmarked hyperglycemia. Thus, we conducted this study to comparethe effects of these three types of treatment.

Case Study: Experience in Insulin Pump Therapy During the Neonatal Period

T.C., a 4-day-old baby girl born at 36 weeks, was brought to the emergency department with a history of poor feeding and lethargy. She was small for gestational age, with a birth weight of 4.6 lb. The pregnancy was complicated with oligohydroamnios. On examination, she appeared emaciated and dehydrated, with sunken eyes and depressed anterior fontanele. Her capillary refill was 4 seconds, and she weighed 4 lb. Her laboratory tests results were significant for elevated blood glucose at 765 mg/dl , and she was diagnosed with neonatal diabetes. T.C. was admitted to the pediatric intensive care unit for the initial management of diabetes with intravenous (IV) insulin infusion (0.01-0.05 units/kg of body weight/hour). After 6 days on IV insulin, she was switched to subcutaneous (SC) insulin injection therapy with NPH and aspart insulin, 2-3 times a day. The insulin doses were titrated frequently to control blood glucose levels (0.5-1 units/kg/day). Because of wide excursions of blood glucose levels with one episode of severe hypoglycemia, her NPH was changed to ultralente insulin. T.C.’s blood glucose remained difficult to manage with SC insulin injections. She required IV insulin infusion again to stabilize her glucose levels. 1. What is the best way to optimize diabetes management for an infant with difficult-to-control neonatal diabetes? 2. What considerations are necessary to develop a safe discharge plan for such a patient? ### Initiating CSII To better control her blood glucose levels, physicians treating T.C. considered initiating insulin pump therapy. After parental consent was obtained and diabetes education was provided, continuous subcutaneous insulin infusion (CSII) therapy was started via an insulin pump (Medtronic 512) on day 27 of T.C.’s life. She was started with an initial basal infusion rate of 0.05 units/hour using lispro insulin in 10x dilution (Humalog U10/ml, Eli Lilly and Co.). For a consistent feeding regimen (every 2-3 hours), …

Index of Suspicion in the Nursery

A 5-week-old previously well female born at 41 weeks gestational age presents to the pediatric emergency department in the winter with a 2-day history of poor feeding. Her mother is concerned that the baby is more tired than usual, “is not getting enough to eat,” and is having difficulty latching on to the breast. The mother explains that 2 weeks ago, the infant developed a dry cough and began having emesis after each feeding. She describes the emesis as nonbilious and nonbloody and approximately 1 ounce. An outside pediatrician prescribed a cough and cold medication and told the mother that the emesis was “normal baby spit-up.” Three days ago, the infant developed projectile vomiting immediately following each feeding. Today, the mother reports that the infant is breathing much harder and deeper than usual, with continued and more frequent coughs. She describes the cough as paroxysmal, although she experiences no color changes. The mother is concerned that her baby does not look like herself and is difficult to arouse. A review of systems reveals that the baby has not taken any human milk today, although her urine output has remained the same, with heavy, wet diapers. Her 2-year-old sister, who attends child care, has a cough and upper respiratory tract infection. The infant has no diarrhea, and her bowel movements are normal. There were no complications during the pregnancy. Her birthweight was 2,722 g, and she has been gaining weight appropriately, although the mother describes her as “scrawny” at birth. Physical examination of the infant in the emergency department shows a temperature …

Incidence of abdominal wall numbness post-liver transplantation and its complications

Liver transplantation (LTx) is a life-saving procedure for end-stage liver disease. However, LTx remains a major surgical procedure with a significant amount of morbidity and mortality. Several different types of post-LTx complications have been studied and reported; however, the numbness of the abdominal skin between the subcostal incision and the umbilicus and its associated complications have not been studied in a large patient population. The aim of this study was to report the incidence of numbness in the abdominal skin post-LTx and its implications in routine life. One hundred and one post-LTx patients were questioned in the clinic about numbness. There were 52 male patients and 49 female patients with a mean age of 51.9 +/- 11.3 years at the time of LTx, and the mean time from transplant was 35.0 +/- 29.5 months (range, 3-113 months). The implications were recorded. All 101 patients (100%) had an area of numbness between the subcostal incision and the umbilicus. Four of these patients had an area of superficial-to-deep burns from hot food (accidentally dropped on the abdomen), heating pads, or a hot cup of tea. One patient had ecchymosis from blunt trauma during gardening. Out of 36 diabetic patients, more than 24 patients were insulin-dependent and used the area for subcutaneous insulin injections. In addition, some of the 43 hepatitis C virus-positive patients used the area for subcutaneous interferon therapy. In conclusion, 100% of the patients had persistent numbness up to 9 years following LTx. Five percent of the patients developed thermal injuries or blunt trauma complications that could have been prevented with better education and awareness. More then 24% of the patients used the area for subcutaneous injections of insulin and/or interferon.

Correlates of quality of life in adults with type 1 diabetes treated with continuous subcutaneous insulin injection

Background and aimsAim of this study was to identify subgroups of adults with Type 1 Diabetes Mellitus (T1DM) treated with Continuous Subcutaneous Insulin Infusion (CSII) at higher risk of poor quality of life (QoL).A sample of consecutive patients completed the Diabetes Specific Quality of Life Scale (DSQOLS), investigating the daily burden and restrictions related to diabetes. Lower DSQOLS scores indicate worse QoL perception. Methods and resultsThe main results were obtained by using a regression-tree technique (RECursive Partitioning and AMalgamation – RECPAM) and multivariate logistic regression.Overall, 472 patients aged between 18 and 55 years were recruited by 43 Italian centers. RECPAM analysis led to the identification of 5 classes characterized by a marked difference in QoL. Male patients not reporting episodes of ketoacidosis and using CSII for >2 years had the lowest likelihood of scoring in the lower tertile of the DSQOLS summary score, and thus represented the reference category.Patients who reported ≥1 ketoacidosis episodes (OR = 5.4; 95% CI 2.4–12.1) and female patients with a duration of diabetes of <10 years (OR = 5.9; 95% CI 2.6–13.5) had the highest likelihood of reporting poor QoL, while females with longer diabetes duration (OR = 2.4; 95% CI 1.3–4.7) and males treated with CSII for ≤2 years (OR = 2.2; 95% CI 1.1–4.6) showed a two-fold risk of poor QoL. Patient age, diabetic complications and civil status were globally predictive variables associated with poor QoL. ConclusionWe identified subgroups of T1DM individuals treated with CSII showing a major impairment in QoL. Specific strategies are needed to help the patient cope with this therapeutic modality, especially during the initial phase of treatment.

Differential effects of insulin detemir and neutral protamine Hagedorn (NPH) insulin on hepatic glucose production and peripheral glucose uptake during hypoglycaemia in type 1 diabetes

We compared the symptoms of hypoglycaemia induced by insulin detemir (NN304) (B29Lys(epsilon-tetradecanoyl),desB30 human insulin) and equally effective doses of neutral protamine Hagedorn (NPH) insulin in relation to possible differential effects on hepatic glucose production and peripheral glucose uptake. After overnight intravenous infusion of soluble human insulin 18 participants with type 1 diabetes received subcutaneous injections of NPH insulin or insulin detemir (0.5 U/kg body weight) on separate occasions in random order. During the ensuing gradual development of hypoglycaemia cognitive function and levels of counter-regulatory hormones were measured and rates of endogenous glucose production and peripheral glucose uptake continuously evaluated using a primed constant infusion of [6,6-(2)H(2)]glucose. The study was terminated when plasma glucose concentration had fallen to 2.4 mmol/l or had reached a minimum at a higher concentration. During the development of hypoglycaemia no difference between the two insulin preparations was observed in symptoms or hormonal responses. Significant differences were seen in rates of glucose flux. At and below plasma glucose concentrations of 3.5 mmol/l suppression of endogenous glucose production was greater with insulin detemir than with NPH insulin, whereas stimulation of peripheral glucose uptake was greater with NPH insulin than with insulin detemir. In participants with type 1 diabetes subcutaneously injected insulin detemir exhibits relative hepatoselectivity compared with NPH insulin, but symptoms of hypoglycaemia and hormonal counter-regulation are similar. ClinicalTrials.gov NCT00760448.

Clinical study on the Treatment of 85 cases of Type 2 Diabetes Mellitus Combined with Abnormal Metabolism of Lipid with Quyuhuatan Decoction

Objective To explone the therapeutic effect and mechanism of Quyuhuatan decoction in treating type 2 diabetes mellitus combined with abnormal metabolism of lipid. Methods 85 cases of type 2 diabetes mellitus combined with abnormal metabolism of lipid were recruited into a control group and a treatment group randomly. The treatment group (45cases) was treated with Quyuhuatan decoction and subcutaneous insulin injection while the control group(40cases) was treated with subcutaneous insulin injection exclusively. Both groups received the treatment for for 8 weeks. The result of TC, TG, LDL-C, and HDT-C were observed before and after the treatment. Results The improvement of blood lipid in the treatment group was superior to that in the control group (t=0.011, P<0.05) . Conclusion Quyuhuatan decoction is effective in treating type 2 diabetes mellitus combined with abnormal metabolism of lipid. The mechanism might be related with its cutting off pathological paths of hyperlipidemia. Key words: Quyuhuatan decoction; Type 2 diabetes mellitus; Abnormal metabolism of lipid