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insulin intensive therapy

Ruth S Weinstock, Ingrid Schütz-Fuhrmann, Crystal G Connor, Julia M Hermann, David M Maahs, Morten Schütt, Shivani Agarwal, Sabine E Hofer, Roy W Beck, Reinhard W Holl
AIMS: Compare characteristics, therapies and clinical outcomes in older adults with type 1 diabetes in the United States T1D Exchange (T1DX) and German/Austrian Diabetes Patienten Verlaufsdokumentation (DPV) registries. METHODS: Cross-sectional study of adults ≥60years old with type 1 diabetes seen in 2011-2012 in the T1DX (n=1283) and DPV (n=2014) registries. Wilcoxon rank-sum test was used for continuous variables and chi-square test for categorical variables...
October 4, 2016: Diabetes Research and Clinical Practice
K Gayathri, P K Ramalingam, Rpsp Santhakumar, B V Manjunath, N Karuppuswamy, B Vetriveran, S Selvamani, P Vishnuram, A Muruganathan, Kumar Natarajan
Lipemia retinalis is a rare and asymptomatic condition which occurs when high levels of triglycerides and chylomicrons are present in blood. We report a rare case of secondary hyperlipoproteinemia in a 27 year old type 1 diabetes patient who presented with diabetic ketoacidosis and this peculiar ocular manifestation. The fundoscopic abnormality and creamy white serum cleared as the level of chylomicrons in the plasma dropped with intensive insulin therapy.
April 2016: Journal of the Association of Physicians of India
Hong-Tu Li, Fang-Xu Jiang, Ping Shi, Tao Zhang, Xiao-Yu Liu, Xue-Wen Lin, Zhong-Yan San, Xi-Ning Pang
Islet transplantation provides curative treatments to patients with type 1 diabetes, but donor shortage restricts the broad use of this therapy. Thus, generation of alternative transplantable cell sources is intensively investigated worldwide. We previously showed that bone marrow-derived mesenchymal stem cells (bmMSCs) can be reprogrammed to pancreatic-like cells through simultaneously forced suppression of Rest/Nrsf (repressor element-1 silencing transcription factor/neuronal restrictive silencing factor) and Shh (sonic hedgehog) and activation of Pdx1 (pancreas and duodenal transcription factor 1)...
October 3, 2016: In Vitro Cellular & Developmental Biology. Animal
Mark F McCarty
In type 1 diabetics, hepatic exposure to insulin is chronically subnormal even in the context of insulin therapy; as a result, expression of glycolytic enzymes is decreased, and that of gluconeogenic enzymes is enhanced, resulting in a physiologically inappropriate elevation of hepatic glucose output. Subnormal expression of glucokinase (GK) is of particular importance in this regard. Possible strategies for correcting this perturbation of hepatic enzyme expression include administration of small molecule allosteric activators of GK, as well as a procedure known as chronic intermittent intravenous insulin therapy (CIIIT); however, side effects accompany the use of GK activators, and CIIIT is time and labor intensive...
October 2016: Medical Hypotheses
Tsutomu Namikawa, Masaya Munekage, Hiroyuki Kitagawa, Tomoaki Yatabe, Hiromichi Maeda, Yuuki Tsukamoto, Kenichi Hirano, Takuji Asano, Yoshihiko Kinoshita, Kazuhiro Hanazaki
This clinical study aimed to compare a novel and conventional artificial pancreas (AP) used in surgical patients for perioperative glycemic control, with respect to usability, blood glucose measurements, and glycemic control characteristics. From July in 2010 to March in 2015, 177 patients underwent perioperative glycemic control using a novel AP. Among them, 166 patients were eligible for inclusion in this study. Intensive insulin therapy (IIT) targeting a blood glucose range of 80-110 mg/dL was implemented in 82 patients (49 %), and the remaining 84 patients (51 %) received a less-intensive regime of insulin therapy...
September 20, 2016: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Lesley-Anne Bissell, Elizabeth M A Hensor, Lukasz Kozera, Sarah L Mackie, Agata N Burska, Jacqueline L Nam, Helen Keen, Edith Villeneuve, Helena Donica, Maya H Buch, Philip G Conaghan, Jacqueline Andrews, Paul Emery, Ann W Morgan
OBJECTIVES: To determine the change in established biomarkers of cardiovascular (CV) risk, namely, total cholesterol/high-density lipoprotein cholesterol ratio (TC/HDL-C), N-terminal pro-brain natriuretic peptide (NT-proBNP) and insulin resistance (IR) in patients with early RA treated with two different treat-to-target strategies. METHODS: Fasting glucose, lipids, insulin and NT-proBNP were measured at baseline, weeks 26 and 78 in 79 DMARD-naïve RA patients, free of CV disease, as part of a double-blind randomized controlled trial of MTX with either infliximab (IFX) or methylprednisolone as induction therapy...
September 16, 2016: Rheumatology
Jessica Turner, Tahmina Begum, Roger D Smalligan
INTRODUCTION: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are relatively new antihyperglycemic agents that lower renal glucose reabsorption. They are used as adjunctive therapy to standard diabetes treatment. CASE REPORT: We present the case of a 62-year-old woman with a past medical history of type 2 diabetes mellitus and sudden-onset diabetic ketoacidosis (DKA). Use of canagliflozin, a SGLT-2 inhibitor, was determined to be the cause of the DKA. The patient ultimately recovered after 5 days in the intensive care unit...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Hiroyuki Ito, Emiko Tsugami, Shigenori Ando, Ayano Imai, Suzuko Matsumoto, Takashi Omoto, Masahiro Shinozaki, Shinya Nishio, Mariko Abe, Shinichi Antoku, Mizuo Mifune, Michiko Togane
BACKGROUND: We investigated the trends in the clinical characteristics and prescriptions of type 2 diabetic patients with severe hypoglycemia because the prescription rate of antidiabetic agents has significantly changed recently. METHODS: A total of 193 patients with type 2 diabetes with severe hypoglycemia induced by antidiabetic agents between 2008 and 2013 were divided into three groups based on the period of visit: 2008 - 2009, 2010 - 2011 and 2012 - 2013. RESULTS: While the proportion of patients with severe hypoglycemia using insulin (from 55% to 74%), biguanides (from 6% to 20%), glinides, and dipeptidyl peptidase-4 inhibitors significantly increased, those using sulfonylureas (from 45% to 20%) significantly decreased...
October 2016: Journal of Clinical Medicine Research
Brigid A Knight, H David McIntyre, Ingrid J Hickman, Marina Noud
BACKGROUND: Modern flexible multiple daily injection (MDI) therapy requires people with diabetes to manage complex mathematical calculations to determine insulin doses on a day to day basis. Automated bolus calculators assist with these calculations, add additional functionality to protect against hypoglycaemia and enhance the record keeping process, however uptake and use depends on the devices meeting the needs of the user. We aimed to obtain user feedback on the usability of a mobile phone bolus calculator application in adults with T1DM to inform future development of mobile phone diabetes support applications...
2016: BMC Medical Informatics and Decision Making
Emil Martinka, Mariana Rončáková, Michaela Mišániková, Arash Davani
BACKGROUND: It is not always easy to classify diabetes (DM) diagnosed in adults, with a significant group of patients initially classified and treated for type 2 diabetes mellitus (DM2T) presenting signs indicating the presence of autoimmune insulitis (AI), which is characteristic of type 1 diabetes mellitus (DM1T), or latent autoimmune diabetes mellitus in adults (LADA). GOAL: Identify the proportion of patients entered with DM2T who present AI signs, and the number of patients of that proportion, who at the same time present low insulin secretion, and what clinical and laboratory manifestations could be used to differentiate between these patients...
2016: Vnitr̆ní Lékar̆ství
Ohad Cohen, William Valentine
BACKGROUND: Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes because of inconsistencies in evidence of effectiveness. We reviewed published guidelines on intensive insulin therapy in type 2 diabetes to assess whether updating of guidance is needed with respect to evidence used and recommendations for CSII in diabetes management. METHODS: A literature review was performed to identify published national and international guidelines on type 2 diabetes management...
September 12, 2016: Journal of Diabetes Science and Technology
M I Maiorino, G Bellastella, F Castaldo, M Petrizzo, D Giugliano, K Esposito
PURPOSE: The aim of this study was to evaluate the prevalence and risk factors associated with female sexual dysfunction (FSD) in young women with type 1 diabetes treated with different intensive insulin regimens. METHODS: Type 1 diabetic women aged 18-35 years were included in this study if they had stable couple relationship and no oral contraceptive use. All women were asked to complete the Female Sexual Function Index (FSFI) and other validated multiple-choice questionnaires assessing sexual-related distress (Female Sexual Distress Scale, FSDS), quality of life (SF-36 Health Survey), physical activity (International Physical Activity Questionnaire), depressive symptoms (Zung Self-Rating Depression Scale, SRDS) and diabetes-related problems (Diabetes Integration Scale ATT-19)...
September 9, 2016: Journal of Endocrinological Investigation
B Tubić, C Pettersson, A Svedlund, H Bertéus Forslund, P Magnusson, D Swolin-Eide
Patients with anorexia nervosa (AN) are at high risk of reduced bone mass. Osteocalcin (OC), a bone formation marker, has been proposed to act as a link between bone and energy metabolism. We investigated how the 3 forms of OC respond during a 12-week intensive nutrition therapy in AN patients, in whom large changes in energy metabolism are expected.Twenty-two female AN patients, mean 20.9 years of age, with a starting mean body mass index (BMI) 15.5 kg/m(2) (minimum-maximum) (13.4-17.3 kg/m(2)) completed the study...
September 2016: Hormone and Metabolic Research, Hormon- und Stoffwechselforschung, Hormones et Métabolisme
Caroline K Kramer, Bernard Zinman, Haysook Choi, Ravi Retnakaran
OBJECTIVE: In early type 2 diabetes (T2DM), short-term intensive insulin therapy (IIT) for 2-4 weeks can decrease insulin resistance, reduce glucagonemia, improve β-cell function, and even induce a remission of diabetes that can last up to 1 year in some patients. However, little is known about the predictors of such a sustained remission. METHODS: We evaluated data from the placebo arm of a double-blind randomized controlled trial in which patients with early T2DM (≤7 years duration) underwent 4 weeks of IIT (basal detemir, bolus aspart), followed by placebo therapy for 48 weeks (n=25)...
2016: BMJ Open Diabetes Research & Care
Mary B Abraham, Raymond Davey, Michael J O'Grady, Trang T Ly, Nirubasini Paramalingam, Paul A Fournier, Anirban Roy, Benyamin Grosman, Natalie Kurtz, Janice M Fairchild, Bruce R King, Geoffrey R Ambler, Fergus Cameron, Timothy W Jones, Elizabeth A Davis
BACKGROUND: Sensor-augmented pump therapy (SAPT) with a predictive algorithm to suspend insulin delivery has the potential to reduce hypoglycemia, a known obstacle in improving physical activity in patients with type 1 diabetes. The predictive low glucose management (PLGM) system employs a predictive algorithm that suspends basal insulin when hypoglycemia is predicted. The aim of this study was to determine the efficacy of this algorithm in the prevention of exercise-induced hypoglycemia under in-clinic conditions...
September 2016: Diabetes Technology & Therapeutics
Lindsey A Muir, Charles E Murry, Jeffrey S Chamberlain
In Duchenne muscular dystrophy (DMD) and other muscle wasting disorders, cell therapies are a promising route for promoting muscle regeneration by supplying a functional copy of the missing dystrophin gene and contributing new muscle fibers. The clinical application of cell-based therapies is resource intensive, and it will therefore be necessary to address key limitations that reduce cell engraftment into muscle tissue. A pressing issue is poor donor cell survival following transplantation, which in preclinical studies limits the ability to effectively test the impact of cell-based therapy on whole muscle function...
September 7, 2016: Stem Cells and Development
K C Hiew, A Sachithanandan, M Arif, B Badmanaban, A Muiz, I Faisal, L Hamdan, O Evi Diana
BACKGROUND: Acute kidney injury (AKI) following cardiac surgery is well established but the reported incidence is variable due to varying definitions and criteria. Furthermore there is a paucity of such data from Southeast Asia. OBJECTIVES: To determine the incidence of AKI, the associated risk factors, and its impact on early mortality and intensive care unit/hospital stay. METHOD: This is a single centre retrospective observational study to evaluate outcomes on 1260 consecutive patients from a multi-ethnic Southeast Asian population who underwent a primary isolated coronary artery bypass graft (CABG) operation...
June 2016: Medical Journal of Malaysia
Jennifer Hayes, Rosie Anderson, Jeffrey W Stephens
Type 2 diabetes mellitus is a progressive disease associated with significant morbidity and mortality. There is good evidence showing that intensive glycemic control reduces the development and progression of complications. In order to achieve glycemic targets, patients often require a combination of oral therapy and/or insulin in addition to lifestyle modification. Unfortunately, many of the traditional therapies for type 2 diabetes are associated with weight gain and hypoglycemia, resulting in poor compliance and subsequent worsening of glycemic control...
2016: Drug Design, Development and Therapy
Masayuki Shibata, Hiroyuki Matsubayashi, Tsuyoshi Aramaki, Katsuhiko Uesaka, Naoyuki Tsutsumi, Keiko Sasaki, Hiroyuki Ono
BACKGROUND: Hepatic inflammatory pseudotumor (IPT) is a rare disease which often mimics a malignant tumor and is therefore often misdiagnosed and surgically resected. Recently, a concept of IgG4-related diseases (IgG4-RD) has been proposed that is becoming widely recognized and includes IgG4-related hepatic IPT. Corticosteroids are widely accepted as the standard treatment. CASE PRESENTATION: A 72-year-old Japanese man, who had been followed for ten years after surgery and chemotherapy for treatment of hilar and lower bile duct cancers, developed intermittent fever and abdominal pain and visited this hospital...
2016: BMC Gastroenterology
Nam K Tran, Zachary R Godwin, Amanda N Steele, Steven E Wolf, Tina L Palmieri
OBJECTIVES: The goal of this study was to retrospectively evaluate the clinical impact of an accurate autocorrecting blood glucose monitoring system in children with severe burns. Blood glucose monitoring system accuracy is essential for providing appropriate intensive insulin therapy and achieving tight glycemic control in critically ill patients. Unfortunately, few comparison studies have been performed to evaluate the clinical impact of accurate blood glucose monitoring system monitoring in the high-risk pediatric burn population...
September 2016: Pediatric Critical Care Medicine
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