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Type 2 diabetes and basal insulin

Muhammad Ali Karamat, Shujah Dar, Srikanth Bellary, Abd A Tahrani
INTRODUCTION: To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal-bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness. METHODS: Patients with T1D who were aged ≥ 18 years, were on a basal-bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness...
March 16, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
K Verboven, K Wouters, K Gaens, D Hansen, M Bijnen, S Wetzels, C D Stehouwer, G H Goossens, C G Schalkwijk, E E Blaak, J W Jocken
Obesity is associated with a disturbed adipose tissue (AT) function characterized by adipocyte hypertrophy, an impaired lipolysis and pro-inflammatory phenotype, which contributes to insulin resistance (IR). We investigated whether AT phenotype in different AT depots of obese individuals with and without type 2 diabetes mellitus (T2DM) is associated with whole-body IR. Subcutaneous (SC) and visceral (V) AT biopsies from 18 lean, 17 obese and 8 obese T2DM men were collected. AT phenotype was characterized by ex vivo measurement of basal and stimulated lipolysis (mature adipocytes), adipocyte size distribution (AT tissue sections) and AT immune cells (flow cytometry)...
March 16, 2018: Scientific Reports
Martin M Grajower
Hypoglycemia is the major side effect of insulin therapy. The elderly are especially vulnerable to episodes of hypoglycemia, and with greater risks of complications such as falls. Two new long-acting basal insulins, glargine-300 (Gla-300) and degludec, are associated with lower incidences of hypoglycemia than previously available basal insulins. One of them, Gla-300, was studied in the elderly and has a lower incidence of hypoglycemia in patients over 65 years old. These new data should be incorporated into decision making when treating the elderly patient with insulin, whether they have type 1 or 2 diabetes...
March 2018: Endocrine Practice
Robyn K Pollom, Timothy Costigan, Lyndon B Lacaya, Liza L Ilag, Priscilla A Hollander
INTRODUCTION: To compare efficacy and safety of Basaglar® [insulin glargine 100 units/mL; LY insulin glargine (LY IGlar)] to Lantus® [insulin glargine 100 units/mL; SA insulin glargine (SA IGlar)] in older (≥ 65 years) or younger (< 65 years) patients with type 2 diabetes (T2D). METHODS: This subgroup analysis of a phase 3, randomized, double-blind, multinational, 24-week study compared LY IGlar and SA IGlar on several clinical efficacy (change in glycated hemoglobin (A1c), basal insulin dose, weight) and safety outcomes (incidence of adverse events, insulin antibodies, hypoglycemia incidence and rates) in patients either ≥ 65 or < 65 years...
March 14, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Özlem Korkmaz, Günay Demir, Hafize Çetin, İlkin Mecidov, Yasemin Atik Altınok, Samim Özen, Şükran Darcan, Damla Gökşen
AIM: To compare continuous subcutaneous insulin infusion therapy (CSII) with multiple daily insulin therapy (MDI) on metabolic control in children and adolescents with type 1 diabetes mellitus (T1DM) over the long term. METHOD: 52 T1DM patients treated with CSII and monitored for at least 1 year prior to and at least five years following CSII were included. 38 age and sex-matched MDI controls with a 5-year follow up were recruited. RESULTS: Mean age of the subjects, duration of diabetes and CSII therapy were 17...
February 28, 2018: Journal of Clinical Research in Pediatric Endocrinology
Laurentiu M Pop, Andrea Mari, Tong-Jin Zhao, Lori Mitchell, Shawn Burgess, Xilong Li, Beverley Adams-Huet, Ildiko Lingvay
AIM: To investigate the physiological mechanisms leading to rapid improvement in diabetes after Roux-en-Y Gastric Bypass (RYGB). In particular, the roles of concurrent peri-operative dietary restrictions, which may also alter glucose metabolism, have not been completely elucidated. MATERIALS AND METHODS: To assess the differential contributions of diet and surgery to the mechanisms leading to the rapid improvement in diabetes after RYGB we enrolled ten patients with type 2 diabetes scheduled to undergo RYGB...
March 13, 2018: Diabetes, Obesity & Metabolism
Tianwei Gu, Ting Hong, Pengzi Zhang, Sunyinyan Tang, Yan Bi, Hai Lu, Lichuang Men, Dongwei Ma, Dalong Zhu
INTRODUCTION: In Asia, patients with type 2 diabetes mellitus (T2DM) often have suboptimal glycemic control for many years prior to initiating basal insulin. Active titration of basal insulin is also required to improve glycemic outcomes. This pooled analysis was conducted to determine the impact of patient baseline covariates on the required dose of basal insulin and treatment response, for the improved management of Asian patients with T2DM. METHODS: Data on insulin-naïve Asian patients with T2DM who initiated and fully titrated insulin glargine 100 U/mL (Gla-100) for ≥ 20 weeks were pooled from seven randomized, controlled, treat-to-target trials...
March 9, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Ian Blumer, Jeremy H Pettus, Tricia Santos Cavaiola
Many individuals with type 2 diabetes (T2D) will eventually require insulin therapy to help achieve and maintain adequate glycemic control. However, the use of insulin can be associated with adverse effects such as hypoglycemia and weight gain, and in some patients the addition of insulin to treatment regimens is often still insufficient to achieve target glycemic control. Combining basal insulin with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) for the treatment of patients with T2D has been demonstrated to be effective and well tolerated, while mitigating many of the adverse events associated with giving either of these drug classes alone...
March 9, 2018: Postgraduate Medicine
Bahendeka Silver, Kaushik Ramaiya, Swai Babu Andrew, Otieno Fredrick, Sarita Bajaj, Sanjay Kalra, Bavuma M Charlotte, Karigire Claudine, Anthony Makhoba
A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A). Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A). Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin...
March 5, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Michael Macia, Emilie Pecchi, Martine Desrois, Carole Lan, Christophe Vilmen, Bernard Portha, Monique Bernard, David Bendahan, Benoît Giannesini
The functional and bioenergetics impact of regular physical activity upon type-2 diabetic skeletal muscle independently of confounding factors of overweight remains undocumented. Here, gastrocnemius muscle energy fluxes, mitochondrial capacity and mechanical performance were assessed noninvasively and longitudinally in non-obese diabetic Goto-Kakizaki rats using magnetic resonance (MR) imaging and dynamic 31-phosphorus MR spectroscopy (31 P-MRS) throughout a 6-min fatiguing bout of exercise performed before, in the middle (4-week) and at the end of an 8-week training protocol consisting in 60-min daily run on a treadmill...
February 27, 2018: Biochimie
Carmen Lambert, Judit Cubedo, Teresa Padró, Gemma Vilahur, Sergi López-Bernal, Milagros Rocha, Antonio Hernández-Mijares, Lina Badimon
BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) have a higher incidence of cardiovascular (CV) events. The ingestion of high-glycemic index (GI) diets, specially sweetened beverage consumption, has been associated with the development of T2DM and CV disease. OBJECTIVE: We investigated the effects of the intake of a sweetened beverage, obtained from natural carbohydrates containing pinitol (PEB) compared to a sucrose-enriched beverage (SEB) in the context of impaired glucose tolerance (IGT) and diabetes...
February 27, 2018: Nutrients
Pau Herrero, Jorge Bondia, Marga Giménez, Nick Oliver, Pantelis Georgiou
BACKGROUND: People with insulin-dependent diabetes rely on an intensified insulin regimen. Despite several guidelines, they are usually impractical and fall short in achieving optimal glycemic outcomes. In this work, a novel technique for automatic adaptation of the basal insulin profile of people with diabetes on sensor-augmented pump therapy is presented. METHODS: The presented technique is based on a run-to-run control law that overcomes some of the limitations of previously proposed methods...
March 2018: Journal of Diabetes Science and Technology
Wesley Nuffer, Ashley Guesnier, Jennifer M Trujillo
There have been several new treatment approaches established for the management of hyperglycemia in type 2 diabetes (T2D), with treatment guidelines listing both glucagon-like peptide 1 receptor agonists (GLP-1 RAs) and basal insulin therapies as considerations for patients who have failed to control their blood glucose with oral antidiabetic agents. New studies have highlighted the importance of initiating combination therapy earlier in the T2D disease process to avoid clinical inertia and prevent the long-term complications arising from uncontrolled diabetes...
March 2018: Therapeutic Advances in Endocrinology and Metabolism
Amanda K Galan-Davila, Jiyoon Ryu, Kun Dong, Yang Xiao, Zhe Dai, Deling Zhang, Zhi Li, Amanda M Dick, Kevin D Liu, Amrita Kamat, Min Lu, Qunfeng Dong, Feng Liu, Lily Q Dong
Adiponectin is an adipocyte-derived hormone with antidiabetic activities, which include increasing the sensitivity of cells to insulin. Adaptor protein containing pleckstrin homology domain, phosphotyrosine-binding domain, and leucine zipper motif (APPL1) stimulates adiponectin signaling and promotes adiponectin's insulin-sensitizing effects by binding to two adiponectin receptors, AdipoR1 and AdipoR2, and the insulin receptor. In the present study, we report on an alternative splicing variant of APPL1 (APPL1sv) that is highly expressed in mouse liver, pancreas, and spleen tissues...
February 26, 2018: Journal of Biological Chemistry
Liana K Billings, Ankur Doshi, Didier Gouet, Alejandra Oviedo, Helena W Rodbard, Nikolaos Tentolouris, Randi Grøn, Natalie Halladin, Esteban Jodar
OBJECTIVE: In patients with uncontrolled type 2 diabetes on basal insulin, prandial insulin may be initiated. We assessed the efficacy and safety of initiating insulin degludec/liraglutide fixed-ratio combination (IDegLira) versus basal-bolus insulin. RESEARCH DESIGN AND METHODS: A phase 3b trial examined patients with uncontrolled type 2 diabetes on insulin glargine (IGlar U100) 20-50 units/day and metformin, randomized to IDegLira or IGlar U100 and insulin aspart four or fewer times per day...
February 26, 2018: Diabetes Care
M E Trautmann, J Vora
As Type 2 diabetes progresses, treatment is intensified with additional therapies in an effort to manage hyperglycaemia effectively and therefore avoid complications. When greater efficacy is required, options for injectable treatments include glucagon-like peptide-1 receptor agonists and insulin, which may be added on to oral glucose-lowering treatments. Among individuals receiving long-acting basal insulin as their first injectable treatment, ~40-60% are unable to achieve or maintain their target HbA1c goals...
February 25, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
Lori Berard, Noreen Antonishyn, Kathryn Arcudi, Sarah Blunden, Alice Cheng, Ronald Goldenberg, Stewart Harris, Shelley Jones, Upender Mehan, James Morrell, Robert Roscoe, Rick Siemens, Michael Vallis, Jean-François Yale
It is currently estimated that 11 million Canadians are living with diabetes or prediabetes. Although hyperglycemia is associated with serious complications, it is well established that improved glycemic control reduces the risk of microvascular complications and can also reduce cardiovascular (CV) complications over the long term. The UKPDS and ADVANCE landmark trials have resulted in diabetes guidelines recommending an A1C target of ≤ 7.0% for most patients or a target of ≤ 6.5% to further reduce the risk of nephropathy and retinopathy in those with type 2 diabetes (T2D), if it can be achieved safely...
February 23, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Andreas Liebl, Viswanathan Mohan, Wenying Yang, Krzysztof Strojek, Sultan Linjawi
Since clinical experience with biphasic insulin aspart 30 (BIAsp 30) in type 2 diabetes mellitus (T2DM) was reviewed in 2012 after 10 years of use worldwide, additional studies have been published that highlight new aspects, including use in real-world populations. Evidence from 35 new studies confirms and builds upon previous work indicating that BIAsp 30 continues to have pharmacodynamic and clinical advantages over biphasic human insulin (BHI 30), including in real-world practice with unselected populations of patients...
February 21, 2018: Drugs in R&D
Jelica Bjekić-Macut, Teodora Beljić Živković, Radivoj Kocić
INTRODUCTION: Basal insulin analogues offer persons with type 2 diabetes mellitus (T2DM) adequate glycemic control combined with a favorable safety profile. BASAL-BALI-a prospective, noninterventional, multicenter disease registry-assessed the effectiveness and safety of basal insulin analogues in adult Serbians with T2DM previously inadequately controlled on other insulin types. METHODS: The primary objective was to assess the reduction in glycated hemoglobin (HbA1c ) from basal insulin analogue initiation to the end of a 6-month observation period...
February 19, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Tomohide Yamada, Nobuhiro Shojima, Hisashi Noma, Toshimasa Yamauchi, Takashi Kadowaki
New treatments for type 1 diabetes are an unmet need. We investigated the efficacy and safety of adding SGLT-2is to insulin for type 1 diabetes by meta-analysis of prospective randomized, placebo-controlled trials. Searching electronic databases up to October 2017 identified 1361 studies, among which 14 were investigated (N=4,591). Meta-analysis revealed that SGLT-2i therapy significantly reduced HbA1c by 0.4% (95% confidence interval [CI]: 0.35, 0.46; P<0.001; I2=0%), fasting plasma glucose by 1.14 mmol/l (0...
February 16, 2018: Diabetes, Obesity & Metabolism
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