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Basal insulin therapy in type 2 DM

Ana María Gómez, Santiago Vallejo, Freddy Ardila, Oscar M Muñoz, Álvaro J Ruiz, Mauricio Sanabria, Alfonso Bunch, Elly Morros, Laura Kattah, Maira García-Jaramillo, Fabián León-Vargas
INTRODUCTION: Clinical interventional studies in diabetes mellitus usually exclude patients undergoing peritoneal dialysis (PD). This study evaluates the impact of an educational program and a basal-bolus insulin regimen on the blood glucose level control and risk of hypoglycemia in this population. METHODS: A before-and-after study was conducted in type 1 and type 2 DM patients undergoing PD at the Renal Therapy Services (RTS) clinic network, Bogota, Colombia. An intervention was instituted consisting of a three-month educational program and a basal-bolus detemir (Levemir, NovoNordisk) and aspart (Novorapid, NovoNordisk) insulin regimen...
January 2018: Journal of Diabetes Science and Technology
Yu-Hung Chang, Der-Wei Hwu, Dao-Ming Chang, Ling-Wang An, Chang-Hsun Hsieh, Yau-Jiunn Lee
AIMS: Clinical outcome may differ owing to the distinct pharmacological characteristics of insulin sensitizers and insulin. This study was performed to compare the metabolic and renal function changes with add-on pioglitazone treatment versus basal insulin in patients with type 2 diabetes mellitus (DM) in whom sulfonylurea and metformin regimens failed. METHODS: Patients who were consecutively managed in the diabetes comprehensive program with add-on pioglitazone or detemir/glargine treatment for at least 2 years following sulfonylurea and metformin treatment failure were included...
June 2017: Acta Diabetologica
Chenxiao Liu, Xiu Feng, Qi Li, Ying Wang, Qian Li, Majian Hua
AIMS: There has been growing evidence that adiponectin, tumor necrosis factor-α (TNF-α) and inflammatory cytokines involved in insulin resistance and may be attractive candidates for assessing risk of the incident type 2 diabetes (T2DM). A systematic review and meta-analysis of prospective studies was conducted to assess the associations of levels of serum adiponectin, TNF-α and inflammatory markers (Interleukin-1 beta (IL-1β), Interleukin-6 (IL-6), Interleukin-18 (IL-18), C-reactive protein (CRP)) with risk of T2DM...
October 2016: Cytokine
Şükrü Hatun, Hüseyin Demirbilek, Şükran Darcan, Ayşegül Yüksel, Cigdem Binay, Damla Gökşen Şimşek, Cengiz Kara, Ergun Çetinkaya, Tolga Ünüvar, Ahmet Uçaktürk, Filiz Tütüncüler, Yaşar Cesur, Ruveyde Bundak, Halil Sağlam, Enver Şimşek, Abdullah Bereket
AIMS: To evaluate the management strategies, glycemic control and complications of pediatric type 1 diabetes mellitus (T1DM) patients in Turkey. METHODS: Study included 498 patients with T1DM between the ages 1-18. Data provided from patients' hospital files were recorded on standard case report forms by applicant clinicians within the 3months of data collection period between October 2012 and July 2013. RESULTS: Mean age of patients was 11...
September 2016: Diabetes Research and Clinical Practice
Freddy Goldberg Eliaschewitz, Tânia Barreto
Diabetes mellitus (DM) is a public health issue, affecting around 382 million people worldwide. In order to achieve glycemic goals, insulin therapy is the frontline therapy for type 1 DM patients; for patients with type 2 DM, use of insulin therapy is an option as initial or add-on therapy for those not achieving glycemic control. Despite insulin therapy developments seen in the last decades, several barriers remain for insulin initiation and optimal maintenance in clinical practice. Fear of hypoglycemia, weight gain, pain associated with blood testing and injection-related pain are the most cited reasons for not starting insulin therapy...
2016: Diabetology & Metabolic Syndrome
Octavian Savu, Viviana Elian, Oana Steriade, Ileana Teodoru, Stela Mihut, Catalin Tacu, Adrian Covic, Cristian Serafinceanu
PURPOSE: We aimed to analyze the impact of basal insulin analogues on glucose variability (GV) in patients with type 2 diabetes (DM) undergoing renal replacement therapy. METHODS: Fourteen subjects on insulin therapy for at least 6 months (detemir, n = 7 vs. glargine, n = 7) were sequentially enrolled in this prospective study. Continuous glucose monitoring system (CGMS Gold, Dex Com 7+) was applied for 5 days, over 3 consecutive sessions of hemodialysis (HD)...
February 2016: International Urology and Nephrology
Charles F Shaefer, Pamela Kushner, Richard Aguilar
Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) are injectable glucose-lowering medications approved for the treatment of adult patients with type 2 diabetes mellitus (T2DM). This article provides practical information to guide primary care physicians on the use of GLP-1RAs in patients with T2DM. Two short-acting (once- or twice-daily administration; exenatide and liraglutide) and three long-acting (weekly administration; albiglutide, dulaglutide and exenatide) GLP-1RAs are currently approved in the US...
2015: Postgraduate Medicine
Yasuo Terauchi, Yusuke Naito, Yukio Ikeda
AIMS: This study determined the unmet medical need of basal insulin therapy among type 2 diabetes patients who participated in the ALOHA study. Also a meta-analysis of the GetGoal-Duo1, -L, and -L-Asia trials was conducted to examine the impact of lixisenatide add-on treatment to basal insulin therapy ± OADs specifically among Asian type 2 diabetes patients. METHODS: The proportions of Japanese patients with an unmet need of diabetes management, defined as not achieving an HbA1c<7% despite having a fasting plasma glucose (FPG)<130 mg/dL, and without an unmet need, defined as having an endpoint HbA1c<7%, regardless of FPG level, were determined for the ALOHA study population, which was conducted as a post-marketing survey for insulin glargine in Japan...
January 2016: Diabetes & Metabolic Syndrome
Francisco J Pasquel, Winter Powell, Limin Peng, Theodore M Johnson, Shadi Sadeghi-Yarandi, Christopher Newton, Dawn Smiley, Marcos T Toyoshima, Pedram Aram, Guillermo E Umpierrez
BACKGROUND: Managing hyperglycemia and diabetes is challenging in geriatric patients admitted to long-term care (LTC) facilities. METHODS: This randomized control trial enrolled patients with type 2 diabetes (T2D) with blood glucose (BG) >180 mg/dL or glycated hemoglobin >7.5% to receive low-dose basal insulin (glargine, starting dose 0.1 U/kg/day) or oral antidiabetic drug (OAD) therapy as per primary care provider discretion for 26 weeks. Both groups received supplemental rapid-acting insulin before meals for BG >200 mg/dL...
2015: BMJ Open Diabetes Research & Care
O A Koshel'skaia, I V Vinnitskaia, T Iu Konko, E S Kravchenko, T E Suslova, R S Karpov
OBJECTIVE: This open randomized study compares the effects of 24-week-long treatment with rosuvastatin and with atorvastatin coadministered with ezetimibe on the parameters of carbohydrate metabolism and the plasma levels of adipokynes in patients with coronary artery disease and type 2 diabetes mellitus or impaired glucose tolerance (IGT). METHOD: A total of 31 patients with coronary artery disease and type 2 diabetes mellitus or IGT were recruited in the study...
2015: Kardiologiia
Charles Shaefer, Timothy Reid, Aleksandra Vlajnic, Rong Zhou, Andres DiGenio
OBJECTIVE: Postprandial hyperglycemia (PPHG) may need addressing when glycemic control cannot be maintained in patients with type 2 diabetes mellitus. We investigated whether glycated hemoglobin A1c (A1c) levels ≥7.0% can indicate postprandial defects warranting prandial therapy after optimized basal insulin therapy. METHODS: From 6 clinical trials of insulin glargine treatment, data were pooled from 496 patients with A1c ≥7.0% after 24 weeks. Patient characteristics and clinical outcomes were summarized according to fasting plasma glucose (FPG) target achievement (<130 mg/dL), postprandial blood glucose (PPBG) levels, and PPBG increments (ΔPPBG)...
December 2015: Endocrine Practice
B Kollhorst, S Behr, D Enders, F-W Dippel, K Theobald, E Garbe
AIMS: To assess the risk of acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus treated with long-acting insulin analogues in comparison with other basal insulin therapy. METHODS: We used German insurance claims data from the years 2004-2009 to conduct a study in a retrospective cohort of patients with type 2 diabetes. Naïve insulin users were defined as patients who had an insulin-free history before the first prescription of long-acting analogue insulin, human NPH insulin or premixed insulin and who were pretreated with oral antidiabetic drugs...
December 2015: Diabetes, Obesity & Metabolism
Kheng Yong Ong, Yu Heng Kwan, Hooi Ching Tay, Doreen Su-Yin Tan, Joanne Yeh Chang
INTRODUCTION: As the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control. METHODS: A retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded...
July 2015: Singapore Medical Journal
Moawia M Al-Tabakha
The current review was designed to compare between the insulin inhalation systems Exubera and Afrezza and to investigate the reasons why Exubera was unsuccessful, when Afrezza maker is expecting their product to be felicitous. In January 2006, Pfizer secured FDA and EC approval for the first of its kind, regular insulin through Exubera inhaler device for the management of types 1 and 2 diabetes mellitus (DM) in adults. The product was no longer available to the market after less than two years from its approval triggering a setback for competitive new inhalable insulins that were already in various clinical development phases...
October 10, 2015: Journal of Controlled Release: Official Journal of the Controlled Release Society
Grace Ledet, Richard A Graves, Levon A Bostanian, Tarun K Mandal
PURPOSE: The pharmacologic properties of a recently approved inhaled insulin product, its unique delivery system, and the results of clinical safety and efficacy trials are reviewed. SUMMARY: Afrezza (also called Technosphere Insulin, MannKind Corporation, Valencia, CA) is a novel ultrarapid-acting insulin formulation indicated for use in improving glycemic control in selected patients with type 1 or type 2 diabetes mellitus. Afrezza is not intended as a substitute for traditional basal therapy with injectable long-acting insulin but may be used to provide prandial insulin coverage; it must be used in combination with long-acting insulin in patients with type 1 diabetes...
July 15, 2015: American Journal of Health-system Pharmacy: AJHP
Mark J W Hanssen, Joris Hoeks, Boudewijn Brans, Anouk A J J van der Lans, Gert Schaart, José J van den Driessche, Johanna A Jörgensen, Mark V Boekschoten, Matthijs K C Hesselink, Bas Havekes, Sander Kersten, Felix M Mottaghy, Wouter D van Marken Lichtenbelt, Patrick Schrauwen
Cold exposure may be a potential therapy for diabetes by increasing brown adipose tissue (BAT) mass and activity. Here we report that 10 d of cold acclimation (14-15 °C) increased peripheral insulin sensitivity by ∼43% in eight type 2 diabetes subjects. Basal skeletal muscle GLUT4 translocation markedly increased, without effects on insulin signaling or AMP-activated protein kinase (AMPK) activation and only a minor increase in BAT glucose uptake.
August 2015: Nature Medicine
G Dailey, F Lavernia
Insulin glargine 100 units/ml (Gla-100) has become a standard of care in diabetes treatment over the past decade, providing 24-h basal insulin coverage after once-daily subcutaneous injection for many people with diabetes, with a well-established efficacy and safety profile. New insulin glargine 300 units/ml (Gla-300) is a basal insulin that provides the same number of units as Gla-100 in a third of the volume. Compared with Gla-100, Gla-300 has shown more constant and prolonged pharmacokinetic (PK)/pharmacodynamic (PD) profiles...
December 2015: Diabetes, Obesity & Metabolism
Wei-Dong Wang, Lin Xing, Jun-Ru Teng, Shuo Li, N A Mi
The aim of this study was to investigate the effects of basal insulin application on the serum visfatin and adiponectin (APN) levels of patients with type 2 diabetes mellitus (T2DM). A total of 200 patients with T2DM, who were diagnosed in The Third People's Hospital of Jinan (glycosylated hemoglobin ≥7%), were randomly divided into treatment and control groups. The patients used only oral hypoglycemic drugs and had never received insulin therapy. In the treatment group, basal insulin was administered in combination with the original application of oral hypoglycemic drugs, whereas the control group maintained the original use of oral hypoglycemic drugs or took other oral hypoglycemic agents...
June 2015: Experimental and Therapeutic Medicine
Boris Kovatchev, Guillermo Umpierrez, Andres DiGenio, Rong Zhou, Silvio E Inzucchi
BACKGROUND: Here we assess associations between glycemic variability (GV) measures and outcomes from glucose-lowering therapy in patients with type 2 diabetes (T2DM) to identify the metrics most sensitive to treatment response. METHODS: Data from 1699 patients in 6 previously reported studies in adults with T2DM treated with basal insulin and/or oral glucose-lowering drugs were included in a post hoc meta-analysis. Using 7-point blood glucose (BG) profiles we compared the GV metrics standard deviation (SD), mean amplitude of glycemic excursion (MAGE), mean absolute glucose (MAG), low and high BG risk indices (LBGI, HBGI), and average daily risk range (ADRR)...
November 2015: Journal of Diabetes Science and Technology
Carla Francés Artigas, Victoria Stokes, Garry D Tan, Michael J Theodorakis
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are gaining ground as therapeutic modalities in combination with insulin in patients with type 2 diabetes mellitus. Exploiting the multiple benefits of incretin-based therapies in certain patient populations, especially in those who would benefit most from potential weight loss or prevention of body weight gain, has provided a valuable add-on option in diabetes management. However, caution needs to be exercised when initiating such a double injectable therapy, as evidence indicates that, in most instances, the insulin dose needs to be re-adjusted...
2015: Expert Opinion on Pharmacotherapy
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