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Insulin Pump Therapy

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https://www.readbyqxmd.com/read/28924484/diabetic-ketoacidosis-producing-extreme-hyperkalemia-in-a-patient-with-type-1-diabetes-on-hemodialysis
#1
Hodaka Yamada, Shunsuke Funazaki, Masafumi Kakei, Kazuo Hara, San-E Ishikawa
Diabetic ketoacidosis (DKA) is a critical complication of type 1 diabetes associated with water and electrolyte disorders. Here, we report a case of DKA with extreme hyperkalemia (9.0 mEq/L) in a patient with type 1 diabetes on hemodialysis. He had a left frontal cerebral infarction resulting in inability to manage his continuous subcutaneous insulin infusion pump. Electrocardiography showed typical changes of hyperkalemia, including absent P waves, prolonged QRS interval and tented T waves. There was no evidence of total body water deficit...
2017: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/28923465/continuous-glucose-monitoring-in-pregnant-women-with-type-1-diabetes-conceptt-a-multicentre-international-randomised-controlled-trial
#2
Denice S Feig, Lois E Donovan, Rosa Corcoy, Kellie E Murphy, Stephanie A Amiel, Katharine F Hunt, Elisabeth Asztalos, Jon F R Barrett, J Johanna Sanchez, Alberto de Leiva, Moshe Hod, Lois Jovanovic, Erin Keely, Ruth McManus, Eileen K Hutton, Claire L Meek, Zoe A Stewart, Tim Wysocki, Robert O'Brien, Katrina Ruedy, Craig Kollman, George Tomlinson, Helen R Murphy
BACKGROUND: Pregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes. METHODS: In this multicentre, open-label, randomised controlled trial, we recruited women aged 18-40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy...
September 14, 2017: Lancet
https://www.readbyqxmd.com/read/28918653/setting-expectations-for-successful-artificial-pancreas-hybrid-closed-loop-automated-insulin-delivery-adoption
#3
Dana Lewis
Hybrid closed loop (or automated insulin delivery systems) and artificial pancreas technology will dramatically change the quality of life for people living with diabetes. However, this technology is not a cure. Without having expectations set, patients may assume that APs will replace critical self-care behaviors. It is important for patients to understand several key things before choosing to adopt and switching to APs for diabetes management. Like any technology, APs will have a learning curve. But like switching from MDI to standard pump therapy, it is not insurmountable...
September 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28913745/management-of-type-1-diabetes-in-the-hospital-setting
#4
REVIEW
Carlos E Mendez, Guillermo E Umpierrez
PURPOSE OF REVIEW: The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings. RECENT FINDINGS: Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described...
September 14, 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28905659/comparative-handling-analysis-of-different-insulin-pump-systems
#5
Delia Waldenmaier, Katharina Schöllkopf, Antje Westhoff, Lutz Heinemann, Guido Freckmann
Insulin pumps are used by many patients with diabetes to manage their diabetes therapy. Adequate handling of the systems is important to avoid errors. In this study, one aspect of device handling-the number of steps required to operate the system-was evaluated for different insulin pump systems. Specific tasks that are usually performed by insulin pump users were simulated and all necessary actions were documented. Differences between the required numbers of steps strongly depended on the specific task. So did the level of guidance for these tasks provided by the systems...
September 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28899222/effects-of-sotagliflozin-added-to-insulin-in-patients-with-type-1-diabetes
#6
Satish K Garg, Robert R Henry, Phillip Banks, John B Buse, Melanie J Davies, Gregory R Fulcher, Paolo Pozzilli, Diane Gesty-Palmer, Pablo Lapuerta, Rafael Simó, Thomas Danne, Darren K McGuire, Jake A Kushner, Anne Peters, Paul Strumph
Background In most patients with type 1 diabetes, adequate glycemic control is not achieved with insulin therapy alone. We evaluated the safety and efficacy of sotagliflozin, an oral inhibitor of sodium-glucose cotransporters 1 and 2, in combination with insulin treatment in patients with type 1 diabetes. Methods In this phase 3, double-blind trial, which was conducted at 133 centers worldwide, we randomly assigned 1402 patients with type 1 diabetes who were receiving treatment with any insulin therapy (pump or injections) to receive sotagliflozin (400 mg per day) or placebo for 24 weeks...
September 13, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28898340/-from-insulin-pump-and-continuous-glucose-monitoring-to-the-artificial-pancreas
#7
Pamela Apablaza, Néstor Soto, Ethel Codner
Technology for diabetes care has undergone major development during recent decades. These technological advances include continuous subcutaneous insulin infusion (CSII), also known as insulin pumps, and real-time continuous glucose monitoring system (RT-CGMS). The integration of CSII and RT-CGMS into a single device has led to sensor-augmented pump therapy and more recently, a technology that has automated delivery of basal insulin therapy, known as hybrid system. These new technologies have led to benefits in attaining better metabolic control and decreasing the incidence of severe hypoglycemia, especially in patients with type 1 diabetes...
May 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/28872765/digital-therapy-in-diabetes
#8
REVIEW
Avivit Cahn, Amit Akirov, Itamar Raz
Diabetes care is largely dependent on patient self-management and empowerment, given that patients with diabetes must make numerous daily decisions of what to eat, when to exercise, and determine their insulin dose and timing if required. Additionally, patients and providers are generating vast amounts of data from many sources including electronic medical records, insulin pumps, sensors, glucometers, other wearables, as well as evolving genomic, proteomic, metabolomic and microbiomic data. Multiple digital tools and apps have been developed to assist patients to choose wisely, as well as enhance their compliance by employing motivational tools and incorporating incentives from social media and gaming techniques...
September 5, 2017: Journal of Diabetes
https://www.readbyqxmd.com/read/28871565/cost-effectiveness-analysis-of-sensor-augmented-insulin-pump-therapy-with-automated-insulin-suspension-versus-standard-insulin-pump-therapy-in-patients-with-type-1-diabetes-in-sweden
#9
Johan Jendle, Jayne Smith-Palmer, Alexis Delbaere, Simona de Portu, Natalie Papo, William Valentine, Stéphane Roze
INTRODUCTION: In Sweden an estimated 10,000 people with type 1 diabetes use continuous subcutaneous insulin infusion (CSII). Sensor-augmented pump therapy (SAP) is associated with higher acquisition costs but provides additional clinical benefits (e.g. reduced rate of hypoglycemic events) over and above that of CSII alone. The aim of the analysis was to assess the cost-effectiveness of SAP with automated insulin suspension relative to CSII alone in two different groups of patients with type 1 diabetes in Sweden...
September 4, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28868899/rate-of-change-of-premeal-glucose-measured-by-continuous-glucose-monitoring-predicts-postmeal-glycemic-excursions-in-patients-with-type-1-diabetes-implications-for-therapy
#10
Amit R Majithia, Alexander B Wiltschko, Hui Zheng, Geoffrey A Walford, David M Nathan
BACKGROUND: Patients with type 1 diabetes routinely utilize a single premeal fingerstick glucose to determine premeal insulin doses. Continuous glucose monitoring (CGM) provides much richer glycemic trend information, including glycemic slope (GS). How to incorporate this information into dosing decisions remains an open question. METHODS: We examined the relationship between premeal GS and postmeal glycemic excursions in 240 individuals with type 1 diabetes receiving CGM augmented insulin pump therapy...
September 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28840741/-insulin-pump-in-type-2-diabetes-b-cell-focused-treatment
#11
Klára Picková, Zdeněk Rušavý
Type 2 diabetes is a disorder characterized by insulin resistance and progressive deterioration of B-cell insulin secretion. B-cell protective strategies for lowering glucolipotoxicity by rapid achievement of normoglycemia using exogenous insulin improve their function and prolong diabetes remission. Insulin pump is an effective treatment method in newly diagnosed diabetes, where even short-term pump therapy is B-cell protective. Combination therapy with insulin pump and antidiabetics targeting the incretin system acts in synergy to protect the B-cell...
2017: Vnitr̆ní Lékar̆ství
https://www.readbyqxmd.com/read/28817302/comparative-effectiveness-and-costs-of-insulin-pump-therapy-for-diabetes
#12
Ronald T Ackermann, Amisha Wallia, Raymond Kang, Andrew Cooper, Theodore A Prospect, Lewis G Sandy, Deneen Vojta
OBJECTIVES: Continuous subcutaneous insulin infusion (CSII), or "insulin pump" therapy, is an alternative to multiple daily insulin injections (MDII) for management of diabetes. This study evaluates patterns of healthcare utilization, costs, and blood glucose control for patients with diabetes who initiate CSII. STUDY DESIGN: Pre-post with propensity-matched comparison design involving commercially insured US adults (aged 18-64 years) with insulin-requiring diabetes who transitioned from MDII to CSII between July 1, 2009, and June 30, 2012 ("CSII initiators"; n = 2539), or who continued using MDI (n = 2539)...
June 2017: American Journal of Managed Care
https://www.readbyqxmd.com/read/28802779/pharmacological-aspects-of-closed-loop-insulin-delivery-for-type-1-diabetes
#13
REVIEW
Chukwuma Uduku, Nick Oliver
Insulin deficiency and impaired glucose homeostasis are hallmarks of type 1 diabetes. Since the discovery of insulin, pharmacological and clinical developments have endeavoured to replicate its endogenous pharmacokinetics (PK) and pharmacodynamics (PD). Closed loop insulin delivery systems operate as an artificial pancreas by making automated insulin dose adjustments based on real time continuous glucose monitoring. The increasing adoption of continuous insulin pump therapy and evolving technological advances have seen significant progress in the development of closed loop insulin delivery systems...
August 10, 2017: Current Opinion in Pharmacology
https://www.readbyqxmd.com/read/28799221/repose-repositioning-insulin-pump-therapy-in-type-1-diabetes
#14
N S Oliver
In 2008, the National Institute for Health and Care Excellence (NICE) technology appraisal of continuous subcutaneous insulin infusion (CSII, insulin pump therapy) for people with Type 1 diabetes was published [1]. Implementation of this enables children under the age of 12 years to access CSII, and consideration of CSII for adults and children over 12 years with challenging hypo- or hyperglycaemia. In Scotland, the Scottish Intercollegiate Guidelines Network (SIGN) guidance for management of diabetes states that CSII therapy should be considered for people unable to achieve their glycaemic targets, for those who experience recurring episodes of severe hypoglycaemia, and in infants and very young children with very low basal insulin requirements, for whom even small doses of basal insulin analogue may result in hypoglycaemia [2]...
August 11, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/28765134/incidence-and-prevalence-of-diabetic-ketoacidosis-dka-among-adults-with-type-1-diabetes-mellitus-t1d-a-systematic-literature-review
#15
Soulmaz Fazeli Farsani, Kimberly Brodovicz, Nima Soleymanlou, Jan Marquard, Erika Wissinger, Brett A Maiese
OBJECTIVES: To summarise incidence and prevalence of diabetic ketoacidosis (DKA) in adults with type 1 diabetes (T1D) for the overall patient population and different subgroups (age, sex, geographical region, ethnicity and type of insulin administration). DESIGN: Systematic literature review (SLR). DATA SOURCES: Medline (via PubMed) and Embase (1 January 2000 to 23 June 2016). STUDY SELECTION: Peer-reviewed observational studies with reported data on the incidence or prevalence of DKA in T1D adults were included...
August 1, 2017: BMJ Open
https://www.readbyqxmd.com/read/28762929/-risk-factors-of-cardiovascular-complications-after-beating-heart-coronary-artery-bypass-grafting-in-patients-with-type-two-diabetes
#16
S Y Borodashkina, K V Protasov, V A Podkamennyi
AIM: to determine risk factors of early cardiovascular complications after beating-heart coronary artery bypass grafting (CABG) in patients with ischemic coronary disease (IHD) and type two diabetes (D2). MATERIALS AND METHODS: We included into this study 188 patients (mean age 59 years, 85.1% men) with IHD and D2 who underwent off-pump CABG. The following cardiovascular complications (CVC) registered within 7 days after surgery were analyzed: myocardial infarction (MI), stroke/transient ischemic attack (S/TIA), atrial fibrillation (AF)...
March 2017: Kardiologiia
https://www.readbyqxmd.com/read/28731823/maternal-fetal-outcomes-in-34-pregnant-women-with-type-1-diabetes-in-sensor-augmented-insulin-pump-therapy
#17
Ana María Gómez, Lisseth Fernanda Marín Carrillo, Carol M Arévalo Correa, Oscar Mauricio Muñoz Velandia, Martín Alonso Rondón Sepúlveda, Jaime Luis Silva Herrera, Diana Cristina Henao Carrillo
BACKGROUND: Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of maternal complications and neonatal morbidity and mortality. Optimizing glycemic control improves these outcomes. OBJECTIVE: To describe the experience of using sensor-augmented insulin pump therapy (SAPT) and SAPT + low-glucose suspension (LGS) on pregnant women with T1D, including neonatal and maternal outcomes. METHODS: A prospective observational study was conducted in women with T1D who started SAPT and SAPT + LGS before or during pregnancy at the San Ignacio University Hospital Diabetes Center in Bogotá, Colombia...
July 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28727196/insulin-regimens-for-newly-diagnosed-children-with-type-1-diabetes-mellitus-in-australia-and-new-zealand-a-survey-of-current-practice
#18
Dharrshinee Selvakumar, Hesham S Al-Sallami, Martin de Bock, Geoffrey R Ambler, Paul Benitez-Aguirre, Esko Wiltshire, Elaine Tham, Peter Simm, Louise S Conwell, Phillipa J Carter, Benjamin B Albert, Jinny Willis, Benjamin J Wheeler
AIM: There is no consensus on the optimal insulin treatment for children newly diagnosed with type 1 diabetes mellitus (T1DM). The aims of this study were (i) to describe the insulin regimens used at diagnosis by patient age and geographical region and (ii) to explore differences between and within Australia (AU) and New Zealand (NZ) with regards to other aspects of patient management and education. METHODS: An online survey of medical professionals caring for children with T1DM in AU and NZ was undertaken...
July 20, 2017: Journal of Paediatrics and Child Health
https://www.readbyqxmd.com/read/28711468/effect-of-initiating-use-of-an-insulin-pump-in-adults-with-type-1-diabetes-using-multiple-daily-insulin-injections-and-continuous-glucose-monitoring-diamond-a-multicentre-randomised-controlled-trial
#19
Roy W Beck, Tonya D Riddlesworth, Katrina J Ruedy, Craig Kollman, Andrew J Ahmann, Richard M Bergenstal, Anuj Bhargava, Bruce W Bode, Stacie Haller, Davida F Kruger, Janet B McGill, William Polonsky, David Price, Elena Toschi
BACKGROUND: The benefit of initiation of insulin pump therapy (continuous subcutaneous insulin infusion; CSII) in patients with type 1 diabetes using continuous glucose monitoring (CGM) has not been studied. We aimed to assess glycaemic outcomes when switching from multiple daily injections (MDI) to CSII in adults with type 1 diabetes using CGM. METHODS: In this multicentre, randomised controlled trial, 75 adults with type 1 diabetes in the CGM group of the DIAMOND trial were randomly assigned via the study website using a computer-generated sequence to continue MDI or switch to CSII, with continuation of CGM, for 28 weeks...
July 12, 2017: Lancet Diabetes & Endocrinology
https://www.readbyqxmd.com/read/28710224/assessing-the-effectiveness-of-a-3-month-day-and-night-home-closed-loop-control-combined-with-pump-suspend-feature-compared-with-sensor-augmented-pump-therapy-in-youths-and-adults-with-suboptimally-controlled-type-1-diabetes-a-randomised-parallel-study-protocol
#20
Lia Bally, Hood Thabit, Martin Tauschmann, Janet M Allen, Sara Hartnell, Malgorzata E Wilinska, Jane Exall, Viki Huegel, Judy Sibayan, Sarah Borgman, Peiyao Cheng, Maxine Blackburn, Julia Lawton, Daniela Elleri, Lalantha Leelarathna, Carlo L Acerini, Fiona Campbell, Viral N Shah, Amy Criego, Mark L Evans, David B Dunger, Craig Kollman, Richard M Bergenstal, Roman Hovorka
INTRODUCTION: Despite therapeutic advances, many individuals with type 1 diabetes are unable to achieve tight glycaemic target without increasing the risk of hypoglycaemia. The objective of this study is to determine the effectiveness of a 3-month day-and-night home closed-loop glucose control combined with a pump suspend feature, compared with sensor-augmented insulin pump therapy in youths and adults with suboptimally controlled type 1 diabetes. METHODS AND ANALYSIS: The study adopts an open-label, multi-centre, multi-national (UK and USA), randomised, single-period, parallel design and aims for 84 randomised patients...
July 13, 2017: BMJ Open
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