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nocturnal hypoglycemia

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https://www.readbyqxmd.com/read/28916043/nocturnal-hypoglycemic-alarm-based-on-near-infrared-spectroscopy-in%C3%A2-vitro-simulation-studies
#1
Sanjeewa R Karunathilaka, Gary W Small
An alarm algorithm for detecting episodes of nocturnal hypoglycemia is demonstrated in simulation studies that incorporate the use of a tissue phantom. Based on transmission spectra collected in the near-infrared combination region of 4000-5000 cm(-1), pattern recognition methods are used to classify spectra into alarm and non-alarm data classes on the basis of whether or not they signify a glucose excursion below a user-defined hypoglycemic alarm threshold. A reference spectrum and corresponding glucose concentration are acquired at the start of the monitoring period, and absorbance values of subsequent spectra are computed relative to this reference...
September 22, 2017: Analytica Chimica Acta
https://www.readbyqxmd.com/read/28888148/hypoglycemia-awareness-among-insulin-treated-patients-with-diabetes-in-malaysia-a-cohort-subanalysis-of-the-hat-study
#2
Zanariah Hussein, Nor Azmi Kamaruddin, Siew Pheng Chan, Anand Jain, Shweta Uppal, Wan Mohamad Wan Bebakar
AIMS: The present Malaysian cohort analysis determined the prevalence of hypoglycemia among patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) attending primary care- or hospital-based diabetes clinics in Malaysia and their awareness of the symptoms of hypoglycemia. METHODS: The Hypoglycemia Assessment Tool (HAT) study was a non-interventional, 6-month retrospective and 4-week prospective analysis of hypoglycemic events in 24 countries, using self-assessment questionnaires and diaries among patients with T1DM/T2DM aged ≥18years, using insulin for >12months...
August 14, 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28870034/-the-efficacy-and-safety-of-insulin-degludec-versus-insulin-glargine-in-insulin-naive-subjects-with-type-2-diabetes-results-of-a-chinese-cohort-from-a-multinational-randomized-controlled-trial
#3
Y M Mu, L X Guo, L Li, Y M Li, X J Xu, Q M Li, M T Xu, L Y Zhu, G Y Yuan, Y Liu, C Xu, Z J Wang, F X Shen, Y Luo, J Y Liu, Q F Li, W H Wang, X Y Lai, H F Xu, C Y Pan
Objective: To compare the safety and efficacy of insulin degludec (IDeg) with those of insulin glargine (IGlar) in insulin-naive subjects with type 2 diabetes (T2DM). Methods: This was a 26-week, randomized, open-label, parallel-group, treat-to-target trial in 560 Chinese subjects with T2DM (men/women: 274/263, mean age 56 years, mean diabetes duration 7 years) inadequately controlled on oral antidiabetic drugs (OADs). Subjects were randomized 2∶1 to once-daily IDeg (373 subjects) or IGlar(187 subjects), both in combination with metformin...
September 1, 2017: Zhonghua Nei Ke za Zhi [Chinese Journal of Internal Medicine]
https://www.readbyqxmd.com/read/28803820/titration-a-randomized-study-to-assess-2-treatment-algorithms-with-new-insulin-glargine-300-units-ml
#4
Jean-François Yale, Lori Berard, Mélanie Groleau, Pasha Javadi, John Stewart, Stewart B Harris
OBJECTIVE: It was uncertain whether an algorithm that involves increasing insulin dosages by 1 unit/day may cause more hypoglycemia with the longer-acting insulin glargine 300 units/mL (GLA-300). The objective of this study was to compare safety and efficacy of 2 titration algorithms, INSIGHT and EDITION, for GLA-300 in people with uncontrolled type 2 diabetes mellitus, mainly in a primary care setting. METHODS: This was a 12-week, open-label, randomized, multicentre pilot study...
August 10, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28795013/management-of-diabetes-mellitus-in-children-and-adolescents-engaging-in-physical-activity
#5
REVIEW
Silpa Nadella, Justin A Indyk, Manmohan K Kamboj
Regular physical activity is an important component in the management of both type 1 and type 2 diabetes mellitus (T1DM and T2DM), as it has the potential to improve glycemic control, delay cardiovascular complications, and increase overall well-being. Unfortunately, many children and adolescents with diabetes do not partake in regular exercise and physical activity for multiple reasons. This review identifies the barriers to participation from the aspect of the patient, caregiver, and the healthcare provider...
July 2017: Translational pediatrics
https://www.readbyqxmd.com/read/28781218/risk-factors-for-nocturnal-hypoglycemia-in-insulin-treated-patients-with-type-2-diabetes-a-secondary-analysis-of-observational-data-derived-from-an-integrated-clinical-trial-database
#6
Jay P Bae, Ran Duan, Haoda Fu, Byron J Hoogwerf
PURPOSE: A trade-off exists in most diabetes therapies between the benefits of good glycemic control and the morbidity of hypoglycemia. Balancing these factors to achieve desired outcomes is a key consideration for personalized diabetes therapy. Hypoglycemia at night (nocturnal hypoglycemia [NH]) is a common but often under-reported problem in insulin-treated patients with type 2 diabetes. To better understand the risk for NH, we pooled data from multiple clinical trials of insulin treatment and specifically examined NH risk factors in relation to glycemic goals...
August 3, 2017: Clinical Therapeutics
https://www.readbyqxmd.com/read/28748191/the-yin-and-yang-between-plasma-glucose-levels-and-cortisol-replacement-therapy-in-schmidt-s-syndrome
#7
Christopher A Newton, Eleni Sheehan, Kathleen Wyne, Kenneth Cusi, Julio Leey, Hans K Ghayee
Objective: To illustrate how steroid replacement in adrenal insufficiency can influence the development of hypoglycemia in a patient with type 1 diabetes mellitus (T1D). Methods: We describe the case of a 36-year-old female patient with T1D and Addison's disease (Schmidt's syndrome) on multiple daily insulin injections who presented with recurrent hypoglycemia despite being on physiological replacement doses of hydrocortisone. Results: With the assistance of continuous glucose monitoring technology, a pattern of nocturnal hypoglycemia was clearly identified...
July 2017: Journal of Investigative Medicine High Impact Case Reports
https://www.readbyqxmd.com/read/28718987/the-impact-of-exercise-on-sleep-in-adults-with-type-1-diabetes
#8
Ravi Reddy, Joseph El Youssef, Kerri Winters-Stone, Deborah Branigan, Joseph Leitschuh, Jessica Castle, Peter G Jacobs
The aim of this pilot study was to investigate the impact of exercise on sleep and nocturnal hypoglycemia in adults with type 1 diabetes (T1D). In a 3-week crossover trial, 10 adults with T1D were randomized to perform aerobic, resistance or no exercise. During each exercise week, participants completed two separate 45-minute exercise sessions at an academic medical center. Participants returned home and wore a continuous glucose monitor and a wrist based activity monitor to estimate sleep duration. Participants on average lost 70 (±49) minutes of sleep (p = 0...
July 18, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28686045/challenges-of-diabetes-management-in-toddlers
#9
Asma Deeb
Toddlers with type 1 diabetes have distinctive combination of challenges to their families and healthcare providers. A major factor is the difficulty in achieving metabolic control without risking hypoglycemia. The rising incidence of type 1 diabetes in toddlers increases the magnitude of the problem and creates a greater need for providing specialized service to cater for this age group's unique need. Type 1 has a specific disease nature in younger children and its clinical presentation mimics common childhood diseases...
July 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28683068/prediction-of-nocturnal-hypoglycemia-unawareness-by-fasting-glucose-levels-or-post-breakfast-glucose-fluctuations-in-patients-with-type-1-diabetes-receiving-insulin-degludec-a-pilot-study
#10
Hiroshi Takahashi, Rimei Nishimura, Yoshiko Onda, Kiyotaka Ando, Daisuke Tsujino, Kazunori Utsunomiya
OBJECTIVE: To evaluate whether nocturnal asymptomatic hypoglycemia (NAH) can be predicted by fasting glucose levels or post-breakfast glucose fluctuations in patients with type 1 diabetes (T1D) receiving insulin degludec. METHODS: Patients with T1D receiving insulin degludec underwent at-home CGM assessments. Indices for glycemic variability before and after breakfast included fasting glucose levels and the range of post-breakfast glucose elevation. For comparison, the patients were classified into those with NAH and those without...
2017: PloS One
https://www.readbyqxmd.com/read/28677416/manual-closed-loop-insulin-delivery-using-a-saddle-point-model-predictive-control-algorithm-results-of-a-crossover-randomized-overnight-study
#11
Isabelle Guilhem, Maxime Penet, Anaïs Paillard, Marc Carpentier, Annabelle Esvant, Marie-Anne Lefebvre, Jean-Yves Poirier
BACKGROUND: The purpose was to assess the efficacy of a new closed-loop algorithm (Saddle Point Model Predictive Control, SP-MPC) in achieving nocturnal normoglycemia while reducing the risk of hypoglycemia in patients with type 1 diabetes. METHOD: In this randomized crossover study, 10 adult patients (mean hemoglobin A1c 7.35 ± 1.04%) were assigned to be treated overnight by open loop using sensor-augmented pump therapy (open-loop SAP) or manual closed-loop delivery...
July 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28672317/effect-of-insulin-degludec-vs-insulin-glargine-u100-on-hypoglycemia-in-patients-with-type-2-diabetes-the-switch-2-randomized-clinical-trial
#12
RANDOMIZED CONTROLLED TRIAL
Carol Wysham, Anuj Bhargava, Louis Chaykin, Raymond de la Rosa, Yehuda Handelsman, Lone N Troelsen, Kajsa Kvist, Paul Norwood
Importance: Hypoglycemia, a serious risk for insulin-treated patients with type 2 diabetes, negatively affects glycemic control. Objective: To test whether treatment with basal insulin degludec is associated with a lower rate of hypoglycemia compared with insulin glargine U100 in patients with type 2 diabetes. Design, Setting, and Participants: Randomized, double-blind, treat-to-target crossover trial including two 32-week treatment periods, each with a 16-week titration period and a 16-week maintenance period...
July 4, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28672316/effect-of-insulin-degludec-vs-insulin-glargine-u100-on-hypoglycemia-in-patients-with-type-1-diabetes-the-switch-1-randomized-clinical-trial
#13
RANDOMIZED CONTROLLED TRIAL
Wendy Lane, Timothy S Bailey, Gregg Gerety, Janusz Gumprecht, Athena Philis-Tsimikas, Charlotte Thim Hansen, Thor S S Nielsen, Mark Warren
Importance: Hypoglycemia, common in patients with type 1 diabetes, is a major barrier to achieving good glycemic control. Severe hypoglycemia can lead to coma or death. Objective: To determine whether insulin degludec is noninferior or superior to insulin glargine U100 in reducing the rate of symptomatic hypoglycemic episodes. Design, Setting, and Participants: Double-blind, randomized, crossover noninferiority trial involving 501 adults with at least 1 hypoglycemia risk factor treated at 84 US and 6 Polish centers (January 2014-January 12, 2016) for two 32-week treatment periods, each with a 16-week titration and a 16-week maintenance period...
July 4, 2017: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/28667580/assessing-the-therapeutic-utility-of-professional-continuous-glucose-monitoring-in-type-2-diabetes-across-various-therapies-a-retrospective-evaluation
#14
Jothydev Kesavadev, Robert Vigersky, John Shin, Pradeep Babu Sadasivan Pillai, Arun Shankar, Geethu Sanal, Gopika Krishnan, Sunitha Jothydev
BACKGROUND: There have been few large studies that have analyzed the effect of professional (masked) continuous glucose monitoring (P-CGM) on glycemic control in patients with type 2 diabetes (T2DM) who were on a broad spectrum of baseline therapies. METHODS: We performed a retrospective, blinded evaluation of glycemic control in 296 T2DM adults for 6 months following a 6- to 7-day study of their glycemic profile using masked P-CGM. At baseline, 91% of the patients were on some form of insulin treatment with oral hypoglycemic agents (OHA), while 7% were on one or more OHAs without insulin, and the remaining 2% were on GLP-1RAs...
June 30, 2017: Advances in Therapy
https://www.readbyqxmd.com/read/28626170/investigating-the-relationship-between-morning-glycemic-variability-and-patient-characteristics-using-continuous-glucose-monitoring-data-in-patients-with-type-2-diabetes
#15
Soichi Takeishi, Akihiro Mori, Miyuka Kawai, Yohei Yoshida, Hiroki Hachiya, Takayuki Yumura, Shun Ito, Takashi Shibuya, Nobutoshi Fushimi, Noritsugu Ohashi, Hiromi Kawai
Objective To investigate the relationship between patient characteristics and morning glycemic variability. Methods We retrospectively evaluated 106 patients with type 2 diabetes who underwent continuous glucose monitoring during admission. The highest postprandial glucose level (within 3 hours after breakfast; 'highest level'), the time from the start of breakfast to the highest postprandial glucose level ('highest time'), the difference between the pre-breakfast and highest postprandial breakfast glucose level ('increase'), the area under the curve (AUC; ≥180 mg/dL) for the glycemic variability within 3 hours after breakfast ('morning AUC'), and the post-breakfast glucose gradient ('gradient') were calculated...
2017: Internal Medicine
https://www.readbyqxmd.com/read/28609547/intensive-insulin-therapy-combined-with-metformin-is-associated-with-reduction-in-both-glucose-variability-and-nocturnal-hypoglycaemia-in-patients-with-type-2-diabetes
#16
Yifei Zhang, Zhiyun Zhao, Shujie Wang, Wei Zhu, Yiran Jiang, Shouyue Sun, Chen Chen, Kai Wang, Liangshan Mu, Jinyi Cao, Yingxia Zhou, Weiqiong Gu, Jie Hong, Weiqing Wang, Guang Ning
BACKGROUND: The effect on glucose variability in patients with intensive insulin therapy has not been fully understood. This observational study investigated the different glucose variability and hypoglycaemia patterns in type 2 diabetes patients treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) with or without metformin administration. METHODS: During hospitalization, a total of 501 patients with poor glycaemic control and in initial treatment with either CSII alone (n = 187), CSII + Metformin (n = 81), MDI alone (n = 146), or MDI + Metformin (n = 87) were involved in the final analysis...
June 13, 2017: Diabetes/metabolism Research and Reviews
https://www.readbyqxmd.com/read/28585180/efficacy-and-safety-of-insulin-degludec-for-hyperglycemia-management-in-noncritical-hospitalized-patients-with-diabetes-an-observational-study
#17
Natalino Simioni, Alessio Filippi, Marco Scardapane, Antonio Nicolucci, Maria Chiara Rossi, Vera Frison
INTRODUCTION: To assess the efficacy and safety of insulin degludec administered in a basal-bolus regimen according to the GesTIO protocol in noncritical hospitalized patients with T1DM and T2DM. METHODS: Mean blood glucose levels (BG) and their standard deviations (SD) at admission vs. discharge were compared in 52 subjects (48.1% ≥75 years) managed through a basal-bolus scheme including degludec. The percentages of patients with BG at target (140-180 mg/dl) or below at discharge and the incidence rate (and the 95% confidence interval for it) of hypoglycemia were assessed...
August 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28579834/hypoglycemia-a-review-of-definitions-used-in-clinical-trials-evaluating-antihyperglycemic-drugs-for-diabetes
#18
REVIEW
Chakrapani Balijepalli, Eric Druyts, Gaye Siliman, Michel Joffres, Kristian Thorlund, Edward J Mills
OBJECTIVE: To understand the severity and potential impact of heterogeneity in definitions of hypoglycemia used in diabetes research, we aimed to review the hypoglycemia definitions adopted in randomized controlled trials (RCTs). METHODS: We reviewed 109 RCTs included in the Canadian Agency for Drugs and Technologies in Health reports for the second- and third-line therapy for the patients with type 2 diabetes (T2D). RESULTS: Nearly 60% (n=66) of the studies reviewed presented the definitions for overall hypoglycemia, and another 20% (n=22) of the studies reported the results for hypoglycemia but did not report a definition...
2017: Clinical Epidemiology
https://www.readbyqxmd.com/read/28547206/glycemic-variability-in-type-1-diabetes-compared-with-degludec-and-glargine-on-the-morning-injection-an-open-label-randomized-controlled-trial
#19
Ryo Iga, Hiroshi Uchino, Ken Kanazawa, Shuki Usui, Masahiko Miyagi, Naoki Kumashiro, Hiroshi Yoshino, Yasuyo Ando, Takahisa Hirose
INTRODUCTION: Optimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depends on its duration of action and peak-less profile. Owing to the ability of long-acting basal insulin to avoid hypoglycemia, we titrated pre-meal glucose to normal fasting blood glucose, 80-110 mg/dL (4.5-6.1 mmol/L), and post-meal glucose to 80-140 mg/dL (4.5-7.8 mmol/L). The purpose of this study was to evaluate two basal insulin analogues degludec (IDeg) and glargine (IGlar), injected in the morning, for GV using continuous glucose monitoring (CGM) in type 1 diabetes (T1DM)...
August 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28537449/understanding-how-pharmacokinetic-and-pharmacodynamic-differences-of-basal-analog-insulins-influence-clinical-practice
#20
Jennifer Goldman, Christoph Kapitza, Jeremy Pettus, Tim Heise
This article reviews pharmacokinetic (PK) and pharmacodynamic (PD) concepts relating to the pharmacology of basal insulin analogs. Understanding the pharmacology of currently available long-acting basal insulins and the techniques used to assess PK and PD parameters (e.g. the euglycemic clamp method) is important when considering the efficacy and safety of these agents, and can help in understanding the rationale for specific dosing strategies when tailoring therapy for a specific patient. Basal insulins such as insulin glargine 100 units (U)/mL and insulin detemir show improved PK/PD characteristics compared with the intermediate-acting NPH insulin, with a longer duration of action, a more consistent glucose-lowering effect and less prominent concentration peaks...
June 23, 2017: Current Medical Research and Opinion
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