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Yi X, Luo Y, Zhou Q, Wang J, Yang Z. Visually controlled pulsatile release of insulin from chitosan poly-acrylic acid nanobubbles triggered by focused ultrasound. Int J Pharm 2023; 643:123266. [PMID: 37482226 DOI: 10.1016/j.ijpharm.2023.123266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023]
Abstract
Insulin therapy is the most effective way to control the blood glucose value of diabetic patients. The most effective administration route for insulin is subcutaneous injection because bioavailability for non-injection administration is low and unstable. However, patients often need a multiple daily insulin injection regimen to control basal and postprandial blood glucose, which causes various complications. Controlled pulsatile drug release technology using ultrasound as an external stimulus source is a very promising method to avoid multiple injections of insulin. However, most of the drug-loaded microbubbles used for ultrasound-mediated treatment have a short half-life, which limits their use in controlled pulsatile drug release. More importantly, how to control insulin release is still a challenge. In this paper, chitosan poly-acrylic acid nanobubbles as drug carriers of insulin were prepared to achieve a visually controlled pulsatile release of insulin triggered by focused ultrasound. The experimental results in vivo demonstrated that nanobubbles were stable enough to achieve long-term visualization for 7 days after intramuscular injection in rats. Under the guidance of ultrasound imaging, it is visible to find the position and observe the gray values change of nanobubbles. Thus, when triggered by focused ultrasound, the amount of insulin could be accurately pulsatile released from nanobubbles. In vivo experiments in rats showed that the visually controlled pulsatile release of insulin could be achieved for a long time, up to 3 consecutive days. The blood glucose level could be repeatedly reduced by focused ultrasound irradiation with just one injection. Our research provided a promising way for visually controlled pulsatile release of insulin, which would significantly reduce the injection frequency of insulin.
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Affiliation(s)
- Xiyuan Yi
- The State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China; Chongqing University Fuling Hospital, Chongqing 408099, China
| | - Yong Luo
- The State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Qi Zhou
- Chongqing University Fuling Hospital, Chongqing 408099, China
| | - Jun Wang
- Chongqing University Fuling Hospital, Chongqing 408099, China
| | - Zengtao Yang
- The State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China.
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Moreno-Fernandez J, Chico A, Martínez-Brocca MA, Beato-Víbora PI, Vidal M, Piedra M, Quirós C, Muñoz-Rodríguez JR. Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes Mellitus Patients: Results from the Spanish National Registry. Diabetes Technol Ther 2022; 24:898-906. [PMID: 35947087 DOI: 10.1089/dia.2022.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Aim: To analyze the clinical effect of continuous subcutaneous insulin infusion (CSII) in type 1 diabetes mellitus (T1D) patients in the Spanish real-world scenario. Methods: All T1D patients on CSII registered in the SPAnish Insulin Pump (SPAIP) registry were included. The primary efficacy outcome was change in HbA1c during follow-up. Secondary efficacy outcomes included: insulin pump indications, diabetes complication rates, insulin and pump use, and continuous glucose monitoring (CGM) glycometrics. Patient data were typed through the web-based SPAIP registry. Results: Data from 2979 T1D patients treated with CSII were analyzed. The median age was 44 years (interquartile range [IQR] 34-52 years), and T1D duration was 27 years (IQR 18-35 years). The median duration of CSII therapy was 6 years (IQR 3-10 years). The main indications for treatment were suboptimal glycemic control (33.8%), hypoglycemia (22.1%), and increased glycemic variability (18.8%). Glycated hemoglobin decreased by 6 mmol/mol (95% CI, -5 to -6 mmol/mol, P < 0.001) [-0.5%, 95% CI, -0.4 to -0.5, P < 0.001] during the follow-up. The percentage of patients with severe hypoglycemia decreased from 14.9% to 0.9% (P < 0.001). We observed an inverse correlation between final HbA1c levels and CGM adherence (R = -0.24, P < 0.001) or percentage of time with active hybrid closed-loop functions (R = -0.25, P < 0.001). Conclusions: CSII treatment was associated with a sustained improvement in glycemic control in the Spanish population. This benefit was greater among patients with higher CGM or active hybrid closed-loop functions adherence. The protocol was publicly registered at ClinicalTrials.gov (NCT04761094).
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Affiliation(s)
- Jesus Moreno-Fernandez
- Department of Endocrinology and Nutrition, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Ana Chico
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Mercé Vidal
- Department of Endocrinology and Nutrition, Barcelona Clinic Hospital, Barcelona, Spain
| | - María Piedra
- Department of Endocrinology and Nutrition, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Carmen Quirós
- Department of Endocrinology and Nutrition, Terrassa Hospital, Terrassa, Barcelona, Spain
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A simulator with realistic and challenging scenarios for virtual T1D patients undergoing CSII and MDI therapy. J Biomed Inform 2022; 132:104141. [PMID: 35835439 DOI: 10.1016/j.jbi.2022.104141] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/28/2022] [Accepted: 07/07/2022] [Indexed: 11/23/2022]
Abstract
In silico simulations have become essential for the development of diabetes treatments. However, currently available simulators are not challenging enough and often suffer from limitations in insulin and meal absorption variability, which is unable to realistically reflect the dynamics of people with type 1 diabetes (T1D). Additionally, T1D simulators are mainly designed for the testing of continuous subcutaneous insulin infusion (CSII) therapies. In this work, a simulator is presented that includes a generated virtual patient (VP) cohort and both fast- and long-acting Glargine-100 U/ml (Gla-100), Glargine-300 U/ml (Gla-300), and Degludec-100 U/ml (Deg-100) insulin models. Therefore, in addition to CSII therapies, multiple daily injections (MDI) therapies can also be tested. The Hovorka model and its published parameter probability distributions were used to generate cohorts of VPs that represent a T1D population. Valid patients are filtered through restrictions that guarantee that they are physiologically acceptable. To obtain more realistic scenarios, basal insulin profile patterns from the literature have been used to identify variability in insulin sensitivity. A library of mixed meals identified from real data has also been included. This work presents and validates a methodology for the creation of realistic VP cohorts that include physiological variability and a simulator that includes challenging and realistic scenarios for in silico testing. A cohort of 47 VPs has been generated and in silico simulations of both CSII and MDI therapies were performed in open-loop. The simulation outcome metrics were contrasted with literature results.
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Hu S, Yang H, Chen Z, Leng X, Li C, Qiao L, Lv W, Li T. Clinical Outcome and Cost-Effectiveness Analysis of CSII Versus MDI in Children and Adolescent With Type 1 Diabetes Mellitus in a Public Health Care System of China. Front Endocrinol (Lausanne) 2021; 12:604028. [PMID: 33859614 PMCID: PMC8043415 DOI: 10.3389/fendo.2021.604028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the clinical and economic consequences of continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) in children and adolescents with type 1 diabetes mellitus (T1DM) from a public health care system in developed areas of developing country, considering changes in glycemic Control, daily insulin requirements, lipid profile, body mass index (BMI), frequency of severe hypoglycemia and Diabetic Ketoacidosis (DKA) and diabetic complications. METHODS This was a retrospective cohort study of children and adolescents with T1DM. Data were collected at baseline and the end of every year including glycated hemoglobin (HbA1c), insulin dose, lipid profile, blood pressure, and adverse events (severe hypoglycemia and DKA). The Cost-effectiveness analysis was performed using the IQVIA CORE Diabetes Model (CDM) to simulate diabetes progression by utilizing the clinical data obtained from the two groups. The main outcome measures were Life Expectancy, Quality adjusted life years (QALYs), Total Costs and Incremental Costs and Effectiveness Ratio (ICER) of CSII compared with MDI in Chinese pediatric patients with T1DM in Qingdao City (60 years). RESULTS Mean HbA1c values and daily insulin doses were significantly lower in those receiving CSII therapy throughout follow-up. Mean direct lifetime costs were ¥ 67,137 higher with CSII treatment than with MDI for pediatric patients. Treatment with CSII was associated with an improvement in life expectancy of 0.41 years for pediatric patients compared with MDI based on CORE diabetes model simulation. The corresponding gains in QALYs were 0.42. These data produced corresponding ICER is ¥ 161,815 per QALY for pediatric T1DM patients in Qingdao. Sensitivity analyses suggested that our base-case assumptions were mostly robust. CONCLUSIONS CSII is associated with improved long-term clinical outcomes compared with MDI. Based on this model analysis, CSII appears to be more cost-effective for the Qingdao TIDM pediatric population and health care system.
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Affiliation(s)
- Sicui Hu
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Hongxiu Yang
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Zhihong Chen
- Neuroendocrine Pediatric Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuefei Leng
- Neuroendocrine Pediatric Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Li
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Lingyan Qiao
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Weiqing Lv
- Research and Development Department, Medtronic (Shanghai) Management Co, Ltd, Shanghai, China
| | - Tang Li
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
- *Correspondence: Tang Li,
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Benioudakis ES. Perceptions in Type 1 Diabetes Mellitus with or Without the Use of Insulin Pump: An Online Study. Curr Diabetes Rev 2020; 16:874-880. [PMID: 31057119 DOI: 10.2174/1573399815666190502115754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/17/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Technological developments concerning the treatment of Type 1 Diabetes Mellitus have been rapid in the latest years. Insulin infusion systems along with continuous glucose monitoring, as well as long-acting insulin analogues, are part of this progress. OBJECTIVE The aim of this study is to present the illness perceptions in type 1 diabetes mellitus, with or without the use of an insulin pump. Sexual life and body image among therapy groups subjected to subcutaneous insulin infusion (CSII) therapy and multiple daily injections (MDI) therapy were also examined. METHODS A modified version of the Brief Illness Perception Questionnaire was used. One hundred and nine adults with type 1 diabetes mellitus, (males / females ratio 1:2.3) completed the online survey. Thirty six of them (33%) used CSII therapy and 73 of them (67%) used MDI therapy. RESULTS Statistically important differences among the CSII and MDI therapy groups were found in treatment control, illness comprehensibility, representations of control, representation of body image and in the perception of sex life. There was no statistically significant difference among the different types of therapy for participants' negative perception of diabetes. DISCUSSION AND CONCLUSION Negative perceptions of MDI users in treatment control, illness comprehensibility, representations of control, body image and sex life with the insulin pump, differentiate CSII and MDI therapy groups to a significant degree. According to the research, these parameters seem to interfere with accepting CSII therapy for MDI users and discourage them.
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Affiliation(s)
- Emmanouil S Benioudakis
- Department of Psychology, University of Crete, Crete, Greece; 2Psychiatric Clinic, General Hospital of Chania, Chania, Greece
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Assessment of Serum Concentrations of Adropin, Afamin, and Neudesin in Children with Type 1 Diabetes. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6128410. [PMID: 31781629 PMCID: PMC6855013 DOI: 10.1155/2019/6128410] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/10/2019] [Indexed: 02/07/2023]
Abstract
Introduction The increasing knowledge of adropin, afamin, and neudesin and the regulation of glucose metabolism and insulin resistance allows for the assessment of the differences in their concentrations between the groups with varied duration of diabetes mellitus (DM). Aim of the Study Assessment of serum levels of adropin, afamin, and neudesin in children with type 1 diabetes, with respect to the disease duration. Materials and Methods The study consisted of 138 patients aged 5–18 years (M 40.58%). Children with type 1 diabetes (n = 68) were compared to the control group (n = 70). The diabetic group was divided into 4 subgroups: (I) newly diagnosed patients, after an episode of ketoacidosis (n = 14), (II) duration no longer than 5 years (n = 18), (III) 5 to 10 years (n = 27), and (IV) longer than 10 years (n = 9). Serum concentrations of adropin, afamin, and neudesin were assessed and compared between the groups of patients. The criterion for statistical significance was p < 0.05. Results The concentrations of adropin and afamin across all subgroups were lower than that in the control group, while neudesin levels were higher in diabetic patients compared to the control group. The differences were statistically significant. Conclusions Adropin, afamin, and neudesin may play a major role in the regulation of glucose metabolism and have a significant potential as novel biomarkers to predict future metabolic disorders. However, further multicentre studies on a larger cohort of patients are necessary to specify the role of these substances in the course and treatment of type 1 diabetes.
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Moreno-Fernandez J, Gomez FJ, Pinés P, González J, López J, López LM, Blanco B, Roa C, Herranz S, Muñoz-Rodríguez JR. Continuous Subcutaneous Insulin Infusion in Adult Type 1 Diabetes Mellitus Patients: Results from a Public Health System. Diabetes Technol Ther 2019; 21:440-447. [PMID: 31199682 DOI: 10.1089/dia.2019.0097] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Aims: To analyze prevalence and clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a public health system real-world scenario. Materials and Methods: All adult T1DM patients on CSII being followed at Castilla-La Mancha Health Public Service were included. Primary efficacy outcome was the change in HbA1c during the follow-up. Secondary efficacy outcomes included evaluation of the following variables: insulin pump indications, diabetes complication rates, insulin and pump use, continuous glucose monitoring use, patients achieving an HbA1c decrease ≥6 mmol/mol (0.5%) with or without severe hypoglycemia, and discontinuations. Direct patient data were typed through the web-based Spanish national registry on CSII therapy by nine diabetologists from eight different health care areas. Results: A total of 7% of T1DM adult patients were treated with insulin pumps in our region, with a regional prevalence of 18.7 CSII patients/100,000 inhabitants. Three hundred thirteen patients were analyzed with a mean age of 34.1 ± 11.0 years and T1DM duration of 16.6 ± 9.7 years. Mean duration of CSII therapy was 6.2 ± 4.0 years. Data completion was 91.2%. Main indications for treatment were high glucose variability (36%) and suboptimal glycemic control (32%). Mean duration of CSII therapy was 6.2 ± 4.0 years. Sensor-augment pump therapy was used by 26% of the patients. Glycated hemoglobin decreased to -5 mmol/mol (95% CI -6 to -3 mmol/mol; P < 0.001) during the follow-up (Mean difference in change -0.4%, 95% CI -0.5 to -0.2; P < 0.001). Percentage of patients with severe hypoglycemia decreased from 32% to 13% (P < 0.001). Frequent nonsevere hypoglycemia, severe hypoglycemia, and diabetic ketoacidosis were less frequent among patients using higher number of daily basal rates at the study end. The rate of CSII interruption was 3.8%. Conclusions: Prevalence of CSII therapy in our region remains under 10% of adult T1DM patients, although CSII treatment was associated with a sustained improvement in glycemic control.
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Affiliation(s)
- Jesus Moreno-Fernandez
- 1Service of Endocrinology and Nutrition, Ciudad Real General University Hospital, Ciudad Real, Spain
| | - Francisco Javier Gomez
- 2Service of Endocrinology and Nutrition, La Mancha-Centro General Hospital, Ciudad Real, Spain
| | - Pedro Pinés
- 3Service of Endocrinology and Nutrition, Albacete University Hospital, Albacete, Spain
| | - Javier González
- 4Service of Endocrinology and Nutrition, Virgen de la Luz Hospital, Cuenca, Spain
| | - José López
- 5Service of Endocrinology and Nutrition, Virgen de la Salud Hospital, Toledo, Spain
| | - Luz María López
- 3Service of Endocrinology and Nutrition, Albacete University Hospital, Albacete, Spain
| | - Benito Blanco
- 6Service of Endocrinology and Nutrition, Nuestra Señora del Prado Hospital, Toledo, Spain
| | - Carlos Roa
- 7Service of Endocrinology and Nutrition, Santa Barbara Hospital, Ciudad Real, Spain
| | - Sandra Herranz
- 8Service of Endocrinology and Nutrition, Guadalajara University Hospital, Guadalajara, Spain
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Cheon CK. Understanding of type 1 diabetes mellitus: what we know and where we go. KOREAN JOURNAL OF PEDIATRICS 2018; 61:307-314. [PMID: 30304895 PMCID: PMC6212709 DOI: 10.3345/kjp.2018.06870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/23/2018] [Accepted: 10/04/2018] [Indexed: 12/12/2022]
Abstract
The incidence of type 1 diabetes mellitus (T1DM) in children and adolescents is increasing worldwide. Combined effects of genetic and environmental factors cause T1DM, which make it difficult to predict whether an individual will inherit the disease. Due to the level of self-care necessary in T1DM maintenance, it is crucial for pediatric settings to support achieving optimal glucose control, especially when adolescents are beginning to take more responsibility for their own health. Innovative insulin delivery systems, such as continuous subcutaneous insulin infusion (CSII), and noninvasive glucose monitoring systems, such as continuous glucose monitoring (CGM), allow patients with T1DM to achieve a normal and flexible lifestyle. However, there are still challenges in achieving optimal glucose control despite advanced technology in T1DM administration. In this article, disease prediction and current management of T1DM are reviewed with special emphasis on biomarkers of pancreatic β-cell stress, CSII, glucose monitoring, and several other adjunctive therapies.
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Affiliation(s)
- Chong Kun Cheon
- Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea
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Rodríguez-Almagro J, García-Manzanares Á, Lucendo AJ, Hernández-Martínez A. Health-related quality of life in diabetes mellitus and its social, demographic and clinical determinants: A nationwide cross-sectional survey. J Clin Nurs 2018; 27:4212-4223. [PMID: 29987853 DOI: 10.1111/jocn.14624] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 06/27/2018] [Accepted: 07/03/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate health-related quality of life in a representative sample of adults with diabetes mellitus in Spain, as well as its clinical and sociodemographic determinants. BACKGROUND Diabetes mellitus is a chronic disease causing considerable morbidity and mortality worldwide, resulting in an impaired quality of life in affected people. DESIGN A nationwide cross-sectional study, based on an online survey and carried out between February-March 2016, was performed on diabetic subjects recruited through diabetic patients' organisations. METHODS A validated Spanish-language version of the self-administered Diabetes Quality of Life questionnaire was used, with 0 being the worst and 100 the best QoL level. Determinant factors of health-related quality of life were assessed with the aid of multivariate analysis to control for confounding factors. RESULTS The responses provided by 456 patients (52.4% being women) revealed an overall mean score of 66.4 ± 13.3. Social/vocational worries and diabetes-related worries were the dimensions with the highest (74.3 ± 20.1) and lowest (61.1 ± 20.6) scores, respectively. Younger age, female gender, having no studies and poor glycaemic control were all independent determinants for an impaired overall health-related quality of life, with most of these factors having a higher impact than the dimensions negative impact of therapy on daily life, satisfaction with therapy and diabetes-related worries. Married (or equivalent) subjects had better scores in the diabetes-related worries dimension. The perception of health-related quality of life progressively worsens as glycaemic control deteriorates and with an increased number of disease complications. Most of the associations did not vary significantly with the type of diabetes mellitus. CONCLUSION Overall health-related quality of life perception in the Spanish diabetic population is moderate and depends on several sociodemographic factors. Adequate glycaemic control to avoid disease complications improves perception. RELEVANCE TO CLINICAL PRACTICE The results can help health professionals to develop strategies to promote diabetic patient self-care, in order to improve the metabolic control of the disease and avoid its complications, as a therapeutic goal towards an improvement in health-related quality of life perception.
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Affiliation(s)
| | - Álvaro García-Manzanares
- Department of Endocrinology and Nutrition, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.,Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid
| | - Antonio Hernández-Martínez
- Nursing Midwife Teaching Unit, Hospital General La Mancha-Centro, Alcázar de San Juan, Ciudad Real, Spain
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Candido R, Wyne K, Romoli E. A Review of Basal-Bolus Therapy Using Insulin Glargine and Insulin Lispro in the Management of Diabetes Mellitus. Diabetes Ther 2018; 9:927-949. [PMID: 29654514 PMCID: PMC5984925 DOI: 10.1007/s13300-018-0422-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Indexed: 12/29/2022] Open
Abstract
UNLABELLED Basal-bolus therapy (BBT) refers to the combination of a long-acting basal insulin with a rapid-acting insulin at mealtimes. Basal insulin glargine 100 U/mL and prandial insulin lispro have been available for many years and there is a substantial evidence base to support the efficacy and safety of these agents when they are used in BBT or basal-plus therapy for patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM). With the growing availability of alternative insulins for use in such regimens, it seems timely to review the data regarding BBT with insulin glargine 100 U/mL and insulin lispro. In patients with T1DM, BBT with insulin glargine plus insulin lispro provides similar or better glycemic control and leads to less nocturnal hypoglycemia compared to BBT using human insulin as the basal and/or prandial component, and generally provides similar glycemic control and rates of severe hypoglycemia to those achieved with insulin lispro administered by continuous subcutaneous insulin infusion (CSII). Studies evaluating BBT with insulin glargine plus insulin lispro in patients with T2DM also demonstrate the efficacy and safety of these insulins. Available data suggest that BBT with insulin glargine and insulin lispro provides similar levels of efficacy and safety in pediatric and adult populations with T1DM and in adult patients and those aged more than 65 years with T2DM. These insulin preparations also appear to be safe and effective for controlling T2DM in people of different ethnicities and in patients with T1DM or T2DM and comorbidities. FUNDING Eli Lilly and Company.
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Affiliation(s)
- Riccardo Candido
- Diabetes Centre District 3, Azienda Sanitaria Universitaria Integrata di Trieste, Via Puccini 48/50, 34100, Trieste, Italy.
| | - Kathleen Wyne
- The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Ester Romoli
- Eli Lilly Italia SPA, via A. Gramsci 731/733, 50019, Sesto Fiorentino, Italy
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Beato-Víbora P, Chico-Ballesteros A, Giménez M, Guerrero-Vázquez R, Barrio-Castellanos R, Goñi-Iriarte MJ, Díaz-Soto G, Merino-Torres JF, Moreno-Fernández J, Martínez-Brocca MA. A national survey on the efficacy and safety of continuous subcutaneous insulin infusion in patients with type 1 diabetes in Spain. Diabetes Res Clin Pract 2018; 137:56-63. [PMID: 29278712 DOI: 10.1016/j.diabres.2017.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/29/2017] [Accepted: 12/12/2017] [Indexed: 11/15/2022]
Abstract
AIMS To assess safety and benefits of continuous subcutaneous insulin infusion (CSII) therapy in a cohort of type 1 diabetes patients in Spain. METHODS A web-based national registry was created by the Working Group of the Spanish Diabetes Association. All patients on CSII being followed at selected referral centers were included. A cross-sectional analysis was performed. RESULTS A total of 1275 patients were included. Data completion for patients on CSII was 67 ± 32%. Indications for treatment were suboptimal glycemic control (32%), high glucose variability (24%), preconception care (14%) and hypoglycemia (11%). In the patients on CSII for ≥1 year (n = 843, mean CSII duration of 5 years), HbA1c decreased by 5 mmol/mol (0.5%) in the whole population and by 8 mmol/mol (0.7%) in subjects with suboptimal glycemic control as CSII indication. Percentage of patients achieving HbA1c ≤ 53 mmol/mol (7%) increased from 20% before CSII to 34% at the end of follow-up. Severe hypoglycemia decreased from 29% to 5%. The rate of discontinuation was 9.5%. HbA1c was lower in patients using bolus advisor and temporary basal rates. CONCLUSIONS CSII was associated with a sustained improvement in glycemic control and a reduction in severe hypoglycemia. The use of advanced CSII settings was related to better glycemic control.
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12
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Layne JE, Parkin CG, Zisser H. Efficacy of the Omnipod Insulin Management System on Glycemic Control in Patients With Type 1 Diabetes Previously Treated With Multiple Daily Injections or Continuous Subcutaneous Insulin Infusion. J Diabetes Sci Technol 2016; 10:1130-5. [PMID: 27290737 PMCID: PMC5032947 DOI: 10.1177/1932296816638674] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion (CSII) treatment with a tubeless patch pump has not been previously evaluated in a large cohort of patients. METHODS This multisite, retrospective study evaluated glycemic control in patients with type 1 diabetes (n = 873) after 3 months treatment the Omnipod(®) insulin management system (Insulet Corporation, Billerica, MA) compared to prior treatment with multiple daily injections (MDI) (78.1%) or CSII (21.9%). The primary outcome was change in HbA1c from baseline at 3 months post-Omnipod treatment initiation. Secondary outcomes included shifts in HbA1c to target levels, change in total daily dose (TDD) of insulin and in the frequency and severity of hypoglycemic episodes. RESULTS HbA1c was significantly improved at 3 months post-Omnipod treatment for the total population (mean ± SD): -0.6% ± 1.3 (P < .001). HbA1c was also significantly lower compared to MDI: -0.3% ± 1.3, -0.4% ± 1.4, -0.8% ± 1.3 and -0.6% ± 1.3 (P = .002 to P < .001) and CSII: -0.3% ± 0.8, -1.1% ± 1.6 (P < .01), -0.4% ± 1.1 (P < .001), and -0.5% ± 1.1 (P < .001) for pediatric, adolescent, adult, and total populations, respectively. There was a 37.9% change increase in the proportion of patients ≥18 years and a 39.3% change increase in those <18 years achieving ADA treatment targets (P = .004 to P < .001). There was a 16.4% change decrease in TDD of insulin at 3 months for the total population (P < .001). The frequency of self-reported hypoglycemia decreased significantly (P < .001) by 1.0 ± 2.4 episodes per week. CONCLUSIONS Treatment with the Omnipod insulin management system was associated with clinically meaningful and statistically significant improvement in glycemic control, reduction in daily insulin requirement and reduction in the frequency and severity of hypoglycemic episodes.
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