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Robinson S, Newson RS, Liao B, Kennedy-Martin T, Battelino T. Missed and Mistimed Insulin Doses in People with Diabetes: A Systematic Literature Review. Diabetes Technol Ther 2021; 23:844-856. [PMID: 34270324 DOI: 10.1089/dia.2021.0164] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Development of coordinated management approaches is important to facilitate self-care in people with diabetes (PwD). Gaining a better understanding of suboptimal insulin use is key in this endeavor. This review aimed, for the first time, to systematically identify and narratively summarize real-world evidence on the extent of suboptimal insulin use (missed and mistimed insulin) in PwD. Methods: A systematic literature search of MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews identified studies reporting on missed and mistimed insulin dosing. Results: From 3305 studies, 37 publications reporting on 30 unique studies that involved 58,617 PwD were included. Studies were conducted across 12 different countries and most employed cross-sectional surveys. Observations regarding missed and mistimed insulin doses were reported in 25 and 10 studies, respectively. PwD reported missing insulin doses, but rates varied due to differences in reporting methods, participant populations, and insulin regimens. The association between missed dosing and glycemic control was evaluated in ten studies in which the authors reported lower glycated hemoglobin (HbA1c) levels in PwD who did not omit insulin. The proportion of PwD reporting mistiming of insulin was in the range of 20-45%, depending on the study; this was associated with higher rates of hypoglycemia and higher HbA1c as reported by study authors. Reasons for suboptimal insulin use were multifactorial, occurring due to disrupted daily routines, social situations, and hypoglycemia avoidance. Conclusions: This review suggests that suboptimal insulin use is widespread and that PwD using insulin may still be struggling with disease management. There is an unmet need for better integrated support in managing the complexities of insulin therapy and for the development of systems (e.g. digital solutions) that empower people to take control of insulin-treated diabetes.
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Affiliation(s)
- Susan Robinson
- Kennedy-Martin Health Outcomes Limited, Brighton, United Kingdom
| | - Rachel S Newson
- Global Patient Outcomes and Real-World Evidence, Eli Lilly, Sydney, Australia
| | - Birong Liao
- Medical Affairs, Eli Lilly, Indianapolis, IN, USA
| | | | - Tadej Battelino
- University Medical Center Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Suzuki J, Yamakawa T, Oba M, Nagakura J, Shigematsu E, Tamura H, Takahashi K, Okamoto Y, Sakamoto R, Shinoda M, Takano T, Kadonosono K, Terauchi Y. Efficacy and safety of insulin degludec U100 and insulin glargine U100 in combination with meal-time bolus insulin in hospitalized patients with type 2 diabetes: an open-label, randomized controlled study. Endocr J 2019; 66:971-982. [PMID: 31270291 DOI: 10.1507/endocrj.ej18-0309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The short-term efficacy and safety of insulin degludec U100 (IDeg) in patients with type 2 diabetes have not been reported widely. We compared insulin IDeg and insulin glargine U100 (IGla) for glycemic control and glucose variability in hospitalized patients with type 2 diabetes. In an open-label, multicenter, randomized controlled trial, 74 patients were randomly assigned to either the IDeg (36 patients) or IGla (38 patients) group and were administered with basal-bolus therapy during hospitalization. Following the start of the treatment, on day 11, glucose variability was assessed by continuous glucose monitoring. A fasting blood glucose level of 110 mg/dL and 2-hour postprandial blood glucose level of 180 mg/dL throughout at least one day during the observation period were achieved in 31.3% (10/32) and 30.6% (11/36) of the patients in the IDeg and IGla groups, respectively. The 6-point self-monitoring of blood glucose profiles showed a significant difference between the two groups. On day 7, the intra-day variation was larger in the IDeg group than in the IGla group. The incidence of hypoglycemia or glucose variability was comparable in the two groups. This study suggests that short-term efficacy and safety of IDeg and IGla in patients with type 2 diabetes during the initial phase of basal-bolus therapy were comparable, and these results can help in deciding which treatment to opt for.
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Affiliation(s)
- Jun Suzuki
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
- Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
| | - Tadashi Yamakawa
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Mari Oba
- Department of Medical Statistics Faculty of Medicine, Toho University, Tokyo 143-8540, Japan
| | - Jo Nagakura
- Department of Diabetes, Yata Ikeda Clinic, Mishima 411-0801, Japan
| | - Erina Shigematsu
- Department of Diabetes and Endocrinology, National Hospital Organization Yokohama Medical Center, Yokohama 245-8575, Japan
| | - Haruka Tamura
- Department of Endocrinology and Metabolism, Chigasaki Municipal Hospital, Chigasaki 253-0042, Japan
| | - Kenichiro Takahashi
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yoshihisa Okamoto
- Department of Diabetes, Japan Community Health Care Organization Yokohama Hodogaya Central Hospital, Yokohama 240-8585, Japan
| | - Rika Sakamoto
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Minori Shinoda
- Department of Endocrinology and Diabetes, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Tatsuro Takano
- Department of Diabetes and Endocrinology, Fujisawa City Hospital, Fujisawa 251-0052, Japan
| | - Kazuaki Kadonosono
- Department of Ophthalmology, Yokohama City University Medical Center, Yokohama 232-0024, Japan
| | - Yasuo Terauchi
- Department of Endocrinology and Metabolism, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
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Pujante P, Ares J, Maciá C, Rodriguez Escobedo R, Menéndez E, Delgado E. Efficacy of sodium glucose cotransporter 2 inhibitors as an adjunct treatment for patients with diabetes type 2. Med Clin (Barc) 2019; 152:438-441. [PMID: 30503071 DOI: 10.1016/j.medcli.2018.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/18/2018] [Accepted: 09/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To analyze the effect of sodium glucose cotransporter 2 (SGLT2) inhibitors in a group of insulin-dependent type 2 diabetes mellitus (T2D) patients. PATIENTS AND METHODS One hundred and five insulin treated T2D patients were enrolled. Primary endpoints were: fasting plasma glucose, HbA1c, weight, total insulin doses (TDI), total basal insulin (TDB) and total rapid insulin (TDR). Secondary variables were: total cholesterol, LDL cholesterol (cLDL), HDL cholesterol (cHDL), triglycerides and systolic (SBP) and diastolic (DBP) blood pressure. Safety and tolerance were evaluated through the appearance of severe hypoglycemia, ketoacidosis and infections. RESULTS After 4 months follow-up, a 0.7 (1.0)% HbA1c reduction was found, accompanied by a -2.8 (11.5) UI/day TDI decrease. Weight dropped for 73.7% of patients, with an average -2.0 (2.7) kg reduction. A global cHDL increase was noted after treatment, while no differences were observed for total cholesterol, triglycerides or cLDL. SBP dropped significantly, but no change in DBP was observed. CONCLUSION The use of SGLT2 inhibitors in insulin treated T2D patients resulted in reduction of HbA1c, which was associated to weight loss, cHDL increase and SBP decrease.
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Affiliation(s)
- Pedro Pujante
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Jessica Ares
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Carmen Maciá
- Hospital San Agustín, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Avilés, Asturias, Spain
| | - Raúl Rodriguez Escobedo
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Edelmiro Menéndez
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Elías Delgado
- Hospital Central de Asturias, Servicio de Endocrinología y Nutrición, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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Hamersky CM, Fridman M, Gamble CL, Iyer NN. Injectable Antihyperglycemics: A Systematic Review and Critical Analysis of the Literature on Adherence, Persistence, and Health Outcomes. Diabetes Ther 2019; 10:865-890. [PMID: 31054132 PMCID: PMC6531561 DOI: 10.1007/s13300-019-0617-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Improving real-world medication adherence to injectable antihyperglycemics in type 2 diabetes mellitus (T2DM) is a clinical challenge. Quantification of the level of adherence required to achieve a minimal clinically important difference (MCID) in glycemic control would assist in meeting this goal. The study objective was to review the literature regarding the relationships of medication adherence and persistence with health outcomes in adult T2DM patients using injectable antihyperglycemics. METHODS Systematic searches were conducted using electronic databases to identify publications over the last decade. Publications were screened against established eligibility criteria. Study data were extracted, evaluated, and used to identify strengths, limitations, and gaps in current evidence. RESULTS Eligibility criteria were met by 38 studies, and this report analyzed 34 studies related to glycemic control (n = 25), healthcare resource use (n = 9), and healthcare costs (n = 14). Eight of these studies examined adherence to glucagon-like peptide-1 receptor agonists (GLP-1 RA), including 1 study regarding adherence to GLP-1 RA or to insulin, and 1 study investigating a GLP-1 RA/insulin combination; the remaining studies involved insulin. Studies used a broad range of measures to classify adherence and persistence, and most measures were unable to reliably evaluate the complexities of patient behavior over time. Better adherence to injectable antihyperglycemic medications was generally found to be associated with improved glycemic control, although no studies attempted to identify a MCID. Although higher diabetes-related pharmacy and total healthcare costs were reported for adherent or persistent patients, these patients tended to have lower diabetes-related and all-cause medical costs. CONCLUSION Results of this review confirmed the effectiveness of injectable antihyperglycemic medications for glycemic control, suggesting that there are clinical and financial consequences to nonadherence. Although attempts were made to quantify the effects of nonadherence, the interpretation of study results was limited by the lack of a MCID and inadequate study design. FUNDING Novo Nordisk, Inc., Plainsboro Township, NJ, USA. Plain language summary available for this article.
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Pedersen‐Bjergaard U, Alsifri S, Aronson R, Berković MC, Galstyan G, Gydesen H, Lekdorf JB, Ludvik B, Moberg E, Ramachandran A, Khunti K. Comparison of the HAT study, the largest global hypoglycaemia study to date, with similar large real-world studies. Diabetes Obes Metab 2019; 21:844-853. [PMID: 30456887 PMCID: PMC6590793 DOI: 10.1111/dom.13588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
Abstract
AIMS Optimal diabetes care requires clear understanding of the incidence of hypoglycaemia in real-world clinical practice. Current data on hypoglycaemia are generally limited to those reported from randomised controlled clinical trials. The Hypoglycaemia Assessment Tool (HAT) study, a non-interventional real-world study of hypoglycaemia, assessed hypoglycaemia in 27 585 individuals across 24 countries. The present study compared the incidence of hypoglycaemia from the HAT study with other similarly designed, large, real-world studies. MATERIALS AND METHODS A literature search of PubMed (1995-2017) for population-based studies of insulin-treated patients with type 1 or type 2 diabetes (T1D, T2D), excluding clinical trials and reviews, identified comparable population-based studies reporting the incidence of hypoglycaemia. RESULTS The 24 comparative studies, including more than 24 000 participants with T1D and more than 160 000 participants with T2D, varied in design, size, inclusion criteria, definitions of hypoglycaemia and method of recording hypoglycaemia. Reported rates (events per patient-year [PPY]) of hypoglycaemia were higher in patients with T1D than in those with T2D (overall T1D, 21.8-73.3 and T2D, 1.3-37.7; mild/non-severe T1D, 29.0-126.7 and T2D, 1.3-41.5; severe T1D, 0.7-5.8 and T2D, 0.0-2.5; nocturnal T1D, 2.6-11.3 and T2D, 0.38-9.7) and were similar to the ranges found in the HAT study. CONCLUSIONS The HAT data on hypoglycaemia incidence were comparable with those from other real-world studies and indicate a high incidence of hypoglycaemia among insulin-treated patients. Differences in rates among studies are mostly explained by differences in patient populations and study methodology. The goal of reducing hypoglycaemia should be a target for continued educational and evidence-based pharmacological interventions.
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Affiliation(s)
| | | | - Ronnie Aronson
- Endocrinology and MetabolismLMC Diabetes and EndocrinologyTorontoOntarioCanada
| | | | | | | | | | - Bernhard Ludvik
- Division of Endocrinology and MetabolismRudolfstiftung Hospital and Karl‐Landsteiner InstituteViennaAustria
| | | | | | - Kamlesh Khunti
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
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