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Davies MJ, Alibegovic AC, Kelkar P, Braae UC, Jensen AB. Glycaemic control and weight outcomes after adding or switching to biphasic insulin aspart 30/70 in people with type 2 diabetes mellitus previously treated with basal-bolus insulin in UK clinical practice. Diabetes Obes Metab 2023; 25:3841-3844. [PMID: 37722973 DOI: 10.1111/dom.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 09/20/2023]
Affiliation(s)
- Melanie J Davies
- Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester General Hospital, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester General Hospital, Leicester, UK
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Builes-Montaño C, Wandurraga E, Ramírez A, Ordóñez JE. Simplification of Complex Insulin Regimens with IdegLira in People with Type 2 Diabetes: Literature Review and Clinical Recommendations. Diabetes Ther 2023; 14:1959-1976. [PMID: 37736786 PMCID: PMC10570232 DOI: 10.1007/s13300-023-01471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION This study developed a simple algorithm based on clinical results described in medical literature and which allows one to simplify complex insulin regimes with IdegLira to avoid adverse events related to the complexity of some insulin treatments. METHODS We conducted a systematic review of the literature that allowed us to identify studies that evaluated the clinical result of simplifying complex insulin regimes. The authors reviewed the common factors these simpler regimes had, including the type of patients who used them. RESULTS We found nine clinical studies published between 2017 and 2022, eight performed in Europe and one in Latin America. The monitoring time of the studies ranged between 3 and 18 months. The size of the study populations was between 61 and 611 patients (the latter was in five countries). In all studies, HbA1c decreased by 0.6-1.7% and the weight decreased by 0.1-3.11 kg. CONCLUSIONS On the basis of the findings of these studies, we made some recommendations for clinical practice to simplify treatment. The results of these studies support an algorithm that simplifies the treatment of complex insulin regimens.
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Affiliation(s)
- C Builes-Montaño
- University of Antioquia Faculty of Medicine, Medellin, Colombia
- Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - E Wandurraga
- Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - A Ramírez
- Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
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Liao Y, Liu X, Huang J, Chen Q, Li N, Zhou P. Insulin injection knowledge, attitude and behaviour of nurses: A cross-sectional study in Guangdong Province. Nurs Open 2023; 10:3754-3765. [PMID: 36808890 PMCID: PMC10170902 DOI: 10.1002/nop2.1633] [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: 05/12/2022] [Revised: 12/07/2022] [Accepted: 01/13/2023] [Indexed: 02/20/2023] Open
Abstract
AIM To understand the insulin injection knowledge, attitude and behaviour of nurses and their influencing factors in Guangdong Province. DESIGN Cross-sectional study. METHODS A total of 19,853 nurses from 82 hospitals in 15 cities in Guangdong, China, participated in this study. The scores of the nurses' insulin injection knowledge, attitude and behaviour were determined through a questionnaire, and multivariate regression analysis was used to evaluate the influencing factors of insulin injection in different dimensions. STROBE. RESULTS Among all nurses involved in this study, 22.3% of nurses had good knowledge, 75.9% of nurses had good attitude and 92.7% of nurses had good behaviour. Pearson's correlation analysis showed that knowledge, attitude scores and behaviour scores were significantly correlated. The influencing factors of knowledge, attitude and behaviour included gender, age, education, nurse level, work experience, type of ward, diabetes nursing certification, position held and most recent insulin administration.
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Affiliation(s)
- Yangyang Liao
- School of Nursing, Jinan University, Guangzhou, China
| | - Xueyan Liu
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jiewei Huang
- School of Nursing, Jinan University, Guangzhou, China.,Nursing Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qingling Chen
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ningning Li
- School of Nursing, Jinan University, Guangzhou, China
| | - Peiru Zhou
- School of Nursing, Jinan University, Guangzhou, China.,Department of Health Management, The Fifth Affiliated Hospital of Jinan University, Heyuan, China
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Peptide Inhibitors of Insulin Fibrillation: Current and Future Challenges. Int J Mol Sci 2023; 24:ijms24021306. [PMID: 36674821 PMCID: PMC9863703 DOI: 10.3390/ijms24021306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/06/2023] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Amyloidoses include a large variety of local and systemic diseases that share the common feature of protein unfolding or refolding into amyloid fibrils. The most studied amyloids are those directly involved in neurodegenerative diseases, while others, such as those formed by insulin, are surprisingly far less studied. Insulin is a very important polypeptide that plays a variety of biological roles and, first and foremost, is at the basis of the therapy of diabetic patients. It is well-known that it can form fibrils at the site of injection, leading to inflammation and immune response, in addition to other side effects. In this concise review, we analyze the current knowledge on insulin fibrillation, with a focus on the development of peptide-based inhibitors, which are promising candidates for their biocompatibility but still pose challenges to their effective use in therapy.
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Alexopoulos AS, Soliman D, Lewinski AA, Strawbridge E, Steinhauser K, Edelman D, Crowley MJ. Simplifying therapy to assure glycemic control and engagement (STAGE) in poorly-controlled diabetes: A pilot study. J Diabetes Complications 2023; 37:108364. [PMID: 36525906 PMCID: PMC9839589 DOI: 10.1016/j.jdiacomp.2022.108364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022]
Abstract
In this single-arm pilot study, we demonstrated feasibility and acceptability of an insulin simplification intervention in patients with persistent, poorly-controlled type 2 diabetes on complex insulin regimens. While not powered to assess clinical outcomes, we observed neither worsened glycemic control nor increased hypoglycemia.
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Affiliation(s)
- Anastasia-Stefania Alexopoulos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; Department of Medicine, Division of Endocrinology, Duke University Medical Center, Rd, Durham, NC 27710, United States.
| | - Diana Soliman
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Rd, Durham, NC 27710, United States
| | - Allison A Lewinski
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; School of Nursing, Duke University, Durham, NC 27710, United States
| | - Elizabeth Strawbridge
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States
| | - Karen Steinhauser
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; Department of Population Health Sciences, Duke University, Durham, NC 27710, United States
| | - David Edelman
- Department of Population Health Sciences, Duke University, Durham, NC 27710, United States; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27710, United States
| | - Matthew J Crowley
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Medical Center, Durham, NC 27710, United States; Department of Medicine, Division of Endocrinology, Duke University Medical Center, Rd, Durham, NC 27710, United States
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Taybani ZJ, Bótyik B, Gyimesi A, Katkó M, Várkonyi T. One-year safety and efficacy results of insulin treatment simplification with IDegLira in type 2 diabetes. Endocrinol Diabetes Metab 2022; 6:e390. [PMID: 36461758 PMCID: PMC9836254 DOI: 10.1002/edm2.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 10/21/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION This study aimed to investigate the sustained safety and efficacy of insulin treatment simplification with IDegLira in patients with type 2 diabetes and an HbA1c ≤ 7.5% (58 mmol/mol) during a 12-month follow-up. METHODS Seventy-two adults with type 2 diabetes and an HbA1c ≤ 7.5% (58 mmol/mol) treated with multiple daily insulin injections (MDI) participated in the trial (age 63.8 ± 9.5 years, HbA1c 6.4 ± 0.7%, [46 ± 8 mmol/mol] body weight 92.95 ± 18.83 kg, total daily insulin dose: 43.21 ± 10.80 units; mean ± SD). Previous insulins were stopped, and once daily IDegLira was started. IDegLira was titrated by the patients to achieve a self-measured prebreakfast plasma glucose concentration of ≥5 mmol/L to ≤6 mmol/L. RESULTS After 12 months, good glycaemic control was maintained, while body weight decreased significantly. Mean HbA1c changed to 6.2 ± 0.8% (44 ± 9 mmol/mol) (p = .109) and body weight changed by -3.89 kg to 89.06 ± 18.61 kg (p < .0001). The simplified treatment was safe and well-tolerated. Percentage of patients experiencing at least one episode of hypoglycaemia was 49% during the month before simplification and 17% during the last 3 months of the follow-up. CONCLUSIONS Insulin treatment simplification with IDegLira in selected patients with type 2 diabetes is safe, maintains adequate glycaemic control and is associated with weight loss over 12 months.
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Affiliation(s)
- Zoltán J. Taybani
- Department of EndocrinologyDr. Réthy Pál Member Hospital, Békés County Central HospitalBékéscsabaHungary
| | - Balázs Bótyik
- Department of EndocrinologyDr. Réthy Pál Member Hospital, Békés County Central HospitalBékéscsabaHungary
| | - András Gyimesi
- Department of EndocrinologyDr. Réthy Pál Member Hospital, Békés County Central HospitalBékéscsabaHungary
| | - Mónika Katkó
- Division of Endocrinology, Department of Internal Medicine, Faculty of MedicineUniversity of DebrecenDebrecenHungary
| | - Tamás Várkonyi
- Department of Internal MedicineUniversity of SzegedSzegedHungary
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Diabetes medication recommendation system using patient similarity analytics. Sci Rep 2022; 12:20910. [PMID: 36463296 PMCID: PMC9719534 DOI: 10.1038/s41598-022-24494-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/16/2022] [Indexed: 12/07/2022] Open
Abstract
Type-2 diabetes mellitus (T2DM) is a medical condition in which oral medications avail to patients to curb their hyperglycaemia after failed dietary therapy. However, individual responses to the prescribed pharmacotherapy may differ due to their clinical profiles, comorbidities, lifestyles and medical adherence. One approach is to identify similar patients within the same community to predict their likely response to the prescribed diabetes medications. This study aims to present an evidence-based diabetes medication recommendation system (DMRS) underpinned by patient similarity analytics. The DMRS was developed using 10-year electronic health records of 54,933 adult patients with T2DM from six primary care clinics in Singapore. Multiple clinical variables including patient demographics, comorbidities, laboratory test results, existing medications, and trajectory patterns of haemoglobin A1c (HbA1c) were used to identify similar patients. The DMRS was evaluated on four groups of patients with comorbidities such as hyperlipidaemia (HLD) and hypertension (HTN). Recommendations were assessed using hit ratio which represents the percentage of patients with at least one recommended sets of medication matches exactly the diabetes prescriptions in both the type and dosage. Recall, precision, and mean reciprocal ranking of the recommendation against the diabetes prescriptions in the EHR records were also computed. Evaluation against the EHR prescriptions revealed that the DMRS recommendations can achieve hit ratio of 81% for diabetes patients with no comorbidity, 84% for those with HLD, 78% for those with HTN, and 75% for those with both HLD and HTN. By considering patients' clinical profiles and their trajectory patterns of HbA1c, the DMRS can provide an individualized recommendation that resembles the actual prescribed medication and dosage. Such a system is useful as a shared decision-making tool to assist clinicians in selecting the appropriate medications for patients with T2DM.
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Tramunt B, Disse E, Chevalier N, Bordier L, Cazals L, Dupuy O, Marre M, Matar O, Meyer L, Noilhan C, Sanz C, Valensi P, Velayoudom FL, Gautier JF, Gourdy P. Initiation of the Fixed Combination IDegLira in Patients with Type 2 Diabetes on Prior Injectable Therapy: Insights from the EASY French Real-World Study. Diabetes Ther 2022; 13:1947-1963. [PMID: 36331712 PMCID: PMC9663793 DOI: 10.1007/s13300-022-01327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Combining basal insulin (BI) with glucagon-like peptide-1 receptor agonist (GLP-1RA) is recognized as a relevant option to optimize glucose control in type 2 diabetes (T2D). The EASY real-world study aimed to evaluate the modalities of initiation and the effectiveness of the insulin Degludec plus Liraglutide (IDegLira) fixed-ratio combination in the French health care system. METHODS A retrospective analysis included all patients with T2D and prior injectable therapy (GLP1-RA and/or insulin) who started treatment with IDegLira from September 2016 to December 2017 in 11 French diabetes centers. Baseline characteristics, reasons for IDegLira initiation, and modes of implementation were collected from the medical records. Changes in HbA1c and body weight were determined in patients with available follow-up data (nearest 6-month visit). RESULTS IDegLira was initiated in 629 patients previously treated with GLP-1RA alone (11.6%), insulin alone (31.5% including 16.5% with BI and 14.9% with multiple daily injections [MDI]) or a free combination of GLP-1RA and insulin (56.9% including 44.8% with BI and 12.1% with MDI), associated or not with oral agents. IDegLira starting dose (mean of 29 ± 11 dose steps) most often exceeded the recommended dose, and was significantly correlated with prior BI but not GLP-1RA dosage. At initiation, mean age, body mass index (BMI) and HbA1c were 60.1 ± 10.2 years, 33.4 ± 6.2 kg/m2 and 8.8 ± 1.7%, respectively. In 461 patients with available follow-up (median 178 days), HbA1c decreased in all subgroups submitted to treatment intensification (- 1.7 ± 1.8% [p < 0.0001], - 1.2 ± 1.8% [p < 0.001] and - 0.8 ± 1.8% [p = 0.0026] in patients with prior GLP-1RA, BI or MDI therapy, respectively) but also in those switching from BI and GLP-1RA free combination (- 0.2 ± 0.9%, p = 0.0419). Significant body weight gain occurred in patients previously treated with GLP-1RA alone (+ 1.5 ± 5.8 kg, p = 0.0572) or combined to BI (+ 1.0 ± 3.1 kg, p < 0.0001) while those on BI (- 1.4 ± 4.6 kg, p = 0.0139) or MDI (- 1.4 ± 5.0 kg, p = 0.0484) experienced weight loss. CONCLUSIONS While providing new information on the use of IDegLira in the French healthcare system, these data confirm the effectiveness of this fixed-ratio combination in the management of T2D.
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Affiliation(s)
- Blandine Tramunt
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
- Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UT3, Toulouse, France
| | - Emmanuel Disse
- Service d'Endocrinologie, Diabète et Nutrition, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Chevalier
- Université Côte d'Azur, Centre Hospitalier Universitaire, INSERM U1065, C3M, Nice, France
| | - Lyse Bordier
- Service d'Endocrinologie, Hôpital d'instruction des Armées Begin, Saint-Mandé, France
| | - Laurent Cazals
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Olivier Dupuy
- Service de Diabétologie et Endocrinologie, Groupe Hospitalier Saint-Joseph, Paris, France
| | - Michel Marre
- Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Odette Matar
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Bichat, Paris, France
| | - Laurent Meyer
- Service d'Endocrinologie, Diabète et Maladies Métaboliques, CHU de Strasbourg, Strasbourg, France
| | - Chloé Noilhan
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France
| | - Caroline Sanz
- Cabinet d'Endocrinologie, de Diabétologie et de Nutrition, Clinique Pasteur, Toulouse, France
| | - Paul Valensi
- Unit of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, Paris Nord University, Bondy, France
| | | | - Jean-François Gautier
- Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, AP-HP, Paris Cité, INSERM 1151, Paris, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker Enfants Malades, 75015, Paris, France
| | - Pierre Gourdy
- Service de Diabétologie, Maladies Métaboliques et Nutrition, CHU et Université de Toulouse, TSA 50032, 31059, Toulouse Cedex 9, France.
- Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UT3, Toulouse, France.
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