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Moreno-Fernandez J, López LM, Gomez FJ, Pinés P, Blanco B, González J, López J, Herranz S, Roa C, Gómez-Romero FJ. Long-term effects of continuous subcutaneous insulin infusion in adults with type 1 diabetes mellitus patients: Results of a public healthcare system. ACTA ACUST UNITED AC 2020; 68:116-122. [PMID: 32007441 DOI: 10.1016/j.endinu.2019.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/11/2019] [Accepted: 10/30/2019] [Indexed: 12/27/2022]
Abstract
AIM To evaluate the long-term clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a regional public healthcare system real-world scenario. METHODS All adult T1DM patients on CSII for ≥10 years subjected to follow-up in the regional Castilla-La Mancha Public Health Service were included. The primary efficacy outcome was the variation in HbA1c during follow-up. Direct patient data were compiled through the web-based Spanish national registry on CSII therapy. RESULTS A total of 69 T1DM adult patients were treated with insulin pumps for ≥10 years in our region. The mean age was 45.0±10.5 years, with a T1DM duration of 13.9±8.5 years. The mean duration of CSII therapy was 11.4±2.1 years. The main indications for treatment were high glucose variability (39%), problematic hypoglycemia (26%), and HbA1c >53mmol/mol (7%) on multiple daily injections (20%). Sensor-augmented pump therapy was used by 31% of the patients. Glycosylated hemoglobin did not change during follow-up (58±11mmol/mol vs. 58±11mmol/mol; 7.5±1.0 vs. 7.5±1.0; p=0.66). However, the percentage of patients with at least one episode of severe hypoglycemia during the last year and unnoticed hypoglycemia decreased from 36% to 7% (p=0.006) and from 38% to 32% (p<0.001), respectively. The proportion of subjects with ≥1 episode of diabetic ketoacidosis in the last year decreased from 30% to 6% (p=0.045). CONCLUSIONS The reduction of severe hypoglycemia without deterioration of glycemic control can be sustained over long-term CSII therapy.
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Affiliation(s)
- Jesus Moreno-Fernandez
- Service of Endocrinology and Nutrition, Ciudad Real University Hospital, Ciudad Real, Spain.
| | - Luz María López
- Service of Endocrinology and Nutrition, Albacete University Hospital, Albacete, Spain
| | - Francisco Javier Gomez
- Service of Endocrinology and Nutrition, La Mancha-Centro General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - Pedro Pinés
- Service of Endocrinology and Nutrition, Albacete University Hospital, Albacete, Spain
| | - Benito Blanco
- Service of Endocrinology and Nutrition, Nuestra Señora del Prado Hospital, Talavera de la Reina, Toledo, Spain
| | - Javier González
- Service of Endocrinology and Nutrition, Virgen de la Luz Hospital, Cuenca, Spain
| | - José López
- Service of Endocrinology and Nutrition, Virgen de la Salud Hospital, Toledo, Spain
| | - Sandra Herranz
- Service of Endocrinology and Nutrition, Guadalajara University Hospital, Guadalajara, Spain
| | - Carlos Roa
- Service of Endocrinology and Nutrition, Santa Barbara Hospital, Puertollano, Ciudad Real, Spain
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Picard S, Hanaire H, Reznik Y, Benhamou PY, Fendri S, Dufaitre L, Leutenegger E, Guerci B. Optimization of Insulin Regimen and Glucose Outcomes with Short-Term Real-Time Continuous Glucose Monitoring in Adult Type 1 Diabetes Patients with Suboptimal Control on Multiple Daily Injections: The Adult DIACCOR Study. Diabetes Technol Ther 2018; 20:403-412. [PMID: 29847735 DOI: 10.1089/dia.2018.0002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The impact of a 7-day real-time continuous glucose monitoring (RT-CGM) on type 1 diabetes (T1D) management remains unclear in patients suboptimally controlled by multiple daily injections (MDI). The DIACCOR Study aimed to describe treatment decisions and glucose outcomes after a short-term RT-CGM sequence. PATIENTS AND METHODS This French multicenter longitudinal observational study included T1D patients with HbA1c >7.5% or history of severe hypoglycemia (SH) or recurrent documented hypoglycemia. A sensor was inserted at the inclusion visit, treatment changes were proposed by the investigator within 7-15 days ("INT" = MDI intensification, "CSII" = switch to continuous insulin infusion, or "ER" = educational reinforcement with no change in insulin regimen), and a 4-month follow-up visit (M4) was scheduled. RESULTS Four hundred fifty-nine patients were recruited by 155 diabetologists, 17.0% had SH history, and 24.2% had recurrent hypoglycemia. Baseline HbA1c was 8.34% ± 1.21% (>7.5% in 79.6%). Overall, 253 (64.4%), 64 (16.3%), and 76 patients (19.3%) were, respectively, included in the "INT," "CSII," and "ER" subgroups. The number of patients who experienced SH or recurrent hypoglycemia dropped dramatically (7.9% vs. 17.0% and 10.8% vs. 24.2%, respectively). The same trend was observed for ketoacidosis and ketosis (0.3% vs. 3.3% and 2.2% vs. 4.8%). At M4, HbA1c was significantly reduced in the whole cohort to 7.98% ± 1.01% (P < 0.0001). The adjusted differences in HbA1c level in the INT, CSII, and ER subgroups were, respectively, -0.32%, -0.69%, and -0.50% (P < 0.0001 for all). CONCLUSION In real-life setting, a 1-week diagnostic RT-CGM supports appropriate treatment changes in patients with uncontrolled T1D resulting in better glucose control and less hypoglycemia.
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Affiliation(s)
- Sylvie Picard
- 1 Point Médical, Rond-Point de la Nation , Dijon, France
| | - Hélène Hanaire
- 2 Endocrinology-Diabetes Care Unit, Toulouse University Hospital , Toulouse, France
| | - Yves Reznik
- 3 Endocrinology-Diabetes Care Unit, Caen University Hospital , Caen, France
| | - Pierre-Yves Benhamou
- 4 Endocrinology-Diabetes Care Unit, Grenoble University Hospital , Grenoble, France
| | - Salha Fendri
- 5 Endocrinology-Diabetes Care Unit, Amiens University Hospital , Amiens, France
| | - Lise Dufaitre
- 6 Endocrinology-Diabetes Care Unit, Marseille University Hospital , Marseille, France
| | | | - Bruno Guerci
- 8 Endocrinology, Diabetology and Nutrition, Brabois Adult Hospital CHRU of Nancy, University of Lorraine , Vandoeuvre Lès Nancy, France
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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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Leelarathna L, Roberts SA, Hindle A, Markakis K, Alam T, Chapman A, Morris J, Urwin A, Jinadev P, Rutter MK. Comparison of different insulin pump makes under routine care conditions in adults with Type 1 diabetes. Diabet Med 2017. [PMID: 28636773 DOI: 10.1111/dme.13412] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIMS To compare long-term HbA1c changes associated with different insulin pumps during routine care in a large cohort of adults with Type 1 diabetes representative of other clinic populations. METHODS Observational, retrospective study of 508 individuals starting pump therapy between 1999 and 2014 (mean age, 40 years; 55% women; diabetes duration, 20 years; 94% Type 1 diabetes; median follow-up, 3.7 years). Mixed linear models compared covariate-adjusted HbA1c changes associated with different pump makes. RESULTS The pumps compared were: 50% Medtronic, 24% Omnipod, 14% Roche and 12% Animas. Overall HbA1c levels improved and improvements were maintained during a follow-up extending to 10 years (HbA1c : pre-continuous subcutaneous insulin infusion (pre-CSII) vs. 12 months post CSII, 71 (61, 82) vs. 66 (56, 74) mmol/mol; 8.7 (7.7, 9.6) vs. 8.2 (7.3, 8.9)%; P < 0.0001). The percentage of individuals with HbA1c ≥ 64 mmol/mol (8.0%) reduced from a pre-CSII level of 68% to 55%. After adjusting for baseline confounders, there were no between-pump differences in HbA1c lowering (P = 0.44), including a comparison of patch pumps with traditional catheter pumps (P = 0.63). There were no significant (P < 0.05) between-pump differences in HbA1c lowering in pre-specified subgroups stratified by pre-pump HbA1c , age or diabetes duration. HbA1c lowering was positively related to baseline HbA1c (P < 0.001) and diabetes duration (P = 0.017), and negatively related to the number of years of CSII use (P = 0.024). CONCLUSIONS Under routine care conditions, there were no covariate-adjusted differences in HbA1c lowering when comparing different pump makes, including a comparison of patch pumps vs. traditional catheter pumps. Therefore, the choice of CSII make should not be influenced by the desired degree of HbA1c lowering.
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Affiliation(s)
- L Leelarathna
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - S A Roberts
- Centre for Biostatistics, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - A Hindle
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - K Markakis
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - T Alam
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
| | - A Chapman
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - J Morris
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - A Urwin
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - P Jinadev
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
| | - M K Rutter
- Manchester Diabetes Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester
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Anyanwagu U, Olaoye H, Jennings P, Ashton-Cleary S, Sugunendran S, Hughes D, Idris I, Wilmot EG. Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control. Diabet Med 2017; 34:1154-1157. [PMID: 28430381 DOI: 10.1111/dme.13367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/12/2022]
Abstract
AIM In the short term, continuous subcutaneous insulin infusion (CSII) has been associated with improved glycaemic control, reduced hypoglycaemia and improved quality of life (QOL). However, limited data are available on its long-term benefits, particularly in the UK. We aimed to assess the impact of CSII on longer term outcomes. METHOD Patient-level data were obtained for CSII users at Derby Teaching Hospitals, UK. Patient confidence and satisfaction questionnaires using the Likert scale were used to assess confidence in self-management. Comparative statistics were conducted using Pearson's chi-square and Student's t-tests. RESULTS Some 258 CSII users were identified (60.1% female, mean age 43.9 ± 13.4 years). Overall, there was significant decrease in HbA1c from 78 mmol/mol (9.3 ± 2.0%) at baseline, to 69 mmol/mol (8.5 ± 1.3%) at 6 months [mean difference (md): -0.64; 95% confidence interval (95% CI): -0.91 to -0.37; P < 0.0001]; which was sustained at 6 years of follow-up (HbA1c : 66 mmol/mol, 8.2 ± 1.3%; md: -1.07%; 95% CI: -1.45 to -0.69; P < 0.0001). One hundred and twenty-one patients (47%) responded to the survey, of whom 95 (78.5%) reported a reduction in the frequency of hypoglycaemia; 102 (84.3%) were satisfied with the quality of care received in the insulin pump service. CONCLUSION CSII therapy led to a sustained long-term improvement in glycaemic control in addition to a reduction in self-reported hypoglycaemia.
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Affiliation(s)
- U Anyanwagu
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham
| | - H Olaoye
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham
| | - P Jennings
- Diabetes Unit, Royal Derby Hospital, Derby, UK
| | | | | | - D Hughes
- Diabetes Unit, Royal Derby Hospital, Derby, UK
| | - I Idris
- Division of Medical Sciences & Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham
- Diabetes Unit, Royal Derby Hospital, Derby, UK
| | - E G Wilmot
- Diabetes Unit, Royal Derby Hospital, Derby, UK
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Maker AV, Sheikh R, Bhagia V. Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia. Langenbecks Arch Surg 2017; 402:873-883. [PMID: 28733926 DOI: 10.1007/s00423-017-1603-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Indications for total pancreatectomy (TP) have increased, including for diffuse main duct intrapapillary mucinous neoplasms of the pancreas and malignancy; therefore, the need persists for surgeons to develop appropriate endocrine post-operative management strategies. The brittle diabetes after TP differs from type 1/2 diabetes in that patients have absolute deficiency of insulin and functional glucagon. This makes glucose management challenging, complicates recovery, and predisposes to hospital readmissions. This article aims to define the disease, describe the cause for its occurrence, review the anatomy of the endocrine pancreas, and explain how this condition differs from diabetes mellitus in the setting of post-operative management. The morbidity and mortality of post-TP endocrine insufficiency and practical treatment strategies are systematically reviewed from the literature. Finally, an evidence-based treatment algorithm is created for the practicing pancreatic surgeon and their care team of endocrinologists to aid in managing these complex patients. METHODS A PubMed, Science Citation Index/Social sciences Citation Index, and Cochrane Evidence-Based Medicine database search was undertaken along with extensive backward search of the references of published articles to identify studies evaluating endocrine morbidity and treatment after TP and to establish an evidence-based treatment strategy. RESULTS Indications for TP and the etiology of pancreatogenic diabetes are reviewed. After TP, ~80% patients develop hypoglycemic episodes and 40% experience severe hypoglycemia, resulting in 0-8% mortality and 25-45% morbidity. Referral to a nutritionist and endocrinologist for patient education before surgery followed by surgical reevaluation to determine if the patient has the appropriate understanding, support, and resources preoperatively has significantly reduced morbidity and mortality. The use of modern recombinant long-acting insulin analogues, continuous subcutaneous insulin infusion, and glucagon rescue therapy has greatly improved management in the modern era and constitute the current standard of care. A simple immediate post-operative algorithm was constructed. CONCLUSION Successful perioperative surgical management of total pancreatectomy and resulting pancreatogenic diabetes is critical to achieve acceptable post-operative outcomes, and we review the pertinent literature and provide a simple, evidence-based algorithm for immediate post-resection glycemic control.
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Affiliation(s)
- Ajay V Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, 835 S. Wolcott Ave. MC790, Chicago, IL, 60612, USA.
- Creticos Cancer Center, Advocate Illinois Masonic Medical Center, University of Illinois Metropolitan Group Hospitals Residency Program in General Surgery, Chicago, IL, USA.
| | - Raashid Sheikh
- Creticos Cancer Center, Advocate Illinois Masonic Medical Center, University of Illinois Metropolitan Group Hospitals Residency Program in General Surgery, Chicago, IL, USA
| | - Vinita Bhagia
- Department of Medicine, Division of Endocrinology, University of Illinois at Chicago and Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Ramirez-Rincon A, Hincapie-García J, Arango CM, Aristizabal N, Castillo E, Hincapie G, Zapata E, Cuesta DP, Delgado M, Abad V, Torres JL, Palacio A, Botero JF. Clinical Outcomes After 1 Year of Augmented Insulin Pump Therapy in Patients with Diabetes in a Specialized Diabetes Center in Medellín, Colombia. Diabetes Technol Ther 2016; 18:713-718. [PMID: 27860498 DOI: 10.1089/dia.2016.0166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Type 1 diabetes can be difficult to control. Augmented pump therapy (CSII-rtCGM) has become an important tool for controlling blood glucose and decreasing hypoglycemia. METHODS Describe the results 1 year after starting CSII-rtCGM in patients with diabetes in Medellín, Colombia. This is an observational, retrospective study. Patients with type 1 and type 2 diabetes started on CSII-rtCGM between January 2008 and June 2015 were included. Qualitative variables were analyzed as absolute or relative frequencies. Quantitative variables were obtained through central tendency and dispersion according to the normal distribution of the analyzed variable using Kolmogorov-Smirnov. SPSS 19 from IBM was used. RESULTS Two hundred forty-seven patients were identified, of those 183 were included. The starting HbA1C was 8.7% ± 1.7% and 7.4% ± 0.8% (P < 0.05) 1 year later. 16.5% of patients had been admitted to the hospital before starting CSII-rtCGM, after 1 year the admission rate was 6.0% (P < 0.05). The incidence of severe hypoglycemia at the beginning was 32%, 1 year later it was 7.1%. CONCLUSION CSII-rtCGM therapy improves glucose control and decreases severe hypoglycemic events and hospital admission rate.
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Affiliation(s)
- Alex Ramirez-Rincon
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Jaime Hincapie-García
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Claudia Monsalve Arango
- 2 Clinica Universitaria Bolivariana , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Natalia Aristizabal
- 2 Clinica Universitaria Bolivariana , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
- 6 Grupo de Investigación de Medicina Interna y Endocrinología, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | | | - Eliana Zapata
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
| | | | - Maria Delgado
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
| | - Veronica Abad
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
| | - Jose Luis Torres
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 4 Clinica Las Américas, Medellín, Colombia
| | - Andres Palacio
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
| | - José Fernando Botero
- 1 Clinica Integral de Diabetes-CLID , Medellín, Colombia
- 3 Universidad Pontificia Bolivariana , Medellín, Colombia
- 5 Grupo de Investigación, Innovación, Desarrollos y Avances en Endocrinología, Medellín, Colombia
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Beato-Víbora P, Yeoh E, Rogers H, Hopkins D, Amiel SA, Choudhary P. Sustained benefit of continuous subcutaneous insulin infusion on glycaemic control and hypoglycaemia in adults with Type 1 diabetes. Diabet Med 2015. [PMID: 26213236 DOI: 10.1111/dme.12869] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM To evaluate the sustainability of the benefits of continuous subcutaneous insulin infusion therapy in routine practice in a cohort of adults with diabetes. METHODS The clinical records of all adults starting continuous subcutaneous insulin infusion over 12 years at our centre were included in this study. Baseline and mean annual HbA(1c) levels were recorded. The frequency of mild-to-moderate and severe hypoglycaemia and hypoglycaemia awareness were analysed in a subgroup. RESULTS Adequate data were available from 327 patients, of whom 71% were female. The patients' mean ± sd age was 41 ± 14 years, the mean ± sd (range) follow-up for continuous subcutaneous insulin infusion was 4.3 ± 2.7 (1-12) years. The mean ± sd HbA(1c) concentration fell by 8 ± 5 mmol/mol (0.7 ± 0.5%) at year 1 [to 63 ± 12 mmol/mol from 70 ± 18 mmol/mol (7.9 ± 1.1% from 8.6 ± 1.6%); P < 0.0005], sustained to year 5. In patients with initial poor control, HbA(1c) dropped by 12 ± 11 mmol/mol (1.1 ± 1.0%; P < 0.0005) at year 1, sustained to year 6. The percentage of patients with ≥ 5 mild to moderate hypoglycaemic episodes per week fell from 29 to 12% (n = 163; P = 0.006). In the subgroup (n = 87; follow-up 2.5 ± mean ± sd 1.1 years), the frequency of severe hypoglycaemia fell from 0.6 ± 1.7 episodes per patient per year to 0.3 ± 0.9 (P = 0.047). Of 24 patients with impaired awareness of hypoglycaemia (Gold score ≥ 4), the mean ± sd Gold score improved from 4.9 ± 0.9 to 3.8 ± 1.7 (P = 0.011). Nine people regained awareness. No deterioration in HbA(1c) was seen in the hypoglycaemia-prone groups. CONCLUSIONS The benefits of continuous subcutaneous insulin infusion with regard to improving glycaemic control and reducing hypoglycaemia frequency, along with improvement in hypoglycaemia awareness without deterioration in glycaemic control, can be sustained over several years in clinical practice.
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Affiliation(s)
- P Beato-Víbora
- Department of Diabetes, King's College Hospital, London, UK
| | - E Yeoh
- Department of Diabetes, King's College Hospital, London, UK
| | - H Rogers
- Department of Diabetes, King's College Hospital, London, UK
| | - D Hopkins
- Department of Diabetes, King's College Hospital, London, UK
| | - S A Amiel
- Diabetes Research Group, King's College London, London, UK
| | - P Choudhary
- Diabetes Research Group, King's College London, London, UK
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Azmi S, Ferdousi M, Petropoulos IN, Ponirakis G, Fadavi H, Tavakoli M, Alam U, Jones W, Marshall A, Jeziorska M, Boulton AJM, Efron N, Malik RA. Corneal confocal microscopy shows an improvement in small-fiber neuropathy in subjects with type 1 diabetes on continuous subcutaneous insulin infusion compared with multiple daily injection. Diabetes Care 2015; 38:e3-4. [PMID: 25538321 DOI: 10.2337/dc14-1698] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Shazli Azmi
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Maryam Ferdousi
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Ioannis N Petropoulos
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K. Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Georgios Ponirakis
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K. Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Hassan Fadavi
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Mitra Tavakoli
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Uazman Alam
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Wendy Jones
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Andrew Marshall
- Department of Clinical Neurophysiology, Central Manchester National Health Services Foundation Trust, Manchester, U.K
| | - Maria Jeziorska
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Andrew J M Boulton
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rayaz A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester National Health Services Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K. Weill Cornell Medical College in Qatar, Doha, Qatar
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Mitragotri S, Burke PA, Langer R. Overcoming the challenges in administering biopharmaceuticals: formulation and delivery strategies. Nat Rev Drug Discov 2014; 13:655-72. [PMID: 25103255 PMCID: PMC4455970 DOI: 10.1038/nrd4363] [Citation(s) in RCA: 1048] [Impact Index Per Article: 104.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The formulation and delivery of biopharmaceutical drugs, such as monoclonal antibodies and recombinant proteins, poses substantial challenges owing to their large size and susceptibility to degradation. In this Review we highlight recent advances in formulation and delivery strategies--such as the use of microsphere-based controlled-release technologies, protein modification methods that make use of polyethylene glycol and other polymers, and genetic manipulation of biopharmaceutical drugs--and discuss their advantages and limitations. We also highlight current and emerging delivery routes that provide an alternative to injection, including transdermal, oral and pulmonary delivery routes. In addition, the potential of targeted and intracellular protein delivery is discussed.
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Affiliation(s)
- Samir Mitragotri
- Department of Chemical Engineering, Center for Bioengineering, University of California, Santa Barbara, California 92106, USA
| | - Paul A Burke
- Burke Bioventures LLC, 277 Broadway, Cambridge, Massachusetts 02139, USA
| | - Robert Langer
- Department of Chemical Engineering, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
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