Continuous subcutaneous insulin infusion in patients with diabetes mellitus

Impact of early-morning administration of rapid-acting insulin on the increase in blood glucose levels related to the dawn phenomenon in individuals with type 1 diabetes

Aims/Introduction

An early-morning elevation of blood glucose levels known as the dawn phenomenon and consequent postbreakfast hyperglycemia occur in some individuals with type 1 diabetes (T1D). Whereas insulin pump therapy can mitigate this phenomenon, some individuals prefer or are limited to alternative treatments. We have now assessed the effectiveness of early-morning administration of rapid-acting insulin for amelioration of the dawn phenomenon in individuals with T1D.

Materials and Methods

Thirteen individuals with T1D who experienced the dawn phenomenon as determined by continuous glucose monitoring (CGM) and who received a small dose of rapid-acting insulin on waking were included in this retrospective study. We evaluated the change in sensor glucose levels during a 2-h period from before to after breakfast consumed at 0700 h. The change in blood glucose levels during additional time intervals, average daily sensor glucose values, CGM indices, and insulin dose were also evaluated.

Results

The early-morning administration of 0.5-1 unit of rapid-acting insulin was associated with a significant reduction in 2-h glucose variability between before (0700 h) and after breakfast from a median of 90.7-51.0 mg/dL. The glucose variability from 0300 to 0700 or 0900 h was also significantly decreased, from 67.7 to 29.0 mg/dL and from 172.5 to 78.3 mg/dL, respectively. Average sensor glucose levels throughout the day were significantly reduced (from 192.7 to 156.7 mg/dL), as was the daily total insulin dose.

Conclusion

Early-morning administration of rapid-acting insulin effectively managed the dawn phenomenon and subsequent postbreakfast hyperglycemia in individuals with T1D.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13340-024-00709-6.

Technology in Diabetes Treatment: Update and Future

Worldwide the number of people with diabetes mellitus is increasing. There are estimations that diabetes is one of the leading causes of death. The most important goals for the treatment of diabetes are self-management of the disease and an optimal quality of diabetes control. In the therapy new technologies, like real-time continuous interstitial glucose monitoring, continuous subcutaneous insulin infusion (CSII), electronic tools for the monitoring of therapeutic approaches, automated bolus calculators for insulin and electronic tools for education and information of patients, have become widespread and play important roles. All these efforts are related to the interaction between patients, caregivers, scientists or researchers and industry. The presentation of different aspects of new technological approaches in the present article should give more information about different technologies. However, because of the rather quickly appearance of new technologies, the presentation can only be a spotlight. Further studies are mandatory to analyze the effects and long-term benefits of each technology and electronic device.

Costs for hospitalized patients with diabetes mellitus in China

AIM

To evaluate direct hospitalization costs attributable to diabetes and their determinants in a tertiary care hospital in mainland China between 2007 and 2008.

METHODS

A retrospective study of the hospitalization expenses for 489 inpatients with diabetes from June 2007 to July 2008 was conducted. All related cost components were defined and valued at the most detailed levels.

RESULTS

Median cost was 5307.8 RMB (range 3672.8-8193.2 RMB). The costs for biochemical tests (28%), pharmacy (26%), and therapies and supplies (21%) were the top 3, about 75% in total expenses. The expenses for the antihyperglycemic treatment alone accounted for 27.6% of total hospitalization expenses. Insulin treatment (P < .001), complication number (P < .001), length of hospitalization (P < .001), diabetes duration (P = .023), and hemoglobin A1C (P = .040) were the main factors affecting costs.

CONCLUSIONS

Antihyperglycemic treatment expenses represent a minority of total costs; major costs are due to treatment of complications.

A comparison of multiple daily insulin therapy with continuous subcutaneous insulin infusion therapy in adolescents with type 1 diabetes mellitus: a single-center experience from Turkey

AIM

To compare the long-term outcomes of continuous subcutaneous insulin infusion (CSII) pump therapy with the clinical and metabolic parameters recorded during multiple daily insulin (MDI) therapy.

PATIENTS AND METHODS

CSII pump was used by volunteer adolescents, who had a duration of diabetes mellitus (DM) longer than one year, regularly attended periodic examinations for the last year, measured and recorded blood glucose levels on average 3 to 4 times a day, and did not achieve the preferred metabolic control even though the use of MDI therapy. Carbohydrate counting and flexible MDI therapy was taught to these patients before CSII pump implantation. The metabolic and clinical parameters of the patients for the post-CSII pump period were compared with the data of flexible and non-flexible MDI periods.

RESULTS

The mean CSII pump implantation age of the 17 adolescents enrolled in the study was 15.53 +/- 1.8 years, duration of DM 6.77 +/- 4.05 years, flexible MDI injection duration 0.70 +/- 0.20 years, and duration of CSII pump use 2.07 +/- 1.12 years. A decrease was detected in HbA(1c) levels of the patients with transition to CSII pump compared to flexible and non-flexible MDI injection periods; however, this decrease was not statistically significant (7.71%, 8.21%, and 8.71%, respectively, p = 0.105). No statistically significant difference was detected in frequency of hypoglycemia, lipid profiles, total daily insulin requirement, and BMI SDS values of the patients when data of the post-CSII pump state were compared with that of flexible and non-flexible MDI therapy groups.

CONCLUSION

In adolescents, it was found that CSII pump therapy is efficient and safe without any increased risk for weight gain and hypoglycemia compared to flexible and non-flexible MDI injection periods. The present study also demonstrated that flexible MDI injection therapy might be efficiently and safely used in patients who cannot receive CSII pump therapy due to social and/or financial factors.

Type 2 diabetes: epidemiologic trends, evolving pathogenetic [corrected] concepts, and recent changes in therapeutic approach

The prevalence of type 2 diabetes has assumed epidemic dimensions. Children are now vulnerable to a disease that was once the exclusive domain of adulthood. Increased body weight and sedentary behavior accelerate insulin resistance and beta-cell dysfunction, leading to the clinical manifestation of hyperglycemia. Other cardiovascular risk factors tend to cluster in this milieu, setting the stage for vastly increased macrovascular morbidity. Many more people have impaired glucose tolerance ('prediabetes'). They are not only at risk for frank diabetes but also for the recently recognized entity of 'metabolic syndrome,' which is further characterized by hypertension, dyslipidemia, and central adiposity. A multifactorial approach addressing these aspects in addition to intensive glycemic control is the most efficacious therapy, optimally achieved through a team effort comprising the clinician, diabetes nurse, dietitian, and other professionals. Early use of oral-agent combinations is gaining favor. Insulin is best utilized in a basal-bolus fashion to manage both fasting and postprandial glycemia, delivered with multiple-dose injections or continuously via the pump. In hospitalized patients, good diabetic control reduces mortality. Finally, recent trials show that optimal weight maintenance and regular exercise can prevent or delay type 2 diabetes. Such information can serve as the foundation for large-scale preventive endeavors at the community level.