1
|
Sagastume D, Mertens E, Sibongwere DK, Dimbelolo JC, Kabundi JCK, de Man J, Van Olmen J, Peñalvo JL. A retrospective database study of the demographic features and glycemic control of patients with type 2 diabetes in Kinshasa, Democratic Republic of the Congo. BMC Med 2022; 20:258. [PMID: 35982436 PMCID: PMC9389797 DOI: 10.1186/s12916-022-02458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Kin-Antwerp project aimed at improving the quality of care provided to patients with diabetes in Kinshasa, the Democratic Republic of the Congo in Central Africa, including the digitalisation of routine clinical data to improve patients' follow-up. We aim to analyse the data of a study population of Kin-Antwerp to characterise their demographic features, assess their achievement of glycemic target over time, and identify groups requiring prioritised attention. METHODS We performed a secondary database analysis of routinely collected information from primary care patients with type 2 diabetes followed from 1991 to 2019. Data included demographics (age, sex), anthropometrics (weight, height), clinical parameters (blood pressure, plasma glucose), and anti-diabetic treatments. Achievement of glycemic target, defined as fasting plasma glucose < 126 mg/dL, over time was assessed using a multilevel mixed-effects logistic regression model. RESULTS Our study population of patients with type 2 diabetes (N = 8976) comprised a higher proportion of women (67%) and patients between 40 and 65 years old (70.4%). At the first follow-up, most patients were on treatment with insulin (56.5%) and had glycemic levels under the target (79.9%). Women presented more often with obesity (27.4%) and high systolic blood pressure (41.8%) than men (8.6% and 37.0%, respectively). Patients had a median follow-up of 1.8 (interquartile range: 0.5-3.4) years. Overall, the odds of achieving glycemic target increased by 18.4% (odds ratio: 1.184, 95% CI: 1.130 to 1.239; p < 0.001) per year of follow-up. Stratified analyses suggested that the odds of achieving glycemic control over time increased among older patients (> 40 years), but not among younger patients (< 40 years). CONCLUSION In our study population, an overall poor glycemic control was observed albeit with a modest improvement in the achievement of glycemic target throughout patients' follow-up. Younger patients may benefit from prioritised attention to achieve glycemic targets. Based on the information provided by the database, continue monitoring and improvement of the project Kin-Antwerp is recommended. Introducing further efforts to improve type 2 diabetes management should include robust glycemia-monitoring tools and haemoglobin A1c, as well as further outlining self-management strategies.
Collapse
Affiliation(s)
- Diana Sagastume
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Elly Mertens
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Deogratias Katsuva Sibongwere
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Jean-Claude Dimbelolo
- Centre d'Éducation Diabète & Santé Boulevard Lumumba n° 1 Musoso district, Municipality of Limete, Kinshasa, Democratic Republic of the Congo
| | - Jean Clovis Kalobu Kabundi
- Memisa, 19 Square de Meeûs, 1050 Brussels, Belgium and Memisa representation in Kinshasa, 47 Kisangani, commune de la Gombe, Kinshasa, Democratic Republic of the Congo
| | - Jeroen de Man
- Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
| | - Josefien Van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
| | - José L Peñalvo
- Unit of Non-Communicable Diseases, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| |
Collapse
|
2
|
Chen J, Williams P, Perez-Nieves M, Piras De Oliveira C, Spaepen E, Osumili B, Poon JL, Schloot NC, Thun B, Blüher M. Satisfaction, Preference and Injection Habits of Switching to 200 Units/ml Insulin Lispro Pen from 100 Units/ml: A Patient Survey in Germany. Diabetes Ther 2021; 12:2939-2953. [PMID: 34542865 PMCID: PMC8519973 DOI: 10.1007/s13300-021-01150-7] [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: 06/23/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The study was designed to assess patient satisfaction, preferences and injection habits for patients using insulin lispro 200 units/ml pen (IL200) compared to their previously used disposable 100 units/ml mealtime insulin pen ("MTI-100 pen") in Germany. METHODS A site-based, cross-sectional study involving a self-reported survey and medical record extraction in patients with diabetes currently using IL200 for between 3 and 12 months and had previously used any disposable MTI-100 pen. RESULTS Of 114 patients included, 83.3% were satisfied with IL200 and 3.5% were dissatisfied; 70.2% preferred IL200 over their previous MTI-100 pen and 4.4% preferred their previous MTI-100 pen. The main reasons for IL200 preference were the amount of insulin the pen carries, longer use before discarding, number of non-empty pens discarded, injection volume and frequency replacing pens. Patients discarded (median) 4 IL200 pens per month with 5.3% discarding more than 10 units in their last pen. When insufficient insulin remained to complete a dose, 74.6% injected the remainder and completed with a new pen, 19.3% discarded the pen with remaining insulin, 7.0% saved it for future use and 1.8% left the dose incomplete. CONCLUSIONS Satisfaction and preference for IL200 was high in this sample of patients using IL200 for 3-12 months. Reasons were consistent with IL200 features, explaining the better patient experience and potential resource saving transitioning from a disposable MTI-100 pen.
Collapse
Affiliation(s)
- Jieling Chen
- Lilly Corporate Center, Indianapolis, IN, 46285, USA
| | - Paul Williams
- IQVIA, Real-World Solutions, 17 bis place des Reflets, Tour D2, TSA 64567, 92099, La Defense Cedex, France.
| | | | | | - Erik Spaepen
- HaaPACS GmbH, Bahnhofstraße 19C, 69198, Schriesheim, Germany
| | - Beatrice Osumili
- Eli Lilly and Company Limited, 8 Arlington Square West, Downshire Way, Bracknell, RG12 1PU, UK
| | | | - Nanette C Schloot
- Lilly Deutschland GmbH, Werner-Reimers-Str. 2, 61352, Bad Homburg vor der Höhe, Germany
| | - Barbara Thun
- IQVIA Commercial GmbH & Co. OHG, Real-World Solutions, Landshuter Allee 10, 80637, München, Germany
| | - Matthias Blüher
- Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| |
Collapse
|
3
|
Edens MA, van Dijk PR, Hak E, Bilo HJG. Course of body weight before and after the initiation of insulin therapy in type 2 diabetes mellitus: Retrospective inception cohort study (ZODIAC 58). Endocrinol Diabetes Metab 2021; 4:e00212. [PMID: 33855214 PMCID: PMC8029529 DOI: 10.1002/edm2.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/03/2020] [Accepted: 11/21/2020] [Indexed: 12/13/2022] Open
Abstract
Aims The aim of this study was to explore the effect of insulin treatment initiation on weight by taking weight change prior to initiation into account. Materials and methods We performed an observational retrospective inception cohort study, concerning Dutch primary care. We identified all patients that initiated insulin treatment (n = 7967) and individually matched patients with a reference patient (n = 5213 pairs). We obtained estimated mean weight changes in the five years prior to five years post insulin therapy. We applied linear regression analysis on weight change in the first year after insulin therapy (T0 to T+1), with matched group as primary determinant adjusted for pre-insulin weight change and additional covariates. Results Estimated mean weight increased in the five consecutive years prior to insulin therapy (-0.23 kg in year T-5 to T-4, 0.01 kg in year T-4 to T-3, 0.07 kg in year T-3 to T-2, 0.24 kg in year T-2 to T-1, and 0.46 kg in year T-1 to T0) and continued to increase in the first year after, that is T0 to T+1, at a slightly lower rate (0.31 ± 3.9 kg). Pre-insulin weight change had the highest explained variance and was inversely and independently associated with weight change (p < .001). Starting insulin was associated with weight increase, independent of pre-insulin weight change (β-adjusted 1.228, p < .001). Stratification revealed that despite having a more or less similar baseline BMI, patients with substantial weight increase showed higher estimated mean BMI's followed by weight loss pre-insulin. In matched references, estimated mean weight changes were negative in all years concerning the study period, indicating consistent weight loss. Conclusions Initiation of insulin therapy was independently associated with weight increase; however, overall effect on weight was small and subject to substantial variation. Pre-insulin weight change is identified as a relatively strong inverse determinant of weight change after insulin initiation.
Collapse
Affiliation(s)
- Mireille A. Edens
- Diabetes Research CenterZwollethe Netherlands
- Epidemiology UnitDepartment Innovation and ScienceIsala HospitalZwollethe Netherlands
| | - Peter R. van Dijk
- Diabetes Research CenterZwollethe Netherlands
- Department of EndocrinologyUniversity of Groningen and University Medical Center GroningenGroningenthe Netherlands
| | - Eelko Hak
- Groningen Research Institute of PharmacyUniversity of GroningenGroningenthe Netherlands
| | - Henk J. G. Bilo
- Diabetes Research CenterZwollethe Netherlands
- Department of Internal MedicineUniversity of Groningen and University Medical Center GroningenGroningenthe Netherlands
| |
Collapse
|
4
|
Chen J, Perez-Nieves M, Piras De Oliveira C, Spaepen E, Osumili B, Poon JL, Schloot N, Lara N, Garcia Alvarez L, Roset M. An assessment of physician reasons for prescribing Insulin Lispro 200 units/ml in Germany. Postgrad Med 2020; 132:727-736. [PMID: 33108957 DOI: 10.1080/00325481.2020.1805968] [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] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To understand physicians' reasons for prescribing Insulin Lispro 200 units/ml (IL200) and their experience with IL200 treatment in Germany. METHODS The survey consisted of 28 questions on physician's profile, average IL200 patients' characteristics and rationales for prescribing IL200. Questions were rated on a scale of 0 ('not at all important'/'strongly disagree') to 4 ('absolutely important'/'strongly agree'). RESULTS The surveyed physicians had a mean (SD) experience of 18.1 (7.0) years managing diabetes, consulted an average of 226.8 patients with diabetes/month and prescribed IL200 to 56.1% of their patients on mealtime insulin (MTI). About 80.0% of IL200 patients had type 2 diabetes mellitus, were overweight/obese, and received >20 units/day of MTI. More than 70.0% of physicians rated patient's insulin dose, pattern of self-measured glucose levels, hemoglobin A1c (HbA1c) (clinical); adherence, hypoglycemia knowledge, motivation to improve lifestyle, desire to reduce injection volume and emotional struggle with controlling HbA1c (behavioral) as 'very important'/'absolutely important' factors when prescribing IL200. CONCLUSION Physicians considered IL200 a promising treatment option that reduces the injection burden for patients on MTI. Physicians adopted a patient-centered perspective by aligning IL200 prescribing decisions with each patient's medical needs and non-clinical preferences, with an aim to encourage treatment adherence through resorting to IL200's advantageous attributes.
Collapse
Affiliation(s)
- Jieling Chen
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company , Indianapolis, Indiana, USA
| | - Magaly Perez-Nieves
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company , Indianapolis, Indiana, USA
| | | | - Erik Spaepen
- Global Medical Affairs, HaaPACS GmbH , Schriesheim, Germany
| | - Beatrice Osumili
- Global Patient Outcomes and Real World Evidence, International, Eli Lilly and Company Ltd , Windesham, Surrey, UK
| | - Jiat-Ling Poon
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company , Indianapolis, Indiana, USA
| | - Nanette Schloot
- Medical Affairs, Lilly Deutschland GmbH , Bad Homburg Vor Der Höhe, Germany
| | - Nuria Lara
- Real World Evidence Solutions, IQVIA, Real-World Evidence Solutions , Barcelona, Spain
| | - Laura Garcia Alvarez
- Real World Evidence Solutions, IQVIA, Real-World Evidence Solutions , Barcelona, Spain
| | - Montserrat Roset
- Real World Evidence Solutions, IQVIA, Real-World Evidence Solutions , Barcelona, Spain
| |
Collapse
|
5
|
Fridman M, Lucas ME, Paprocki Y, Dang-Tan T, Iyer NN. Impact of Weight Change in Adults with Type 2 Diabetes Mellitus: A Literature Review and Critical Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:555-566. [PMID: 33061488 PMCID: PMC7535113 DOI: 10.2147/ceor.s266873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/09/2020] [Indexed: 12/11/2022] Open
Abstract
Objective Weight reduction is a key component of diabetes management in adults with type 2 diabetes mellitus (T2DM), yet the benefits of weight loss in T2DM patients have been difficult to quantify. We examined the medical literature regarding the relationships between weight change and 1) glycemic control and 2) cost and resource use. Methods Systematic searches were conducted in the electronic databases Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify publications regarding the impact of weight change on T2DM outcomes from 2007 onward. Identified publications were screened for relevance against predefined eligibility criteria, and methodological approaches and results were extracted. Evidence for the impact of weight change on outcomes was evaluated and used to identify strengths, limitations, and gaps in the current literature. Results The number of studies meeting eligibility criteria for each outcome was: glycemic control (n=38) and cost and resource use (n=11). The relationship between weight change and glycemic control was dependent on the interplay of multiple factors, eg, the weight loss interventions employed, the antidiabetic medication classes used, the time horizon, and baseline BMI and glycemic control. With respect to cost and resource use, the review indicated that savings were associated with weight loss, and increased costs were associated with weight gain. Conclusion Studies regarding weight change in T2DM patients demonstrated varying effects on glycemic control and a positive association with costs and resource use, where weight loss was associated with decreased costs and resource use. Future studies may be able to clarify these relationships.
Collapse
Affiliation(s)
| | - Mariann E Lucas
- Information Science, Scientific Analytics, Novo Nordisk Inc, Plainsboro Township, NJ, USA
| | - Yurek Paprocki
- Medical Affairs, Novo Nordisk Inc, Plainsboro Township, NJ, USA
| | - Tam Dang-Tan
- Medical Affairs, Novo Nordisk Inc, Plainsboro Township, NJ, USA
| | - Neeraj N Iyer
- HEOR Strategy & Evidence Generation - Diabetes, Novo Nordisk Inc, Plainsboro Township, NJ, USA
| |
Collapse
|
6
|
Hirsch IB, Juneja R, Beals JM, Antalis CJ, Wright EE. The Evolution of Insulin and How it Informs Therapy and Treatment Choices. Endocr Rev 2020; 41:bnaa015. [PMID: 32396624 PMCID: PMC7366348 DOI: 10.1210/endrev/bnaa015] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/05/2020] [Indexed: 01/05/2023]
Abstract
Insulin has been available for the treatment of diabetes for almost a century, and the variety of insulin choices today represents many years of discovery and innovation. Insulin has gone from poorly defined extracts of animal pancreata to pure and precisely controlled formulations that can be prescribed and administered with high accuracy and predictability of action. Modifications of the insulin formulation and of the insulin molecule itself have made it possible to approximate the natural endogenous insulin response. Insulin and insulin formulations had to be designed to produce either a constant low basal level of insulin or the spikes of insulin released in response to meals. We discuss how the biochemical properties of endogenous insulin were exploited to either shorten or extend the time-action profiles of injectable insulins by varying the pharmacokinetics (time for appearance of insulin in the blood after injection) and pharmacodynamics (time-dependent changes in blood sugar after injection). This has resulted in rapid-acting, short-acting, intermediate-acting, and long-acting insulins, as well as mixtures and concentrated formulations. An understanding of how various insulins and formulations were designed to solve the challenges of insulin replacement will assist clinicians in meeting the needs of their individual patients.
Collapse
Affiliation(s)
- Irl B Hirsch
- University of Washington Diabetes Institute, Seattle, Washington
| | - Rattan Juneja
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
| | - John M Beals
- Eli Lilly and Company, Lilly Biotechnology Center, San Diego, California
| | - Caryl J Antalis
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
| | - Eugene E Wright
- Charlotte Area Health Education Center, Charlotte, North Carolina
| |
Collapse
|
7
|
Mueller AM, Meier CR, Jick SS, Schneider C. Weight change and blood glucose concentration as markers for pancreatic cancer in subjects with new-onset diabetes mellitus: A matched case-control study. Pancreatology 2019; 19:578-586. [PMID: 30952448 DOI: 10.1016/j.pan.2019.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the potential of blood glucose levels and weight change before the onset of diabetes as predictors of pancreatic cancer among subjects with new-onset diabetes, that is, cancer-related diabetes versus normal type 2 diabetes. METHODS We conducted a case-control study among subjects with new diabetes in the United Kingdom-based Clinical Practice Research Datalink. Cases were pancreatic cancer subjects with diabetes for ≤2 years before the cancer diagnosis (i.e., cancer-related diabetes). Controls were cancer-free, type 2 diabetic subjects matched to cases on age, sex, and diabetes duration. We calculated adjusted odds ratios (aORs) for pancreatic cancer as a function of both weight change and blood glucose before the onset of diabetes. RESULTS Weight loss of 10.0%-14.9% at diabetes onset was associated with an aOR for pancreatic cancer of 3.58 (95% CI 2.31-5.54), loss of ≥15.0%, with an aOR of 4.56 (95% CI 2.82-7.36), compared with stable weight. Blood glucose levels of ≤5.1 mmol/L or 5.2-5.6 mmol/L before diabetes onset were associated with an increased risk of a pancreatic cancer diagnosis, with aORs of 2.42 (95% CI 1.60-3.66) and 2.20 (95% CI 1.45-3.35), respectively, when compared with blood glucose levels ≥6.3 mmol/L within >2-3 years before cancer detection. CONCLUSIONS Weight loss as well as blood glucose levels in the normal range (and thus rapid development of hyperglycemia) before diabetes onset may be predictive of pancreatic cancer-related diabetes and may help target which subjects with new diabetes to refer for pancreatic cancer screening examinations.
Collapse
Affiliation(s)
- Alexandra M Mueller
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland; Boston Collaborative Drug Surveillance Program, Lexington, MA, United States.
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Lexington, MA, United States; Boston University School of Public Health, Boston, MA, United States
| | - Cornelia Schneider
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland; Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
8
|
Heinemann L, Beals JM, Malone J, Anderson J, Jacobson JG, Sinha V, Corrigan SM. Concentrated insulins: History and critical reappraisal. J Diabetes 2019; 11:292-300. [PMID: 30264527 DOI: 10.1111/1753-0407.12861] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 09/03/2018] [Accepted: 09/22/2018] [Indexed: 02/02/2023] Open
Abstract
The earliest marketed insulins were crude acidic formulations with concentrations of ≤10 units/mL. Since the early 1920s, insulins have improved continually, via bioengineering, process, and chemical modifications. Today, most insulin formulations have a concentration of 100 units/mL (U100). However, more concentrated insulin formulations (200, 300, and 500 units/mL; U200, U300, and U500, respectively) are also available. There is a tendency to assume that concentrated insulins are similar, both to each other and to their U100 counterparts, but this is not always the case: two concentrated insulins, namely insulin degludec U200 and insulin lispro U200, are bioequivalent to their U100 counterparts, whereas regular human insulin U500 and insulin glargine U300 are not. The advent of these concentrated insulins offers greater opportunities to provide tailored therapy for patients; it also introduces potential confusion, and highlights the need for prescriber and patient education. Precise and accurate dedicated insulin delivery devices are also necessary for the safe use of these concentrated insulins. Although some clinicians only use concentrated insulin with obese and severely insulin-resistant patients, other patients would also benefit from the reduced injection volume associated with concentrated insulins, or the modified time-action profile of some concentrated insulins. The aim of this review is to enhance understanding of the historic development and the safe and effective use of concentrated insulins in clinical practice.
Collapse
Affiliation(s)
| | - John M Beals
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - James Malone
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - James Anderson
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | - Jennie G Jacobson
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| | | | - Sheila M Corrigan
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana, USA
| |
Collapse
|
9
|
Anyanwagu U, Mamza J, Donnelly R, Idris I. Effects of obesity on metabolic and cardiovascular outcomes following insulin initiation in patients with type 2 diabetes. Obes Res Clin Pract 2018; 12:72-84. [DOI: 10.1016/j.orcp.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/04/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022]
|
10
|
Brown A, Guess N, Dornhorst A, Taheri S, Frost G. Insulin-associated weight gain in obese type 2 diabetes mellitus patients: What can be done? Diabetes Obes Metab 2017; 19:1655-1668. [PMID: 28509408 DOI: 10.1111/dom.13009] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
Abstract
Insulin therapy (IT) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT, which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin-associated weight gain (IAWG) is reported to occur in the first year of initiating IT, predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch-up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co-morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT, that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG, and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.
Collapse
Affiliation(s)
- Adrian Brown
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
| | - Nicola Guess
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
- Division of Diabetes and Nutritional Sciences, Kings College London, London, UK
| | - Anne Dornhorst
- Department of Metabolic Medicine, Imperial College London, London, UK
| | - Shahrad Taheri
- Department of Metabolic Medicine, Imperial College London, London, UK
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine, New York, New York
- Department of Medicine and Clinical Research Core, Weill Cornell Medicine, Doha, Qatar
| | - Gary Frost
- Department of Medicine, Faculty of Medicine, Nutrition and Dietetic Research Group, Imperial College, London, UK
| |
Collapse
|
11
|
Van Brunt K, Pedersini R, Rooney J, Corrigan SM. Behaviours, thoughts and perceptions around mealtime insulin usage and wastage among people with type 1 and type 2 diabetes mellitus: A cross-sectional survey study. Diabetes Res Clin Pract 2017; 126:30-42. [PMID: 28189952 DOI: 10.1016/j.diabres.2016.12.002] [Citation(s) in RCA: 8] [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] [Received: 04/07/2016] [Revised: 11/16/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
Abstract
AIMS People with diabetes who use mealtime insulin (MTI) were surveyed about insulin wastage and injection habits when insufficient insulin remains in a disposable prefilled pen/cartridge to administer a full dose in a single injection. METHODS Cross-sectional, online, self-reported survey of MTI usage/wastage behaviour in 400 adults with type 1 (n=120) or type 2 (n=280) diabetes mellitus administering >20units/day of MTI via 100units/ml prefilled pens/cartridges for ⩾1month, conducted in France, Germany, Italy and UK. RESULTS Participants' mean±standard deviation age was 54.5±12.2years, body mass index was 29.9±7.2kg/m2 and duration of MTI therapy was 8.6±7.8years. They administered 3.7±5.9 injections/day with meals, using 11.3±18.0 prefilled pens/cartridges per month. Overall, 63.5% split the dose across two prefilled pens/cartridges (i.e. administered two injections to obtain a full dose), 15.0% used just what remained in their current pen (i.e. took a lower-than-prescribed dose) and 36.3% discarded prefilled pens/cartridges still containing insulin (i.e. took full dose with new pen). The latter participants discarded a mean 5.5±8.2 prefilled pens/cartridges monthly still containing insulin, each containing 8.6±8.7 units of insulin. Participants who wasted insulin considered it frustrating, time-consuming and painful to inject twice. CONCLUSIONS Patients taking >20units/day MTI can find transitions between insulin pens challenging. This study highlights the need to identify ways of improving transitions between pens to make transitions easier for insulin users, which could potentially improve adherence to prescribed doses and reduce waste.
Collapse
Affiliation(s)
- Kate Van Brunt
- Eli Lilly & Company Ltd, Erl Wood Manor, Sunninghill Road, Windlesham, Surrey GU20 6PH, UK.
| | - Riccardo Pedersini
- Kantar Health, The Kirkgate, 19-31 Church Street, Epsom, Surrey KT17 4PF, UK; RTI Health Solutions, Travessera de Gracia 56, Ático 1(a), 08006 Barcelona, Spain.
| | - Jillian Rooney
- Kantar Health, 11 Madison Avenue 12th Floor, New York, NY 10010, USA.
| | - Sheila M Corrigan
- Eli Lilly & Company, Lilly Corporate Center, Indianapolis, IN 46285, USA.
| |
Collapse
|
12
|
Kokoszka A. Treatment adherence in patients with type 2 diabetes mellitus correlates with different coping styles, low perception of self-influence on disease, and depressive symptoms. Patient Prefer Adherence 2017; 11:587-595. [PMID: 28360512 PMCID: PMC5364005 DOI: 10.2147/ppa.s124605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Insulin analogs are regarded as more convenient to use than human insulin; however, they require a different administration scheme due to their unique pharmacokinetic and pharmacodynamic properties. This study aimed to assess difficulties with adherence to treatment with insulin analogs in patients with type 2 diabetes mellitus (T2DM), who had previously been treated with human insulin. The associations between difficulties with adherence and clinical, demographic, and psychological characteristics were also evaluated. PATIENTS AND METHODS The study was conducted on 3,467 consecutively enrolled patients with T2DM (54.4% women), mean age 63.9 years (SD =9.57), who had recently undergone a physician-directed change in treatment from human insulin to insulin analogs. The questionnaires addressed difficulties with switching the therapy, coping styles, well-being, and perception of self-influence on the disease. RESULTS No adherence problems in switching therapy were reported in 56.6% of patients. Specific moderate difficulties were reported in 10.4%-22.1% of patients, major difficulties in 0.7%-6.9% of patients, and very significant difficulties in 0.03%-1.3% of patients. Overall, remembering to modify the insulin dose in the case of additional meals was the most frequently reported difficulty, and problems with identifying hypoglycemic symptoms were the least frequently reported. The increased risk of difficulties was moderately related to low perception of self-influence on diabetes and poor well-being. The intensity of problems was higher among those who were less-educated, lived in rural areas, had complications, and/or reported maladaptive coping styles. CONCLUSION Switching from human insulin to an insulin analog did not cause adherence problems in more than half of the patients. In the remaining patients, difficulties in adherence correlated with maladaptive coping styles, low perception of self-influence on disease course, and depressive symptoms.
Collapse
Affiliation(s)
- Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw
- Department of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| |
Collapse
|
13
|
Umeh K. Are Ethnic Disparities in HbA1c Levels Explained by Mental Wellbeing? Analysis of Population-Based Data from the Health Survey for England. J Racial Ethn Health Disparities 2017; 5:86-95. [PMID: 28281176 PMCID: PMC5816119 DOI: 10.1007/s40615-017-0346-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 01/06/2017] [Accepted: 01/29/2017] [Indexed: 12/20/2022]
Abstract
Aims It is unclear how ethnic differences in HbA1c levels are affected by individual variations in mental wellbeing. Thus, the aim of this study was to assess the extent to which HbA1c disparities between Caucasian and South Asian adults are mediated by various aspects of positive psychological functioning. Methods Data from the 2014 Health Survey for England was analysed using bootstrapping methods. A total of 3894 UK residents with HbA1c data were eligible to participate. Mental wellbeing was assessed using the Warwick-Edinburgh Mental Well-being Scale. To reduce bias BMI, blood pressure, diabetes status, and other factors were treated as covariates. Results Ethnicity directly predicted blood sugar control (unadjusted coefficient −2.15; 95% CI −3.64, −0.67), with Caucasians generating lower average HbA1c levels (37.68 mmol/mol (5.6%)) compared to South Asians (39.87 mmol/mol (5.8%)). This association was mediated by positive mental wellbeing, specifically concerning perceived vigour (unadjusted effect 0.30; 95% CI 0.13, 0.58): South Asians felt more energetic than Caucasians (unadjusted coefficient −0.32; 95% CI −0.49, −0.16), and greater perceived energy predicted lower HbA1c levels (unadjusted coefficient −0.92; 95% CI −1.29, −0.55). This mediator effect accounted for just over 14% of the HbA1c variance and was negated after adjusting for BMI. Conclusions Caucasian experience better HbA1c levels compared with their South Asian counterparts. However, this association is partly confounded by individual differences in perceived energy levels, which is implicated in better glycaemic control, and appears to serve a protective function in South Asians.
Collapse
Affiliation(s)
- Kanayo Umeh
- School of Natural Sciences & Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK.
| |
Collapse
|
14
|
Bramlage P, Bluhmki T, Fleischmann H, Kaltheuner M, Beyersmann J, Holl RW, Danne T. Determinants of weight change in patients on basal insulin treatment: an analysis of the DIVE registry. BMJ Open Diabetes Res Care 2017; 5:e000301. [PMID: 28176957 PMCID: PMC5278215 DOI: 10.1136/bmjdrc-2016-000301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE We aimed to describe patterns of weight change in insulin-naive patients with type 2 diabetes mellitus (T2DM) starting basal insulin (BI) treatment. RESEARCH DESIGN AND METHODS Diabetes Versorgungs-Evaluation (DIVE) is an observational, multicenter, prospective registry in patients with T2DM. Patients were divided into those initiating BI therapy for the first time (with optional oral antidiabetic drugs (OADs)) and those initiating OADs only (OADo). RESULTS 521 patients were included in the analysis, 113 in the BI arm and 408 in the OADo arm. Relative to baseline, the BI group gained an average of 0.98±7.1 kg at 1 year, compared with a loss of 1.52±11.8 kg in the OADo group (p<0.001). This difference remained statistically significant when expressed as a proportional change from baseline (+0.014±0.08 vs -0.015±0.12, respectively (p<0.001)). Baseline weight (regression coefficient (RC) 0.89; 95% CI 0.81 to 0.97; p<0.001) and diabetes duration (RC 2.52; 95% CI 0.53 to 4.52; p=0.01) were the only factors identified as significant predictors of weight gain between baseline and 1 year follow-up in BI patients. CONCLUSIONS Though BI therapy leads to modest weight gain over the subsequent year, this may be limited by BI initiation at an early stage of the disease. As such, delaying the start of insulin therapy based on fears of weight gain appears counter-productive, and should be reconsidered.
Collapse
Affiliation(s)
- Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Mahlow, Germany
| | | | | | - Matthias Kaltheuner
- winDiab GmbH, Düsseldorf, Germany
- Gemeinschaftspraxis Kaltheuner—v. Boxberg, Leverkusen, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Neuherberg, Germany
| | - Thomas Danne
- Kinder- und Jugendkrankenhaus “AUF DER BULT”, Hannover, Germany
| |
Collapse
|
15
|
Yadgar-Yalda R, Colman PG, Fourlanos S, Wentworth JM. Factors associated with insulin-induced weight gain in an Australian type 2 diabetes outpatient clinic. Intern Med J 2016; 46:834-9. [DOI: 10.1111/imj.13122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/15/2016] [Accepted: 04/17/2016] [Indexed: 01/20/2023]
Affiliation(s)
- R. Yadgar-Yalda
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - P. G. Colman
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - S. Fourlanos
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
| | - J. M. Wentworth
- Department of Medicine; The University of Melbourne; Melbourne Victoria Australia
- Department of Diabetes and Endocrinology; Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Population Health and Immunity; Walter and Eliza Hall Institute of Medical Research; Melbourne Victoria Australia
| |
Collapse
|
16
|
Wang T, Conrad KA, van Brunt K, Rees TM. Attributes Influencing Insulin Pen Preference Among Caregivers and Patients With Diabetes Who Require Greater Than 20 Units of Mealtime Insulin. J Diabetes Sci Technol 2016; 10:923-31. [PMID: 26920640 PMCID: PMC4928226 DOI: 10.1177/1932296816633232] [Citation(s) in RCA: 14] [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: 11/16/2022]
Abstract
BACKGROUND This study compared patient preference for Humalog® KwikPen™ 200 units/mL (insulin lispro; hereafter, IL 200 pen; Eli Lilly and Company, Indianapolis, IN) versus the Humalog KwikPen 100 units/mL (insulin lispro; hereafter, IL 100 pen; Eli Lilly and Company, Indianapolis, IN) in patients with diabetes requiring >20 units of mealtime insulin and diabetes caregivers. This study also determined which attributes had the greatest influence on pen preference selection. METHODS In this 2-period, crossover, simulated-use study, 106 participants were randomized to 1 of 8 sequences that varied the pen order (IL 100 pen or IL 200 pen) and dosing order (15 units = low dose or 50 units = high dose) for a total of 4 simulated injections. Participants then completed a self-administered questionnaire to select their overall preference between the 2 pens and then rated the importance of 11 pen attributes in contributing to their overall preference. RESULTS Of the 90 participants expressing an overall preference, significantly more preferred the IL 200 pen to the IL 100 pen (IL 200 pen: 80 respondents; IL 100 pen: 10 respondents; 95% confidence interval [0.81, 0.94], P < .0001). The total amount of insulin in the pen, the ease in pressing the injection button, and the amount of fluid injected were key attributes influencing IL 200 pen preference. CONCLUSIONS Based on these key attributes, the IL 200 pen was significantly preferred over the IL 100 pen by patients with diabetes who require >20 daily mealtime insulin units or diabetes caregivers and may improve the injection experience for these patients.
Collapse
Affiliation(s)
- Tao Wang
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, IN, USA
| | - Kenneth A Conrad
- Delivery Device Human Factors, Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Tina M Rees
- Lilly Diabetes, Eli Lilly and Company, Indianapolis, IN, USA
| |
Collapse
|
17
|
Wilding JPH, Bain SC. Role of incretin-based therapies and sodium-glucose co-transporter-2 inhibitors as adjuncts to insulin therapy in Type 2 diabetes, with special reference to IDegLira. Diabet Med 2016; 33:864-76. [PMID: 26525806 DOI: 10.1111/dme.13021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 12/24/2022]
Abstract
The progressive nature of Type 2 diabetes necessitates treatment intensification over time in order to maintain glycaemic control, with many patients ultimately requiring insulin therapy. While insulin has unlimited potential efficacy, its initiation is often delayed and improvements in glycaemic control are typically accompanied by weight gain and an increased risk of hypoglycaemia, particularly as HbA1c approaches and falls below target levels. This may account for the sub-optimal control often achieved after insulin initiation. Combining insulin with antihyperglycaemic therapies that have a low risk of hypoglycaemia and are weight-neutral or result in weight loss is a therapeutic strategy with the potential to improve Type 2 diabetes management. Although the effects differ with each individual class of therapy, clinical trials have shown that adding a glucagon-like peptide-1 receptor agonist, dipeptidyl peptidase-4 inhibitor or sodium-glucose co-transporter-2 inhibitor to insulin regimens can offer a significant reduction in HbA1c without substantially increasing hypoglycaemia risk, or weight. The evidence and merit of each approach are reviewed in this paper. Once-daily co-formulations of a basal insulin and a glucagon-like peptide-1 receptor agonist have been developed (insulin degludec/liraglutide) or are under development (lixisenatide/insulin glargine). Insulin degludec/liraglutide phase III trials and a lixisenatide/insulin glargine phase II trial have shown robust HbA1c reductions, with weight loss and a low risk of hypoglycaemia. With insulin degludec/liraglutide now approved in Europe, an important consideration will be the types of patients who may benefit most from a fixed-ratio combination; this is discussed in the present review, and we also take a look toward future developments in the field.
Collapse
Affiliation(s)
- J P H Wilding
- Department of Obesity and Endocrinology, University of Liverpool, Liverpool, UK
| | - S C Bain
- Institute of Life Science, Swansea University, Swansea, UK
| |
Collapse
|
18
|
Mast MR, Walraven I, Hoekstra T, Jansen APD, van der Heijden AAWA, Elders PJM, Heine RJ, Dekker JM, Nijpels G, Hugtenburg JG. Effectiveness of insulin therapy in people with Type 2 diabetes in the Hoorn Diabetes Care System. Diabet Med 2016; 33:794-802. [PMID: 26946450 DOI: 10.1111/dme.13110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/28/2022]
Abstract
AIMS To identify HbA1c trajectories after the start of insulin treatment and to identify clinically applicable predictors of the response to insulin therapy. METHODS The study population comprised 1203 people with Type 2 diabetes included in the Hoorn Diabetes Care System (n = 9849). Inclusion criteria were: age ≥ 40 years; initiation of insulin during follow-up after failure to reach HbA1c levels ≤ 53 mmol/mol (7%) with oral glucose-lowering agents; and a follow up ≥ 2 years after initiating insulin. Latent class growth modelling was used to identify trajectories of HbA1c . Subjects considered to be 'off target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during one-third or more of the follow-up time, and those considered to be 'on target' had HbA1c levels ≥ 53 mmol/mol (7.0%) during less than one-third of the follow-up time. RESULTS Four HbA1c trajectories were identified. Most people (88.7%) were classified as having a stable HbA1c trajectory of ~57 mmol/mol (7.4%). Only 24.4% of the people were on target in response to insulin; this was associated with lower HbA1c levels and a higher age at the start of insulin treatment. CONCLUSIONS Using latent class growth modelling, four HbA1c trajectories were identified. A quarter of the people starting insulin were on target. Low HbA1c levels and advanced age at the start of insulin therapy were associated with better response to insulin therapy. Initiating insulin earlier improves the likelihood of achieving and sustaining glycaemic control.
Collapse
Affiliation(s)
- M R Mast
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands
| | - I Walraven
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
- Department of Ophthalmology, VU University Medical Centre, Amsterdam, The Netherlands
| | - T Hoekstra
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands
| | - A P D Jansen
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - A A W A van der Heijden
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - P J M Elders
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - R J Heine
- Eli Lilly and Company, Indianapolis, IN, USA
| | - J M Dekker
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University, Amsterdam, The Netherlands
| | - G Nijpels
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, VU University, Amsterdam, The Netherlands
| | - J G Hugtenburg
- EMGO Institute for Health and Care Research, VU University, Amsterdam, The Netherlands
- Department of Clinical Pharmacology and Pharmacy, VU University, Amsterdam, The Netherlands
| |
Collapse
|
19
|
de la Peña A, Seger M, Soon D, Scott AJ, Reddy SR, Dobbins MA, Brown-Augsburger P, Linnebjerg H. Bioequivalence and comparative pharmacodynamics of insulin lispro 200 U/mL relative to insulin lispro (Humalog®) 100 U/mL. Clin Pharmacol Drug Dev 2015; 5:69-75. [PMID: 27119580 PMCID: PMC5054907 DOI: 10.1002/cpdd.221] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 08/04/2015] [Indexed: 12/02/2022]
Abstract
Insulin lispro 200 U/mL (IL200) is a new strength formulation of insulin lispro (Humalog®, IL100), developed as an option for diabetic patients on higher daily mealtime insulin doses. This phase 1, open‐label, 2‐sequence, 4‐period crossover, randomized, 8‐hour euglycemic clamp study aimed to demonstrate the bioequivalence of IL200 and IL100 after subcutaneous administration of 20 U (U) to healthy subjects (n = 38). Pharmacokinetic (PK) and pharmacodynamic (PD) responses were similar in both formulations. All 90%CIs for the ratios of area under the concentration‐versus‐time curve from time zero to the time of the last measurable concentration (AUC0–tlast) and maximum observed drug concentration (Cmax), as well as the total glucose infused throughout the clamp (Gtot) and the maximum glucose infusion rate (Rmax), were contained within 0.80 and 1.25. Time of maximum observed drug concentration (tmax) was similar between formulations, with a median difference of 15 minutes and a 95%CI of the difference that included zero. Inter‐ and intrasubject variability estimates were similar for both formulations. Both formulations were well tolerated. IL200 was bioequivalent to IL100 after subcutaneous administration of 20‐U single doses, and PD responses were comparable between formulation strengths.
Collapse
Affiliation(s)
| | - Mary Seger
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | | | | | | |
Collapse
|
20
|
McEwan P, Gordon J, Evans M, Ward T, Bennett H, Bergenheim K. Estimating Cost-Effectiveness in Type 2 Diabetes: The Impact of Treatment Guidelines and Therapy Duration. Med Decis Making 2015; 35:660-70. [PMID: 25596535 DOI: 10.1177/0272989x14565821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 11/23/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) clinical guidelines focus on optimizing glucose control, with therapy escalation classically initiated within a "failure-based" regimen. Within many diabetes models, HbA1c therapy escalation thresholds play a pivotal role, controlling duration of therapy and, consequently, incremental costs and benefits. The objective of this study was to assess the relationship between therapy escalation threshold and time to therapy escalation on predicted cost-effectiveness of T2DM treatments. METHODS This study used the Cardiff Diabetes Model to illustrate the relationship between costs and health outcomes associated with first-, second-, and third-line therapy as a function of time on each. Data from routine clinical practice were used to contrast predicted costs and health outcomes associated with guideline therapy escalation thresholds compared with clinical practice. The impact of baseline HbA1c and therapy escalation thresholds on cost-effectiveness was investigated, comparing a sodium/glucose cotransporter 2 inhibitor v. sulfonylurea added to metformin monotherapy. RESULTS Lower thresholds are associated with a shorter time spent on monotherapy, ranging from 1.1 years (escalation at 6.5%) to 13 years (escalation at 9.0%) and an increase in total lifetime cost of therapy. Treatment-related disutility is minimized with higher thresholds because progression to insulin is delayed. Using metformin combined with either dapagliflozin or a sulfonylurea to illustrate lower baseline HbA1c and/or higher therapy escalation thresholds was associated with increased cost-effectiveness ratios, driven by a longer duration of therapy. DISCUSSION A marked difference in treatment cost-effectiveness was demonstrated when comparing routine clinical practice with guideline-advocated therapy escalation. This is important to both health care professionals and the wider health economic community with respect to understanding the true cost-effectiveness profile of any particular T2DM therapy option.
Collapse
Affiliation(s)
- Phil McEwan
- Swansea Centre for Health Economics, Swansea University, Wales, UK (PCM, HB),Health Economics & Outcomes Research Ltd., Wales, UK (PCM, JG, TW)
| | - Jason Gordon
- Health Economics & Outcomes Research Ltd., Wales, UK (PCM, JG, TW),Department of Public Health, University of Adelaide, South Australia, Australia (JG)
| | - Marc Evans
- University Health Board, Llandough, Wales, UK (ME)
| | - Thomas Ward
- Health Economics & Outcomes Research Ltd., Wales, UK (PCM, JG, TW)
| | - Hayley Bennett
- Swansea Centre for Health Economics, Swansea University, Wales, UK (PCM, HB)
| | - Klas Bergenheim
- Global Health Economics & Outcomes Research, AstraZeneca, Molndal, Sweden (KB)
| |
Collapse
|
21
|
Shaefer CF, Reid TS, Dailey G, Mabrey ME, Vlajnic A, Stuhr A, Stewart J, Zhou R. Weight change in patients with type 2 diabetes starting basal insulin therapy: correlates and impact on outcomes. Postgrad Med 2015; 126:93-105. [PMID: 25414938 DOI: 10.3810/pgm.2014.10.2824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND An increase in body weight is a commonly perceived effect of insulin therapy for type 2 diabetes mellitus, and this may serve as a barrier to insulin initiation and usage. OBJECTIVE To investigate the baseline clinical and demographic factors associated with weight gain during insulin glargine therapy, and the implications of weight change on clinical outcomes. METHODS This was a retrospective analysis of patient-level data from phase 3 or 4 randomized controlled, treat-to-target (fasting plasma glucose [FPG] ≤ 100 mg/dL) trials evaluating basal insulin glargine for ≥ 24 weeks. The Pearson correlation coefficient and Cochran-Armitage trend statistic were used to calculate the existence of a trend between absolute and relative weight change, and relative glycated hemoglobin (HbA1c) change from baseline; likelihood of achieving target HbA1c < 7.0%; change from baseline FPG; insulin dose requirements; incidence of hypoglycemia; and adverse events. RESULTS Eleven studies were included, encompassing a total of 2140 patients. Patients starting insulin glargine treatment gained a mean ± standard deviation 1.8 ± 3.7 kg (4.0 ± 8.2 lb). Most patients had limited weight change (± 2.5 kg or 5.5 lb). Younger age, higher baseline HbA1c, and higher baseline FPG were predictive of greater weight gain (P < 0.0001). Those who gained more weight experienced the largest decrease from baseline in HbA1c and FPG. More weight gain was associated with higher insulin dose requirements, an increased risk of experiencing either symptomatic or glucose-confirmed (< 70 mg/dL) hypoglycemia, and more adverse events. Older patients (> 65 years) were less likely to gain weight or to experience glucose-confirmed hypoglycemia, but more likely to experience severe hypoglycemia. CONCLUSIONS In this retrospective analysis of patient-level data, most patients had a stable weight (defined as ± 2.5 kg) after 24 weeks of insulin glargine, and weight gain varied with patient demographics. Therefore, insulin glargine can be used in these patient groups with type 2 diabetes without expectation of significant weight gain.
Collapse
|
22
|
Balkau B, Home PD, Vincent M, Marre M, Freemantle N. Factors associated with weight gain in people with type 2 diabetes starting on insulin. Diabetes Care 2014; 37:2108-13. [PMID: 24824546 DOI: 10.2337/dc13-3010] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Moderate weight gain is usual after starting insulin therapy. The identification and quantification of factors associated with weight gain may help target strategies for avoidance of weight gain. RESEARCH DESIGN AND METHODS The noninterventional CREDIT (Cardiovascular Risk Evaluation in people with type 2 Diabetes on Insulin Therapy) study included data from people with type 2 diabetes starting any insulin in 314 centers, in 12 countries. From a number of predefined candidate explanatory variables, analyses identified factors associated with weight gain 1 year after starting insulin treatment, after adjusting for investigational site as a random factor. A multivariable backward regression analysis selected a subset of these factors associated with weight gain. RESULTS We studied the 2,179 people with data for body weight change at 1 year and for potential predictive factors. The mean weight gain was 1.78 kg, and 24% gained ≥5.0 kg. Baseline factors associated with weight gain were BMI, A1C, insulin regimen, insulin dose, other glucose-lowering therapies, and hypertension; at 1 year, additional factors were A1C, insulin regimen, insulin dose, and use of other glucose-lowering therapies. In multivariable analysis, weight gain at 1 year was associated with a higher A1C at baseline, a higher insulin dose at baseline and at 1 year, and a lower baseline BMI. CONCLUSIONS By the time insulin was started, a high baseline A1C and insulin dose requirements were independently associated with greater weight gain, as was lower baseline BMI. Insulin regimen per se was not a predictive factor.
Collapse
Affiliation(s)
- Beverley Balkau
- INSERM Centre for Research in Epidemiology and Population Health, U1018, Villejuif, FranceUniversity Paris-Sud, URMS 1018, Villejuif, France
| | | | | | - Michel Marre
- INSERM U695, University of Paris 7, Paris, France
| | | |
Collapse
|
23
|
Abstract
Many patients with type 2 diabetes mellitus do not achieve target glycosylated hemoglobin A1c levels despite optimally titrated basal insulin and satisfactory fasting plasma glucose levels. Current evidence suggests that HbA1c levels are dictated by both basal glucose and postprandial glucose levels. This has led to a consensus that postprandial glucose excursions contribute to poor glycemic control in these patients. Lixisenatide is a once-daily, prandial glucagon-like peptide 1 (GLP-1) receptor agonist with a four-fold affinity for the GLP-1 receptor compared with native GLP-1. Importantly, lixisenatide causes a significant delay in gastric emptying time, an important determinant of the once-daily dosing regimen. An exendin-4 mimetic with six lysine residues removed at the C-terminal, lixisenatide has pronounced postprandial glucose-lowering effects, making it a novel incretin agent for use in combination with optimally titrated basal insulin. Lixisenatide exerts profound effects on postprandial glucose through established mechanisms of glucose-dependent insulin secretion and glucagon suppression in combination with delayed gastric emptying. This review discusses the likely place that lixisenatide will occupy in clinical practice, given its profound effects on postprandial glucose and potential to reduce glycemic variability.
Collapse
Affiliation(s)
| | | | - Marc Evans
- Diabetes Department, University Hospital Llandough, Cardiff, UK
| |
Collapse
|