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Brixner D, Edelman SV, Sieradzan R, Gavin JR. Addressing the Burden of Multiple Daily Insulin Injections in Type 2 Diabetes with Insulin Pump Technology: A Narrative Review. Diabetes Ther 2024; 15:1525-1534. [PMID: 38771470 PMCID: PMC11211306 DOI: 10.1007/s13300-024-01598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
The growing prevalence of type 2 diabetes (T2D) remains a leading health concern in the US. Despite new medications and technologies, glycemic control in this population remains suboptimal, which increases the risk of poor outcomes, increased healthcare resource utilization, and associated costs. This article reviews the clinical and economic impacts of suboptimal glycemic control in patients on basal-bolus insulin or multiple daily injections (MDI) and discusses how new technologies, such as tubeless insulin delivery devices, referred to as "patch pumps", have the potential to improve outcomes in patients with T2D.
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Affiliation(s)
- Diana Brixner
- The University of Utah, L.S. Skaggs Pharmacy Research Institute, 30 South 2000 East, Room 4781, Salt Lake City, UT, 84112, USA
| | - Steven V Edelman
- University of California San Diego, TCOYD, 990 Highland Drive, Ste. 312, Solana Beach, CA, USA
| | - Ray Sieradzan
- Medical Outcomes Liaison Lead, Embecta Medical Affairs, 300 Kimball Drive, Parsippany, NJ, 07054, USA.
| | - James R Gavin
- Emory University School of Medicine, and Healing Our Village, Inc., 100 Woodruff Circle, Atlanta, GA, 30322, USA
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2
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Heidemann C, Du Y, Mauz E, Walther L, Peitz D, Müller A, Buchmann M, Allen J, Scheidt-Nave C, Baumert J. Healthcare and health situation of adults with type 2 diabetes in Germany: The study GEDA 2021/2022-Diabetes. JOURNAL OF HEALTH MONITORING 2024; 9:e12128. [PMID: 39081469 PMCID: PMC11262738 DOI: 10.25646/12128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/19/2024] [Indexed: 08/02/2024]
Abstract
Background The nationwide study German Health Update (GEDA) 2021/2022-Diabetes was conducted to assess the current healthcare and health situation of adults with diabetes in Germany. Methods GEDA 2021/2022-Diabetes comprises a sample of adults with diagnosed diabetes from the general population. The analysis focuses on adults aged 45 years and over with type 2 diabetes (N = 1,448) and provides selected indicators on diabetes care as well as mental, social and general health. Results 87.5 % of participants aged 45 years and over with type 2 diabetes are treated with blood glucose-lowering medication. 36.5 % receive insulin alone or in combination with other antidiabetics; 0.7 % use an insulin pump. Almost 96 % had an HbA1c measurement in the last year and about two thirds each report annual foot and eye examinations, participation in a diabetes self-management education programme and self-monitoring of their feet and of blood glucose (12.0 % with continuous glucose monitoring). On average, the quality of diabetes care is perceived as moderate. 23.8 % rate their mental health as excellent/very good. More than a tenth each have anxiety or depressive symptoms and feelings of loneliness. Half rate their general health as very good/good. Conclusions There is a potential for improvement in the quality of diabetes care and the mental and physical health of adults with type 2 diabetes.
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Affiliation(s)
- Christin Heidemann
- Robert Koch Institute, Department of Epidemiology and Health Monitoring, Berlin, Germany
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3
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Clemente G, Della Pia N, Bramanti A, Cerbara L, Russo G, De Rosa P, Marotta V, Tortora A, Riccio M, Vitale M. Role of nutritional therapy on dietary habits and glycemic control in insulin-treated kidney transplant patients with diabetes. Diabetes Res Clin Pract 2024; 211:111680. [PMID: 38657795 DOI: 10.1016/j.diabres.2024.111680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/03/2024] [Accepted: 04/21/2024] [Indexed: 04/26/2024]
Abstract
AIMS To evaluate the effect of nutritional therapy on glycemic compensation and key cardio-renal risk markers in patients with diabetes and kidney transplant, on insulin treatment by Multiple Daily Injection (MDI) or Continuous Subcutaneous Insulin Infusion (CSII). METHODS 34 patients with diabetes on insulin treatment and kidney transplant recipients were enrolled;12 participated in the structured nutritional program (intervention group), 22 patients (control group) did not receive nutritional protocol. Both groups were then divided into subgroups according to the method of insulin administration (MDI and CSII). RESULTS Statistically significant reduction in fasting blood glucose values, glycosylated hemoglobin (HbA1c) and glycosuria were observed in both groups at the end of the study. The intervention group, significantly reduced total cholesterolemia and the glycemic index, together with reduced dietary intake of lipids, cholesterol, soluble carbohydrates and increased consumption of carbohydrates and fiber. These improvements were even more pronounced in patients treated with CSII. CONCLUSIONS A proper nutritional approach optimize glycometabolic outcomes and contribute significantly to the reduction of the major cardiovascular risk factors in renal transplant patients.
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Affiliation(s)
- G Clemente
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno); IRPPS-Institute for Research on Population and Social Policies of the Italian National Research Council, Fisciano (Salerno).
| | - N Della Pia
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - A Bramanti
- Department of Medicine, Surgery and Dentistry, University of Salerno (Salerno)
| | - L Cerbara
- IRPPS-Institute for Research on Population and Social Policies of the Italian National Research Council, Fisciano (Salerno)
| | - G Russo
- Department of Clinical and Experimental Medicine, University of Messina (Messina)
| | - P De Rosa
- General Surgery and Kidney Transplants. A.O.U San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - V Marotta
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - A Tortora
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - M Riccio
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno)
| | - M Vitale
- University Hospital San Giovanni di Dio e Ruggi D'Aragona (Salerno); Department of Medicine, Surgery and Dentistry, University of Salerno (Salerno)
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4
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Chen S, Wu P, Zhang T, Zhang J, Gao H. Global scientific trends on the islet transplantation in the 21st century: A bibliometric and visualized analysis. Medicine (Baltimore) 2024; 103:e37945. [PMID: 38669398 PMCID: PMC11049693 DOI: 10.1097/md.0000000000037945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Islet transplantation (IT) has emerged as a significant research area for the treatment of diabetes mellitus and has witnessed a surge in scholarly attention. Despite its growing importance, there is a lack of bibliometric analyses that encapsulate the evolution and scientific underpinnings of this field. This study aims to fill this gap by conducting a comprehensive bibliometric analysis to delineate current research hotspots and forecast future trajectories within the IT domain with a particular focus on evidence-based medicine practices. METHODS This analysis scrutinized literature from January 1, 2000, to October 1, 2023, using the Web of Science Core Collection (WoSCC). Employing bibliometric tools such as VOSviewer, CiteSpace, and the R package "bibliometrix," we systematically evaluated the literature to uncover scientific trends and collaboration networks in IT research. RESULTS The analysis revealed 8388 publications from 82 countries, predominantly the United States and China. However, global cross-institutional collaboration in IT research requires further strengthening. The number of IT-related publications has increased annually. Leading research institutions in this field include Harvard University, the University of Alberta, the University of Miami, and the University of Minnesota. "Transplantation" emerges as the most frequently cited journal in this area. Shapiro and Ricordi were the most prolific authors, with 126 and 121 publications, respectively. Shapiro also led to co-citations, totaling 4808. Key research focuses on IT sites and procedures as well as novel therapies in IT. Emerging research hotspots are identified by terms like "xenotransplantation," "apoptosis," "stem cells," "immunosuppression," and "microencapsulation." CONCLUSIONS The findings underscore a mounting anticipation for future IT research, which is expected to delve deeper into evidence-based methodologies for IT sites, procedures, and novel therapeutic interventions. This shift toward evidence-based medicine underscores the field's commitment to enhancing the efficacy and safety of IT for diabetes treatment, signaling a promising direction for future investigations aimed at optimizing patient outcomes.
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Affiliation(s)
- Sheng Chen
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - PeiZhong Wu
- Graduate School, Guangxi University of Chinese Medicine, Nanning, China
| | - Ting Zhang
- Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Jianqiang Zhang
- Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, China
| | - Hongjun Gao
- Ruikang Hospital, Guangxi University of Chinese Medicine, Nanning, China
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5
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Li Y, Shao Z, Zhu Y, Chen D, Zhu J. Comparing Equil patch versus traditional catheter insulin pump in type 2 diabetes using continuous glucose monitoring metrics and profiles. J Diabetes 2024; 16:e13536. [PMID: 38599884 PMCID: PMC11006617 DOI: 10.1111/1753-0407.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/02/2024] [Accepted: 01/13/2024] [Indexed: 04/12/2024] Open
Abstract
AIMS It is not clear whether there are differences in glycemic control between the Equil patch and the MMT-712 insulin pump. Our objective was to compare two types of insulin pumps in the treatment of type 2 diabetes mellitus (T2DM), using continuous glucose monitoring (CGM) metrics and profiles. METHODS This was a randomized case-crossover clinical trial. Participants were hospitalized and randomly allocated to two groups and underwent two types of insulin pump treatments (group A: Equil patch-Medtronic MMT-712 insulin pump; group B: Medtronic MMT-712-Equil patch insulin pump) separated by a 1-day washout period. Glycemic control was achieved after 7-8 days of insulin pump therapy. Each patient received CGM for 5 consecutive days (from day 1 to day 5). On day 3 of CGM performance, the Equil patch insulin pump treatment was switched to Medtronic MMT-712 insulin pump treatment at the same basal and bolus insulin doses or vice versa. CGM metrics and profiles including glycemic variability (GV), time in range (TIR, 3.9-10.0 mmol/L), time below range (TBR, <3.9 mmol/L), time above range (TAR, >10.0 mmol/L), and postprandial glucose excursions, as well as incidence of hypoglycemia. RESULTS Forty-six T2DM patients completed the study. There was no significant difference in parameters of daily GV and postprandial glucose excursions between the Equil patch insulin pump treatment and the Medtronic insulin pump treatment. Similarly, there was no between-treatment difference in TIR, TBR, and TAR, as well as the incidence of hypoglycemia. CONCLUSION The Equil patch insulin pump was similar to the traditional MMT-712 insulin pump in terms of glycemic control. Equil patch insulin pump is a reliable tool for glycemic management of diabetes mellitus.
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Affiliation(s)
- Yu‐Jiao Li
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Zi‐Yue Shao
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Yun‐Qing Zhu
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Da‐Shuang Chen
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
| | - Jian Zhu
- Department of Endocrinology, Nanjing First HospitalNanjing Medical UniversityNanjingChina
- Department of EndocrinologyAffiliated Hospital of Jiangnan UniversityWuxiChina
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6
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Kruger DF, Isaacs D, Hughes L, Miller E, Bailey TS. Opportunities to overcome underutilization of enhanced insulin delivery technologies in people with type 2 diabetes: a narrative review. Postgrad Med 2024; 136:246-254. [PMID: 38497381 DOI: 10.1080/00325481.2024.2331417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
Use of innovative technologies such as continuous glucose monitoring (CGM) and insulin delivery systems have been shown to be safe and effective in helping patients with diabetes achieve significantly improved glycemic outcomes compared to their previous therapies. However, these technologies are underutilized in many primary care practices. This narrative review discusses some of the clinical and economic benefits of tubeless insulin delivery devices and discusses how this technology can overcome the main obstacles inherent to use of conventional insulin delivery devices.
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Affiliation(s)
- Davida F Kruger
- Division of Endocrinology, Diabetes, Bone & Mineral, Henry Ford Health System, Detroit, MI, USA
| | - Diana Isaacs
- Endocrinology and Metabolism Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lucille Hughes
- Diabetes Education and Program Design, Catholic Health, Melville, NY, USA
| | - Eden Miller
- Endocrinology and Metabolism Institute, Diabetes and Obesity Care LLC, Bend, OR, USA
| | - Timothy S Bailey
- Endocrinology and Metabolism Institute, AMCR Institute, Escondido, CA, USA
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7
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Zhang E, Shi Y, Han X, Zhu H, Song B, Yang C, Cao Z. An injectable and biodegradable zwitterionic gel for extending the longevity and performance of insulin infusion catheters. Nat Biomed Eng 2023:10.1038/s41551-023-01108-z. [PMID: 37884794 DOI: 10.1038/s41551-023-01108-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/18/2023] [Indexed: 10/28/2023]
Abstract
Continuous subcutaneous insulin infusion (CSII) is an essential insulin replacement therapy in the management of diabetes. However, the longevity of clinical CSII is limited by skin complications, by impaired insulin absorption and by occlusions associated with the subcutaneous insertion of CSII catheters, which require replacement and rotation of the insertion site every few days. Here we show that a biodegradable zwitterionic gel covering the tip end of commercial off-the-shelf CSII catheters fully resolves early skin irritations, extends the longevity of catheters and improves the rate of insulin absorption (also with respect to conventional syringe-based subcutaneous injection) for longer than 6 months in diabetic mice, and by 11 days in diabetic minipigs (from 2 to 13 days, under standard CSII-wearing conditions of insulin pump therapy and in a continuous basal-plus-bolus-infusion setting). The implanted gel displayed anti-inflammatory and anti-foreign-body-reaction properties and promoted the local formation of new blood vessels. The gel is subcutaneously injected before the tip of catheter is inserted into it, and should be generally applicable to CSII catheters and other implantable devices.
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Affiliation(s)
- Ershuai Zhang
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Yuanjie Shi
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Xiangfei Han
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Hui Zhu
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Boyi Song
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Chengbiao Yang
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA
| | - Zhiqiang Cao
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, MI, USA.
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8
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Waataja JJ, Asp AJ, Billington CJ. Combining Celiac and Hepatic Vagus Nerve Neuromodulation Reverses Glucose Intolerance and Improves Glycemic Control in Pre- and Overt-Type 2 Diabetes Mellitus. Biomedicines 2023; 11:2452. [PMID: 37760895 PMCID: PMC10525327 DOI: 10.3390/biomedicines11092452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Neurological disorders and type 2 diabetes mellitus (T2DM) are deeply intertwined. For example, autonomic neuropathy contributes to the development of T2DM and continued unmanaged T2DM causes further progression of nerve damage. Increasing glycemic control has been shown to prevent the onset and progression of diabetic autonomic neuropathies. Neuromodulation consisting of combined stimulation of celiac vagal fibers innervating the pancreas with concurrent electrical blockade of neuronal hepatic vagal fibers innervating the liver has been shown to increase glycemic control in animal models of T2DM. The present study demonstrated that the neuromodulation reversed glucose intolerance in alloxan-treated swine in both pre- and overt stages of T2DM. This was demonstrated by improved performance on oral glucose tolerance tests (OGTTs), as assessed by area under the curve (AUC). In prediabetic swine (fasting plasma glucose (FPG) range: 101-119 mg/dL) the median AUC decreased from 31.9 AUs (IQR = 28.6, 35.5) to 15.9 AUs (IQR = 15.1, 18.3) p = 0.004. In diabetic swine (FPG range: 133-207 mg/dL) the median AUC decreased from 54.2 AUs (IQR = 41.5, 56.6) to 16.0 AUs (IQR = 15.4, 21.5) p = 0.003. This neuromodulation technique may offer a new treatment for T2DM and reverse glycemic dysregulation at multiple states of T2DM involved in diabetic neuropathy including at its development and during progression.
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Affiliation(s)
| | - Anders J. Asp
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55605, USA
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9
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Bober T, Rothenberger S, Lin J, Ng JM, Zupa M. Factors Associated With Receipt of Diabetes Self-Management Education and Support for Type 2 Diabetes: Potential for a Population Health Management Approach. J Diabetes Sci Technol 2023; 17:1198-1205. [PMID: 37264614 PMCID: PMC10563527 DOI: 10.1177/19322968231176303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Population health management approaches can help target diabetes resources like Diabetes Self-Management Education and Support (DSMES) to individuals at the highest risk of complications and poor outcomes. Little is known about patient characteristics associated with DSMES receipt since widespread uptake of telemedicine for diabetes care in 2020. METHODS In this retrospective cohort study, we used electronic medical record (EMR) data to assess patterns of DSMES delivery from May 2020 to May 2022 among adults who used telemedicine for type 2 diabetes (T2D) endocrinology care in a large integrated health system. Multilevel regression models were used to evaluate the association of key patient characteristics with DSMES receipt. RESULTS Of 3530 patients in the overall cohort, 401 patients (11%) received DSMES. In adjusted multivariable logistic regression, higher baseline HbA1c (odds ratios [OR] 3.10 [95% confidence interval 2.22-4.33] for HbA1c ≥9% vs <7%), insulin regimen complexity (OR 3.53 [2.59-4.80] for multiple daily injections vs no insulin), and number of noninsulin medications (OR 1.17 [1.05-1.30] per 1 additional medication) were significantly associated with receipt of DSMES, whereas rurality and area-level deprivation of patient residence were not. CONCLUSIONS Diabetes Self-Management Education and Support remains underutilized in this cohort of adults using telemedicine to access endocrinology care for T2D. Factors contributing to clinical complexity increased the odds of receiving DSMES. These results support a potential population health management approach using EMR data, which could target DSMES resources to those at higher risk of poor outcomes. This risk-stratified approach may be even more effective now that more people can access DSMES via telemedicine in addition to in-person care.
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Affiliation(s)
- Timothy Bober
- Center for Research on Health Care,
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Scott Rothenberger
- Center for Research on Health Care,
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Jonathan Lin
- Center for Research on Health Care,
Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA,
USA
| | - Jason M. Ng
- Division of Endocrinology and
Metabolism, University of Pittsburgh, Pittsburgh, PA, USA
| | - Margaret Zupa
- Division of Endocrinology and
Metabolism, University of Pittsburgh, Pittsburgh, PA, USA
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10
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Song W, Wen J, Zhang J, Luo M, Hu Y, Zhang Y, Fan G, Zhao L. Short-Term Effect of Continuous Subcutaneous Insulin Infusion and Multiple Daily Injection in Perioperative Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2023; 2023:8542262. [PMID: 37396491 PMCID: PMC10313463 DOI: 10.1155/2023/8542262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/05/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023] Open
Abstract
Background Hyperglycemia is common and difficult to control in perioperative patients with type 2 diabetes mellitus (T2DM), which impacts their prognosis after operation. Our study investigated the short-term effect of continuous subcutaneous insulin infusion (CSII) and multiple daily injection (MDI) in perioperative T2DM patients using the data envelopment analysis (DEA). Methods T2DM patients (n = 639) who underwent surgeries in Guangdong Provincial Hospital of Traditional Chinese Medicine (2009.01-2017.12) were included. Insulin was provided to each patient during the study and separated into a CSII group (n = 369) and an MDI group (n = 270). DEA was performed to compare the therapeutic indexes and investigate the short-term effect of the CSII group and MDI group. Results Scale efficiencies of the CSII group with CCR model and BCC model were better than that of the MDI group. Regarding slack variables, with higher surgical levels, the CSII group was closer to the ideal state than the MDI group, which indicated in improving the average fasting blood glucose (AFBG), antibiotic use days (AUD), preoperative blood glucose control time (PBGCT), first postoperative day fasting blood glucose (FPDFBG), and postoperative hospitalization days (PHD). Conclusion CSII could effectively control blood glucose levels and shorten perioperative hospitalizing time for T2DM patients, indicating that CSII was beneficial in perioperative period and should be promoted clinically.
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Affiliation(s)
- Wei Song
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, 510210 Guangdong Province, China
| | - Jianxuan Wen
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, 510210 Guangdong Province, China
| | - Jinming Zhang
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, 510210 Guangdong Province, China
| | - Meng Luo
- Department of Endocrinology, Huizhou Hospital of Guangzhou, University of Chinese Medicine, Huizhou, 516000 Guangdong Province, China
| | - Yue Hu
- Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120 Guangdong Province, China
| | - Yu Zhang
- Second Clinical College of Guangzhou, University of Chinese Medicine, Guangzhou, 510120 Guangdong Province, China
| | - Guanjie Fan
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, 510210 Guangdong Province, China
| | - Ling Zhao
- The Second Affiliated Hospital of Guangzhou, University of Chinese Medicine, Guangzhou, 510210 Guangdong Province, China
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11
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Pieralice S, Coppola A, Maddaloni E. Updates on Glycaemic Control Strategies: A Range of Opportunities after Total Pancreatectomy. J Clin Med 2023; 12:jcm12093306. [PMID: 37176746 PMCID: PMC10179154 DOI: 10.3390/jcm12093306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
In the past, indications for total pancreatectomy (TP) were rare, with several concerns about patients' postoperative quality of life due to exocrine and endocrine post-pancreatectomy management [...].
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Affiliation(s)
- Silvia Pieralice
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | | | - Ernesto Maddaloni
- Department of Experimental Medicine, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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12
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Guzman GE, Escobar MF, Arias-Valderrama O, Guerra MA, Martínez V. Clinical Experience of Using Telemedicine for the Management of Patients Using Continuous Subcutaneous Insulin Infusion in a Highly Complex Latin American Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095719. [PMID: 37174237 PMCID: PMC10178677 DOI: 10.3390/ijerph20095719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/11/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Continuous subcutaneous insulin infusion (CSII) has emerged as a potential solution for diabetes management during the pandemic, as it reduces the need for in-person visits and allows for remote monitoring of patients. Telemedicine has also become increasingly important in the management of diabetes during the pandemic, as it allows healthcare providers to provide remote consultations and support. Here, we discuss the implications of this approach for diabetes management beyond the pandemic, including the potential for increased access to care and improved patient outcomes. METHODS We performed a longitudinal observational study between 1 March 2020 and 31 December 2020 to evaluate glycemic parameters in diabetic patients with CSII in a telehealth service. Glycemic parameters were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability control. RESULTS A total of 36 patients were included in the study, with 29 having type 1 diabetes and 6 having type 2 diabetes. The study found that the proportion of patients achieving target glucose variability and GMI remained unchanged during follow-up. However, in patients with type 2 diabetes, the time in target range increased from 70% to 80%, and the time in hyperglycemia decreased from 2% to 0%. CONCLUSIONS The results of this study suggest that telemedicine is a strategy for maintaining glycemic control in patients using CSII. However, the lack of access to the internet and adequate telemonitoring devices make it difficult to use on a large scale in emerging countries like ours.
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Affiliation(s)
- Guillermo Edinson Guzman
- Fundación Valle del Lili, Departamento de Endocrinología, Cali 760032, Colombia
- Departamento Medicina, Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
| | - María Fernanda Escobar
- Departamento Medicina, Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
- Fundación Valle del Lili, Departamento de Telemedicina, Cali 760032, Colombia
| | - Oriana Arias-Valderrama
- Departamento Medicina, Facultad de Ciencias de la Salud, Universidad Icesi, Cali 760031, Colombia
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cali 760032, Colombia
| | | | - Veline Martínez
- Fundación Valle del Lili, Departamento de Medicina Interna, Cali 760032, Colombia
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13
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Hendel K, Stumpe T, Ozer K. Impact of Infusion Set Materials and Designs on the Subcutaneous Response in People With Diabetes: A Rapid Review of the Literature. J Diabetes Sci Technol 2023; 17:314-321. [PMID: 36398844 PMCID: PMC10012358 DOI: 10.1177/19322968221138076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Insulin infusion sets (IISs) are an integral and intricate part of continuous subcutaneous insulin infusion for subjects with type 1 diabetes, infusing insulin from pump to the subcutaneous space. Insulin infusion sets interface with the skin surface, the dermis, and the subcutaneous space and may be the cause of infusion failure due to biological events or mechanical problems. Novel IISs with extended wear time and anti-inflammatory properties to mitigate these issues are described in the literature although material-tissue interactions are poorly understood. This rapid review focuses on the impact of IIS materials and designs on the subcutaneous response in people with diabetes and includes literature identified in PubMed, Embase, and Cochrane databases. Twenty-one studies were identified for qualitative synthesis that encompassed a limited and heterogenic body of evidence including 10 clinical reports, six reviews, one case report, two abstracts, and two communications. Two clinical reports were randomized crossover studies. Reports on materials mostly compared steel versus polytetrafluoroethylene (Teflon) cannulas and suggested no substantial difference in tissue response to these materials. Reports on designs focused mostly on the angle of cannula insertion. To drive and improve research on extended wear and nonimmunogenic IISs, future studies should focus on material-tissue interaction as dedicated outcome measures, quantified with punch biopsy and imaging techniques such as ultrasound, optical coherence tomography, and confocal reflectance microscopy. Original studies are required to further a field too young for a systematic meta-analysis.
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Affiliation(s)
| | - Tobias Stumpe
- Technology & Innovation, Convatec
Infusion Care, Søborg, Denmark
| | - Kerem Ozer
- Technology & Innovation, Convatec
Infusion Care, Lexington, MA, USA
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14
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Yang B, Han L, Wang Y, Cheng K. Effectiveness of continuous subcutaneous insulin infusion versus multiple daily injections on glycaemic control among older adults with type 2 diabetes: protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e063161. [PMID: 36631237 PMCID: PMC9835874 DOI: 10.1136/bmjopen-2022-063161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Insulin therapy plays an irreplaceable role in glycaemic control among older adults with type 2 diabetes mellitus (T2DM) and can be administered by either multiple daily injections (MDI) of insulin or by a continuous subcutaneous insulin infusion (CSII) pump. Many clinical trials have compared the effects of CSII pumps and MDI in various diabetic populations, but there has been no systematic review and meta-analysis focusing on older adults with T2DM. This study aims to determine whether the CSII pump is associated with better glycaemic control relative to the MDI in older adults with T2DM. METHODS AND ANALYSIS PubMed, Medline, Cochrane Library, Web of Science core collection, China National Knowledge Infrastructure (CNKI), Wan Fang Database, Chinese Science and Technology Journal Database (VIP) and Chinese Biomedical Literature Database (SinoMed) will be searched from inception to December 2021. Only randomised controlled trials will be included, and the language of the selected studies will be restricted to English and Chinese. Two researchers will independently screen the studies, extract data, assess the risk of bias and evaluate the quality of evidence. Any disagreement will be resolved by consensus or by a third researcher. Data analysis and synthesis will be conducted using RevMan V.5.3. Subgroup analysis, sensitivity analysis and publication bias assessment will be performed, as necessary. ETHICS AND DISSEMINATION As this study will not contain personal information, ethical approval will not be required. The results of the study will be published in a peer-reviewed journal or at relevant conference. PROSPERO REGISTRATION NUMBER CRD42021283729.
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Affiliation(s)
- Bei Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin Han
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yin Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kangyao Cheng
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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15
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Chatziravdeli V, Lambrou GI, Samartzi A, Kotsalas N, Vlachou E, Komninos J, Tsartsalis AN. A Systematic Review and Meta-Analysis of Continuous Subcutaneous Insulin Infusion vs. Multiple Daily Injections in Type-2 Diabetes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:141. [PMID: 36676765 PMCID: PMC9861993 DOI: 10.3390/medicina59010141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/12/2023]
Abstract
Diabetes mellitus (DM) has a growing prevalence worldwide, even in developing countries. Many antidiabetic agents are used to improve glycemic control; however, in cases of an insufficient outcome, insulin is administered. Yet, the timing of proper insulin administration is still a subject of intense research. To date, there have been no recommendations or guidelines for the use of continuous subcutaneous insulin infusion (CSII) in Type 2 Diabetes Mellitus (T2DM). In the present study, we have performed a meta-analysis to evaluate the use of CSII in patients with T2DM. An extensive literature search was conducted through the electronic databases Pubmed, Clinicaltrials.gov, and Cochrane Central Register of Controlled Trials (CENTRAL) from October 2019-May 2022, for interventional studies related to T2DMI and CSII versus multiple daily injections (MDI). We included articles published in the English language only, yielding a total of thirteen studies. We found better outcomes in patients receiving CSII, in regard to glycated hemoglobin (HbA1c) and total insulin dose. In contrast, fasting plasma glucose and body weight did not show statistically significant differences between the two groups. Our analyses showed that CSII could be beneficial in patients with T2DM in order to achieve their glucose targets.
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Affiliation(s)
- Vasiliki Chatziravdeli
- Department of Orthopedics, General Hospital “Ippokrateion”, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - George I. Lambrou
- Choremeio Research Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens, Thivon & Levadeias 8, 11527 Athens, Greece
- University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, Thivon & Levadeias 8, 11527 Athens, Greece
| | - Athanasia Samartzi
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Dinokratous 70, 11521 Athens, Greece
| | - Nikolaos Kotsalas
- Department of Nephrology, Naval Hospital of Athens, Dinokratous 70, 11521 Athens, Greece
| | - Eugenia Vlachou
- Department of Nursing, School of Health Sciences, University of West Attica, Ag. Spydironos 28, 12243 Athens, Greece
| | - John Komninos
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Dinokratous 70, 11521 Athens, Greece
| | - Athanasios N. Tsartsalis
- Department of Endocrinology Diabetes and Metabolism, Naval Hospital of Athens, Dinokratous 70, 11521 Athens, Greece
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16
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Lechleitner M, Roden M, Weitgasser R, Ludvik B, Fasching P, Hoppichler F, Kautzky-Willer A, Schernthaner G, Prager R, Kaser S, Wascher TC. [Injection therapy of diabetes]. Wien Klin Wochenschr 2023; 135:45-52. [PMID: 37101024 PMCID: PMC10133050 DOI: 10.1007/s00508-023-02171-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
The present article is a recommendation of the Austrian Diabetes Association for the practical use of injection therapy (GLP1-receptor agonists and insulin) in type 2 diabetes.
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Affiliation(s)
- Monika Lechleitner
- Avomed-Arbeitskreis für Vorsorgemedizin und Gesundheitsförderung in Tirol, Innsbruck, Österreich
| | - Michael Roden
- Klinik für Endokrinologie und Diabetologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Deutschland
- Institut für Klinische Diabetologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetesforschung, Düsseldorf, Deutschland
- Deutsches Zentrum für Diabetesforschung (DZD e. V.), München-Neuherberg, Deutschland
| | - Raimund Weitgasser
- Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
- Universitätsklinik für Innere Medizin I, LKH Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Österreich
| | - Bernhard Ludvik
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Peter Fasching
- Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Spitalgasse 23, 1090, Wien, Österreich.
| | - Guntram Schernthaner
- Department of Internal Medicine II, Medizinische Universität Wien, Wien, Österreich
| | - Rudolf Prager
- Stoffwechselzentrum im Rudolfinerhaus, Rudolfinerhaus Privatklinik, Wien, Österreich
| | - Susanne Kaser
- Department für Innere Medizin 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - T C Wascher
- Medizinische Abteilung, Hanusch-Krankenhaus, Wien, Österreich
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17
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Gonzalez-Flo E, Kheirabadi E, Rodriguez-Caso C, Macía J. Evolutionary algorithm for the optimization of meal intake and insulin administration in patients with type 2 diabetes. Front Physiol 2023; 14:1149698. [PMID: 37089422 PMCID: PMC10115945 DOI: 10.3389/fphys.2023.1149698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023] Open
Abstract
The optimal management of type 2 diabetes (T2DM) is complex and involves an appropriate combination of diet, exercise, and different pharmacological treatments. Artificial intelligence-based tools have been shown to be very useful for the diagnosis and treatment of diverse pathologies, including diabetes. In the present study, we present a proof of concept of the potential of an evolutionary algorithm to optimize the meal size, timing and insulin dose for the control of glycemia. We found that an appropriate distribution of food intake throughout the day permits a reduction in the insulin dose required to maintain glycemia within the range recommended by the American Diabetes Association for patients with T2DM of a range of severities. Furthermore, the effects of restrictions to both the timing and amount of food ingested were assessed, and we found that an increase in the amount of insulin was required to control glycemia as dietary intake became more restricted. In the near future, the use of these computational tools should permit patients with T2DM to optimize their personal meal schedule and insulin dose, according to the severity of their diabetes.
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Affiliation(s)
- Eva Gonzalez-Flo
- Synthetic Biology for Biomedical Applications, Department of Medicine and Living Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Elaheh Kheirabadi
- Synthetic Biology for Biomedical Applications, Department of Medicine and Living Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Rodriguez-Caso
- Department of Molecular Biology and Biochemistry, Faculty of Sciences, Andalucía Tech, University of Malaga, Malaga, Spain
- IBIMA (Biomedical Research Institute of Malaga), Malaga, Spain
| | - Javier Macía
- Synthetic Biology for Biomedical Applications, Department of Medicine and Living Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- *Correspondence: Javier Macía,
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18
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Pitocco D, Laurenzi A, Tomaselli L, Assaloni R, Consoli A, Di Bartolo P, Guardasole V, Lombardo F, Maffeis C, Rossi A, Gesuita R, Di Molfetta S, Rigamonti A, Scaramuzza A, Irace C, Cherubini V. Health care organization and use of technological devices in people with diabetes in Italy: Results from a survey of the Working Group on Diabetes and Technology. Nutr Metab Cardiovasc Dis 2022; 32:2392-2398. [PMID: 35970683 DOI: 10.1016/j.numecd.2022.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/13/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND AND AIM The use of technology offers recognized benefits to persons with diabetes. The aim of this study was to evaluate the organization of healthcare facilities, the composition of the diabetes team, and the use of Continuous Subcutaneous Insulin Infusion (CSII) and Continuous Glucose Monitoring (CGM) in Italy. METHODS AND RESULTS Diabetes care centers were asked to complete a web survey based on information collected in 2018. Sixty-one pediatric and 243 adult centers participated in the survey, accounting for 507,386 patients, mostly with type 2 diabetes (86.4%). Fifty-three percent of pediatric centers and 11% of adult centers reported a team composed of diabetologists, nurses, and psychologists. Overall, 13,204 patients (2.6%) were using CSII (95% with type 1 diabetes), and 28,936 (5.7%), were using CGM (74% with type 1 diabetes). When stratifying for the type of diabetes, 24% and 40.8% of patients with type 1 were using CSII and CGM, respectively, whereas low use of technology was reported for patients with type 2 and women with gestational diabetes. The percentage of adult and pediatric patients with type 1 diabetes on CSII and CGM was respectively 21% and 32%, and 35% and 57%. CONCLUSIONS The spread of CGM and CSII increased in Italy between 2013 and 2018. However, the percentage of users is still lower than what is expected based on clinical indications for use of technology. The inadequate number of professionals in the diabetes care team and insufficient economic resources are relevant barriers to disseminating technology for diabetes management.
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Affiliation(s)
- Dario Pitocco
- Diabetes Care Unit, UOSD Diabetologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Andrea Laurenzi
- San Raffaele Diabetes Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Roberta Assaloni
- Diabetes Unit ASS2 Bassa-Friulana Isontina, Udine, Monfalcone [GO], Italy
| | - Agostino Consoli
- Endocrinology and Metabolic Diseases, University of Chieti-Pescara, Chieti, Italy
| | | | - Vincenzo Guardasole
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi", University of Messina, Messina, Italy
| | - Claudio Maffeis
- Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
| | - Antonio Rossi
- Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Sergio Di Molfetta
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Andrea Rigamonti
- Division of Pediatrics, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Andrea Scaramuzza
- Division of Pediatrics, ASST Cremona, "Ospedale Maggiore di Cremona", Cremona, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia, Catanzaro, Italy.
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
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Evaluation of Short-Term Insulin Pump for Treatment of Patients with Type 2 Diabetes Mellitus Complicated with Lower Extremity Arterial Disease in Endocrinology by Ultrasonography. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9128208. [PMID: 35669363 PMCID: PMC9167118 DOI: 10.1155/2022/9128208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 11/29/2022]
Abstract
This research aimed to explore the curative effect of short-term insulin pump in the treatment of type 2 diabetes mellitus (T2DM) patients with lower extremity arterial disease (LEAD) based on ultrasonography. 422 patients (220 males and 202 females) with T2DM in the hospital were selected, and they were randomly divided into control group (n = 211, oral hypoglycemic drugs or diet control, appropriate exercise to lower blood glucose) and experimental group (n = 211, insulin pump was used to reduce blood glucose). After 2 weeks, the therapeutic effect was evaluated by ultrasonography. The results showed that after two weeks of treatment, the difference in lumen intima between the two groups was statistically significant (P < 0.05). The intima-media thickness (IMT) values of the experimental group were 0.83 ± 0.03 mm, 0.62 ± 0.03 mm, and 0.41 ± 0.04 mm, respectively, which were significantly different from those of the control group (1.62 ± 0.54 mm, 1.23 ± 0.14 mm, and 0.78 ± 0.11 mm) (P < 0.05). There was obvious difference in low-density lipoprotein cholesterol (LDL-C) level between the experimental group (2.22 ± 0.46 mmol/L) and the control group (3.21 ± 0.62 mmol/L) (P < 0.05). The LEAD score of the experimental group was 5.51 ± 1.11, which was significantly different from that of the control group (7.08 ± 2.73) (P < 0.05). There was clear difference in LEAD score between the two groups under different course of disease (CD) (P < 0.05). Studies indicated that short-term application of insulin pump therapy could effectively improve the pathological changes of lower limbs in patients with T2DM, which had clinical application value.
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20
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Baeza M, Sáenz-Ravello G, Cuadrado C. Detección de Nuevas Tecnologías Sanitarias Para Mejorar el Control Metabólico de Pacientes Con Diabetes Tipo 2 Atendidos en el Programa de Salud Cardiovascular de Chile. Value Health Reg Issues 2022; 31:81-92. [PMID: 35568012 DOI: 10.1016/j.vhri.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/02/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In Chile, > 900,000 people with type 2 diabetes mellitus (DM2) are controlled in the Cardiovascular Health Program (PSCV). Even though the PSCV includes a set of interventions for the control of patients with DM2, the results are still insufficient, generating a high human, economic, and social cost. This study aimed to identify and select new health technologies for the control of patients with DM2 not currently incorporated into the PSCV to be proposed as candidates for an economic evaluation in the Chilean context. METHODS For the identification of new health technologies, consultations with key informants and an umbrella review of updated scientific evidence were used as sources of information. In a second step, selection among those technologies was conducted based on the effectiveness of the intervention, target population, nature of the intervention, and international evidence of cost-effectiveness antecedents. RESULTS Key informants identified 12 candidate health technologies not currently incorporated into the PSCV. From the umbrella review, an additional 9 health technologies were identified that were not identified by the key informants. Of the 21 new health technologies identified, finally 8 health technologies were selected (structured group education, pedometer use, periodontal treatment, cognitive-behavioral therapy, telemonitoring, sitagliptin, canagliflozin, and insulin degludec). CONCLUSIONS The health technologies detected have a high potential to be studied through economic evaluations that allow guiding decision making around improving the health outcomes of patients with DM2 in Chile.
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Affiliation(s)
- Mauricio Baeza
- Programa de Doctorado en Salud Pública, Universidad de Chile, Santiago, Chile; Escuela de Salud Pública, Universidad de Chile, Santiago, Chile; Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | | | - Cristóbal Cuadrado
- Escuela de Salud Pública, Universidad de Chile, Santiago, Chile; Centre for Health Economics, University of York, York, England, UK.
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21
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Jarosinski MA, Chen YS, Varas N, Dhayalan B, Chatterjee D, Weiss MA. New Horizons: Next-Generation Insulin Analogues: Structural Principles and Clinical Goals. J Clin Endocrinol Metab 2022; 107:909-928. [PMID: 34850005 PMCID: PMC8947325 DOI: 10.1210/clinem/dgab849] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 11/19/2022]
Abstract
Design of "first-generation" insulin analogues over the past 3 decades has provided pharmaceutical formulations with tailored pharmacokinetic (PK) and pharmacodynamic (PD) properties. Application of a molecular tool kit-integrating protein sequence, chemical modification, and formulation-has thus led to improved prandial and basal formulations for the treatment of diabetes mellitus. Although PK/PD changes were modest in relation to prior formulations of human and animal insulins, significant clinical advantages in efficacy (mean glycemia) and safety (rates of hypoglycemia) were obtained. Continuing innovation is providing further improvements to achieve ultrarapid and ultrabasal analogue formulations in an effort to reduce glycemic variability and optimize time in range. Beyond such PK/PD metrics, next-generation insulin analogues seek to exploit therapeutic mechanisms: glucose-responsive ("smart") analogues, pathway-specific ("biased") analogues, and organ-targeted analogues. Smart insulin analogues and delivery systems promise to mitigate hypoglycemic risk, a critical barrier to glycemic control, whereas biased and organ-targeted insulin analogues may better recapitulate physiologic hormonal regulation. In each therapeutic class considerations of cost and stability will affect use and global distribution. This review highlights structural principles underlying next-generation design efforts, their respective biological rationale, and potential clinical applications.
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Affiliation(s)
- Mark A Jarosinski
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Yen-Shan Chen
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicolás Varas
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Balamurugan Dhayalan
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Deepak Chatterjee
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael A Weiss
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Chemistry, Indiana University, Bloomington, Indiana, USA
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, USA
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22
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Zupa MF, Krall J, Collins K, Marroquin O, Ng JM, Siminerio L. A Risk Stratification Approach to Allocating Diabetes Education and Support Services. Diabetes Technol Ther 2022; 24:75-78. [PMID: 34524006 PMCID: PMC8783623 DOI: 10.1089/dia.2021.0253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The objective of this study was to describe a predictive modeling approach to risk stratify people with type 2 diabetes for diabetes self-management education and support (DSMES) services. With data from a large health system, a predictive model including age, glycated hemoglobin (HbA1c), and insulin use among other factors, was developed to assess risk of future high HbA1c. The model was retrospectively applied to a cohort of people who received DSMES over a 2-year period to assess the impact of DSMES on glycemia by risk strata. Of 6934 eligible people, 4014 (58%) were in the composite low-risk group and 2604 (38%) were in the composite high-risk group. Mean HbA1c change after DSMES was -0.38% in the low-risk group and -0.84% in the high-risk group. This analysis demonstrates the potential application of predictive modeling as one approach to target DSMES resources to people who will benefit most.
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Affiliation(s)
- Margaret F. Zupa
- University of Pittsburgh Division of Endocrinology and Metabolism, Pittsburgh, Pennsylvania, USA
- Address correspondence to: Margaret F. Zupa, MD, MS, University of Pittsburgh Division of Endocrinology and Metabolism, 3601 Fifth Avenue, Center for Diabetes and Endocrinology, Suite 3B, Pittsburgh, PA 15218, USA
| | - Jodie Krall
- University of Pittsburgh Diabetes Institute, Division of Endocrinology and Metabolism, Pittsburgh, Pennsylvania, USA
| | - Kevin Collins
- University of Pittsburgh Medical Center Health Care Data and Analytics, Pittsburgh, Pennsylvania, USA
| | - Oscar Marroquin
- University of Pittsburgh Medical Center Health Care Data and Analytics, Pittsburgh, Pennsylvania, USA
| | - Jason M. Ng
- University of Pittsburgh Division of Endocrinology and Metabolism, Pittsburgh, Pennsylvania, USA
| | - Linda Siminerio
- University of Pittsburgh Division of Endocrinology and Metabolism, Pittsburgh, Pennsylvania, USA
- University of Pittsburgh Diabetes Institute, Division of Endocrinology and Metabolism, Pittsburgh, Pennsylvania, USA
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23
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Jarosinski MA, Dhayalan B, Chen YS, Chatterjee D, Varas N, Weiss MA. Structural principles of insulin formulation and analog design: A century of innovation. Mol Metab 2021; 52:101325. [PMID: 34428558 PMCID: PMC8513154 DOI: 10.1016/j.molmet.2021.101325] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The discovery of insulin in 1921 and its near-immediate clinical use initiated a century of innovation. Advances extended across a broad front, from the stabilization of animal insulin formulations to the frontiers of synthetic peptide chemistry, and in turn, from the advent of recombinant DNA manufacturing to structure-based protein analog design. In each case, a creative interplay was observed between pharmaceutical applications and then-emerging principles of protein science; indeed, translational objectives contributed to a growing molecular understanding of protein structure, aggregation and misfolding. SCOPE OF REVIEW Pioneering crystallographic analyses-beginning with Hodgkin's solving of the 2-Zn insulin hexamer-elucidated general features of protein self-assembly, including zinc coordination and the allosteric transmission of conformational change. Crystallization of insulin was exploited both as a step in manufacturing and as a means of obtaining protracted action. Forty years ago, the confluence of recombinant human insulin with techniques for site-directed mutagenesis initiated the present era of insulin analogs. Variant or modified insulins were developed that exhibit improved prandial or basal pharmacokinetic (PK) properties. Encouraged by clinical trials demonstrating the long-term importance of glycemic control, regimens based on such analogs sought to resemble daily patterns of endogenous β-cell secretion more closely, ideally with reduced risk of hypoglycemia. MAJOR CONCLUSIONS Next-generation insulin analog design seeks to explore new frontiers, including glucose-responsive insulins, organ-selective analogs and biased agonists tailored to address yet-unmet clinical needs. In the coming decade, we envision ever more powerful scientific synergies at the interface of structural biology, molecular physiology and therapeutics.
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Affiliation(s)
- Mark A Jarosinski
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, 46202, IN, USA
| | - Balamurugan Dhayalan
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, 46202, IN, USA
| | - Yen-Shan Chen
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, 46202, IN, USA
| | - Deepak Chatterjee
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, 46202, IN, USA
| | - Nicolás Varas
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, 46202, IN, USA
| | - Michael A Weiss
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, 46202, IN, USA; Department of Chemistry, Indiana University, Bloomington, 47405, IN, USA; Weldon School of Biomedical Engineering, Purdue University, West Lafayette, 47907, IN, USA.
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