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Wen S, Ruan Y, Shi Z, Dan S, Zhou L. The Barriers to Insulin Therapy Initiation in Type 2 Diabetes Patients: A Study of General Practitioner Perceptions in Huinan Community in South Shanghai. Diabetes Metab Syndr Obes 2024; 17:393-405. [PMID: 38283634 PMCID: PMC10822111 DOI: 10.2147/dmso.s446349] [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: 10/24/2023] [Accepted: 01/19/2024] [Indexed: 01/30/2024] Open
Abstract
Background Despite the demonstrated benefits of insulin therapy, many general practitioners (GPs) are hesitant to administer it due to challenges such as a lack of knowledge, time constraints, and patient reluctance. The barriers that prevent a GP from initiating insulin therapy may vary in comparison to those encountered by a diabetic patient; this aspect of clinical research in the South Shanghai metropolitan area has received limited attention so far. Objective This is a 6-months of interventional analytic cohort study. The prime aim is to investigate the barriers general practitioners (GPs) face when initiating insulin therapy for patients with type 2 diabetes (T2D). Materials and Methods As part of a training program, all 189 registered GPs in Nanhui Health Service Center in Shanghai were given a structured online-multi-choice questionnaire before and after a six-month interval, during which the GPs received sessions of training on insulin therapy either on theoretic classes or clinical practices. Results Before and after training, via the methods of multiple-response analyses, the results showed that social, GP's, and patient barriers to initiating insulin therapy were comparable. However, through the crosstabs chi-square test, we found significant changes in the basal insulin initiation following the prescription of the senior endocrinologists, the titration of insulin, and the need for training (p<0.05). The Spearman analyses discovered significant changes associated with the cause of initial insulin refusal and the factors influencing insulin administration. Finally, the binary logistic regression analysis revealed that distinct causes such as social factors, insurance, GP experience, insulin dosage calculation, follow-up, and patients' feelings are related to insulin treatment application before and after training. Conclusion According to this study, training increased general practitioners' confidence in initiating insulin administration, especially basal insulin. General practitioners require additional education on insulin therapy, with a potential need for increased face-to-face training for insulin initiation.
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Affiliation(s)
- Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yufeng Ruan
- Department of General Practice, Huinan Health Service Center, Shanghai, People’s Republic of China
| | - Zhongyu Shi
- Department of International Medicine, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Shujie Dan
- Department of General Practice, Huinan Health Service Center, Shanghai, People’s Republic of China
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
- Department of General Practice, Huinan Health Service Center, Shanghai, People’s Republic of China
- Department of International Medicine, Shanghai Pudong Hospital, Fudan University, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai, People’s Republic of China
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Yeung C, Shi IQ, Sung HK. Physiological Responses of Post-Dietary Effects: Lessons from Pre-Clinical and Clinical Studies. Metabolites 2021; 11:metabo11020062. [PMID: 33498462 PMCID: PMC7909542 DOI: 10.3390/metabo11020062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/17/2021] [Accepted: 01/18/2021] [Indexed: 02/07/2023] Open
Abstract
Dieting regimens such as calorie restriction (CR) are among the most commonly practiced interventions for weight management and metabolic abnormalities. Due to its independence from pharmacological agents and considerable flexibility in regimens, many individuals turn to dieting as a form of mitigation and maintenance of metabolic health. While metabolic benefits of CR have been widely studied, weight loss maintenance and metabolic benefits are reported to be lost overtime when the diet regimen has been terminated—referred to as post-dietary effects. Specifically, due to the challenges of long-term adherence and compliance to dieting, post-dietary repercussions such as body weight regain and loss of metabolic benefits pose as major factors in the efficacy of CR. Intermittent fasting (IF) regimens, which are defined by periodic energy restriction, have been deemed as more flexible, compliant, and easily adapted diet interventions that result in many metabolic benefits which resemble conventional CR diets. Many individuals find that IF regimens are easier to adhere to, resulting in fewer post-dietary effects; therefore, IF may be a more effective intervention. Unfortunately, there is a severe gap in current research regarding IF post-dietary effects. We recognize the importance of understanding the sustainability of dieting; as such, we will review the known physiological responses of CR post-dietary effects and its potential mechanisms through synthesizing lessons from both pre-clinical and clinical studies. This review aims to provide insight from a translational medicine perspective to allow for the development of more practical and effective diet interventions. We suggest more flexible and easily practiced dieting regimens such as IF due to its more adaptable and practical nature.
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Affiliation(s)
- Christy Yeung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (C.Y.); (I.Q.S.)
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Irisa Qianwen Shi
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (C.Y.); (I.Q.S.)
| | - Hoon-Ki Sung
- Translational Medicine Program, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (C.Y.); (I.Q.S.)
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
- Correspondence:
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Role of ultrafast-acting insulin analogues in the management of diabetes. J Am Assoc Nurse Pract 2019; 31:537-548. [DOI: 10.1097/jxx.0000000000000261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Silva JPD, Pereira Junior GA, Meska MHG, Mazzo A. Construction and validation of a low-cost simulator for training patients with diabetes mellitus and/or their caregivers in insulin administration. ESCOLA ANNA NERY 2018. [DOI: 10.1590/2177-9465-ean-2017-0387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: The objective of this study was to construct and validate a low-cost simulator to train diabetes mellitus patients and their caregivers on the administration of insulin. Method: Action research study with a qualitative approach, through a validation methodological study. Results: A low-fidelity simulator was constructed with the areas recommended for insulin administration adapted to allow skill training. Validation was done by nine experts on the subject. Conclusions: The prototype has low cost and greater anatomical functional fidelity than the models currently available in the market. Implications for practice: The simulator developed can be used by health professionals, caregivers or by the patients themselves as a tool in the training for insulin administration. Its use may favor the identification of critical points related to the application technique, allowing the planning of more directive and effective educational interventions.
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Kim SG, Kim NH, Ku BJ, Shon HS, Kim DM, Park TS, Kim YS, Kim IJ, Choi DS. Delay of insulin initiation in patients with type 2 diabetes mellitus inadequately controlled with oral hypoglycemic agents (analysis of patient- and physician-related factors): A prospective observational DIPP-FACTOR study in Korea. J Diabetes Investig 2017; 8:346-353. [PMID: 27712034 PMCID: PMC5415458 DOI: 10.1111/jdi.12581] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/07/2016] [Accepted: 09/27/2016] [Indexed: 01/07/2023] Open
Abstract
Aims/Introduction To assess the time to initiation of insulin therapy, and concurrently investigate both patient‐ and physician‐related factors associated with delaying insulin therapy in Korean patients with type 2 diabetes uncontrolled by oral hypoglycemic agents (OHAs). Materials and Methods This prospective, observational disease registry study was carried out across 69 centers in Korea. Type 2 diabetes patients who had received two or more OHAs within the past 5 years, had a glycated hemoglobin ≥8% in the past 6 months and had not received insulin were included. Data recorded on data collection forms during a 12‐month period were analyzed. Results Of 2168 patients enrolled, 1959 were evaluated and classified as the insulin‐initiated or insulin‐delayed group. Insulin was prescribed for just 20% of the patients during a 1‐year follow‐up period, and less than half (44.5%) of the patients who were taking two OHAs started insulin after 6 years. Patient‐related factors for delay in insulin initiation included older age, shorter duration of diabetes and lower glycated hemoglobin. Physician‐related factors included age (~50 to <60 years), sex (women) and number (<1000) of patients consulted per month. Patient refusal (33.6%) and physicians’ concerns of patient non‐compliance (26.5%) were the major physician‐reported reasons for delaying insulin therapy. Inconvenience of insulin therapy (51.6%) and fear of injection (48.2%) were the major reasons for patient refusal. Conclusions Insulin initiation is delayed in patients with type 2 diabetes uncontrolled by two or more OHAs in Korea. Patient‐ and physician‐related factors associated with this delay need to be addressed for better diabetes management.
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Affiliation(s)
- Sin Gon Kim
- Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea
| | - Nam Hoon Kim
- Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea
| | - Bon Jeong Ku
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Ho Sang Shon
- Division of Endocrinology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Doo Man Kim
- Division of Endocrinology, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Tae Sun Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Yong-Seong Kim
- Division of Endocrinology & Metabolism, Department of Internal Medicine, Inha University Incheon, Incheon, Korea
| | - In Joo Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Dong Seop Choi
- Division of Endocrinology, Korea University Anam Hospital, Seoul, Korea
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Robb A, Reid B, Laird EA. Insulin knowledge and practice: a survey of district nurses in Northern Ireland. Br J Community Nurs 2017; 22:138-145. [PMID: 28252323 DOI: 10.12968/bjcn.2017.22.3.138] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Insulin is one of the top ten high-alert medications worldwide. Approximately 30% of people with diabetes in the UK use injectable therapies, most commonly insulin, to manage their condition. With an increasing number of people with diabetes being managed within the community, district nurses play an important role in the safe and effective use of insulin. This study surveyed a convenience sample of 164 district nurses working within one Health and Social Care Trust in Northern Ireland to ascertain their knowledge and practice regarding insulin. Study response rate was 38% (n=63). It was found that district nurses' knowledge and practice relating to insulin therapy was lacking as indicated by a total mean score of 53.1%. Total knowledge scores were slightly higher (58%) than total practice scores (46%). Nevertheless, 79.4% of district nurses felt secure and 6.3% felt very secure in managing diabetes. Deficits in district nurses' knowledge and practice were identified in areas relating to insulin action, dosage, storage, injection site technique and rotation, hypoglycaemic/hyperglycaemic management, pharmacological action and prescription format. These deficits highlight the need for workplacebased learning and development programmes, incorporating real time, point of care interventions, to enhance and maintain district nurses' insulin knowledge and practice.
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Affiliation(s)
- Alison Robb
- District Nurse, Western Health and Social Care Trust
| | - Bernie Reid
- Lecturer in Nursing, School of Nursing, Ulster University
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Escalada J, Orozco-Beltran D, Morillas C, Alvarez-Guisasola F, Gomez-Peralta F, Mata-Cases M, Palomares R, Iglesias R, Carratalá-Munuera C. Attitudes towards insulin initiation in type 2 diabetes patients among healthcare providers: A survey research. Diabetes Res Clin Pract 2016; 122:46-53. [PMID: 27810685 DOI: 10.1016/j.diabres.2016.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/10/2016] [Indexed: 11/22/2022]
Abstract
AIMS To describe the views of healthcare providers about starting insulin in patients with type 2 diabetes and to determine the specific factors that contribute to delay insulin initiation. METHODS Two-phases observational descriptive study. In the quantitative phase we conducted a cross-sectional survey of a sample of 380 healthcare professionals (general practitioners (GPs), endocrinologists, internists and nurses). In the qualitative phase, a discussion group reviewed the results of the survey to propose solutions. RESULTS In poorly controlled patients, 46% of GPs vs. 43.2% of internists and 31.3% of endocrinologists waited 3-6months before starting insulin, and 71.4% of GPs vs. 66.7% of internists vs. 58.8% of endocrinologists need to confirm twice the HbA1c levels. The upper level of basal glucose more frequently considered as good control is 130mg/dL for GPs (35.7%), and 120mg/dL for internists (35.8%) and endocrinologists (37.5%). In patients without comorbidities, 32.5% of endocrinologists vs. 27.2% of internists vs. 17.9% of GPs initiated insulin when HbA1c was >7% while 26.3% of endocrinologists vs. 28.4% of internists vs. 38.4% of GPs initiated insulin when HbA1c was >8%. The interference of the therapy with the patient' social life and the need for time management were the most accepted barriers to initiate insulin. CONCLUSIONS There are significant differences between GPs and endocrinologists regarding the insulin initiation and GPs and internists felt less empowered to manage patients with diabetes. Specific training for professionals and joint work with patients could improve the glycemic control.
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Affiliation(s)
| | | | - Carlos Morillas
- Peset University Hospital, University of Valencia, Valencia, Spain.
| | | | | | - Manel Mata-Cases
- Primary Health Care Centre La Mina - Institut Català de la Salut, Sant Adrià de Besòs, Barcelona, Spain; Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.
| | | | - Rosario Iglesias
- Primary Care Health Centre Pedro Laín Entralgo, Alcorcon, Madrid, Spain.
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Huang MC, Hung CH, Yu CY, Berry DC, Shin SJ, Hsu YY. The effectiveness of multimedia education for patients with type 2 diabetes mellitus. J Adv Nurs 2016; 73:943-954. [PMID: 27779772 DOI: 10.1111/jan.13194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 12/29/2022]
Abstract
AIMS The aim of this study was to explore the effectiveness of two types of health education on improving knowledge concerning diabetes and insulin injection, insulin injection skills and self-efficacy, satisfaction with health education and glycated haemoglobin (HbA1c) and creatinine levels among patients with type 2 diabetes who began insulin therapy using a pen injector. BACKGROUND Insulin therapy is recommended to facilitate the regulation of plasma glucose; however, patient's acceptance of insulin therapy is generally low. Healthcare providers should help them improve their knowledge of diabetes and insulin injection, as well as their insulin injection skills. DESIGN A randomized repeated measures experimental study design. METHODS The experimental (n = 21) and control (n = 21) groups received multimedia and regular health education programmes, respectively from October 2013-August 2014. Four structured questionnaires were used and videotapes were applied to demonstrate injection skills. RESULTS Generalized estimating equations showed that the experimental group's scores were significantly higher than those of the control group for diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. On the other hand, an analysis of covariance revealed glycated hemoglobin (HbA1c) and creatinine levels did not differ significantly between the two groups. CONCLUSIONS Implementation of a multimedia diabetes education programme could improve patients' diabetes and insulin injection knowledge, insulin injection skills, self-efficacy in insulin injection and satisfaction with health education. Healthcare providers should improve quality of patient care by providing multimedia diabetes health education.
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Affiliation(s)
- Mei-Chuan Huang
- School of Nursing, National Tainan Junior College of Nursing, Tainan, Taiwan
| | - Chich-Hsiu Hung
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Yun Yu
- School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Diane C Berry
- School of Nursing, Beerstecher-Blackwell Distinguished Term Scholar, Chapel Hill, North Carolina, U.S.A
| | - Shyi-Jang Shin
- School of Medicine, Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Yun Hsu
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Manski-Nankervis JA, Blackberry I, Young D, O'Neal D, Patterson E, Furler J. Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey. BMC Health Serv Res 2014; 14:515. [PMID: 25361788 PMCID: PMC4224690 DOI: 10.1186/s12913-014-0515-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 10/13/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The majority of people with type 2 diabetes (T2D) receive their care in general practice and will eventually require initiation of insulin as part of their management. However, this is often delayed and frequently involves referral to specialists. If insulin initiation is to become more frequent and routine within general practice, coordination of care with specialist services may be required. Relational coordination (RC) provides a framework to explore this. The aim of this study was to explore RC between specialist physicians, specialist diabetes nurses (DNEs), generalist physicians in primary care (GPs) and generalist nurses (practice nurses (PNs)) and to explore the association between RC and the initiation of insulin in general practice, and the belief that it is appropriate for this task to be carried out in general practice. METHODS A survey was distributed to a convenience sample of specialist physicians, DNEs, GPs and practice nurses. We collected data on demographics, models of care and RC in relation to insulin initiation. We expected that RC would be higher between specialists than between specialists and generalists. We expected higher RC between specialists and generalists to be associated with insulin initiation in general practice and with the belief that it is appropriate for insulin initiation to be carried out in general practice. We used descriptive statistics and non-parametric tests to explore these hypotheses. RESULTS 179 health professionals returned completed surveys. Specialists reported higher RC with each other and lower RC with PNs. All groups except PNs reported their highest RC with DNEs, suggesting the potential for DNEs to serve as boundary spanners. Lower RC with specialists was reported by those working within a general practice model of care. Health professionals who felt that a general practice model was appropriate reported lower communication with specialist physicians and higher shared knowledge with GPs. CONCLUSION Given the need for coordination between specialist and generalist care for the task of insulin initiation, this study's results suggest the need to build relationships and communication between specialist and generalist health professional groups and the potential for DNE's to play a boundary spanner role in this process.
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Seufert J, Brath H, Pscherer S, Borck A, Bramlage P, Siegmund T. Composite efficacy parameters and predictors of hypoglycaemia in basal-plus insulin therapy--a combined analysis of 713 type 2 diabetic patients. Diabetes Obes Metab 2014; 16:248-54. [PMID: 24033863 DOI: 10.1111/dom.12211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/24/2013] [Accepted: 08/21/2013] [Indexed: 11/30/2022]
Abstract
AIMS We aimed to identify predictors of hypoglycaemia in patients with poorly controlled type 2 diabetes treated with a single daily bolus of insulin glulisine on top of insulin glargine and oral antidiabetic drugs (basal-plus regimen). METHODS We retrospectively analysed four large basal-plus trials including 713 patients (47% female) with type 2 diabetes, mean age of 59.9 ± 9.5 years and diabetes duration of 11 ± 7.0 years. Predictors for symptomatic, severe and nocturnal hypoglycaemia were identified by multivariate logistic regression analyses, calculation of odds ratios (ORs) and Wald 95% confidence intervals (CIs). RESULTS Mean numbers of hypoglycaemic events per year were 4.64 ± 11.4 (symptomatic < 60 mg/dl), 0.59 ± 2.28 (nocturnal) and 0.03 ± 0.22 (severe). A total of 44.5% of patients reached the composite endpoint of glycated haemoglobin (HbA1c) <7.0% plus no severe hypoglycaemia, and 26.7% reached the composite of HbA1c <7.0% plus no symptomatic hypoglycaemia. Predictors of nocturnal and symptomatic hypoglycaemia were female gender (OR 1.82; 95% CI 1.07-3.11 and OR 1.89; 95% CI 1.31-2.78), diabetes duration >10 versus <5 years (OR 2.61; 95% CI 1.03-6.59 and OR 2.01; 95% CI 1.15-3.51) and higher basal insulin dose (per unit of increase) (OR 1.01; 95% CI 1.00-1.03 and OR 1.01; 95% CI 1.00-1.02). Conversely, a higher body mass index (BMI) (27-30 vs. <27 kg/m(2) and >30 vs. <27 kg/m(2) ) conferred a reduced risk of symptomatic hypoglycaemia with an OR of 0.53 (95% CI 0.31-0.90) and an OR of 0.61 (95% CI 0.39-0.97). CONCLUSIONS Female gender, a long diabetes duration and higher basal insulin dose were predictors of hypoglycaemia, while protection was provided by BMI > 30. These results may help to successfully establish basal-plus insulin regimen in individual patients on their transition from basal-only to basal-bolus treatment.
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Affiliation(s)
- J Seufert
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Freiburg, Germany
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