1
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Gaglia JL, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S158-S178. [PMID: 38078590 PMCID: PMC10725810 DOI: 10.2337/dc24-s009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
2
|
Stewart-Lynch A, Meyers R, Sidig D, McConville SO, Heiple L. Quantifying and Characterizing the Presence of Insulin Overbasalization in a Family Medicine Practice. Clin Diabetes 2023; 42:266-273. [PMID: 38694250 PMCID: PMC11060609 DOI: 10.2337/cd23-0044] [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] [Indexed: 05/04/2024]
Abstract
The American Diabetes Association advises clinicians of the potential for insulin overbasalization in the management of type 2 diabetes. Described as the titration of basal insulin beyond an appropriate dose, overbasalization increases risks for adverse effects such as hypoglycemia and weight gain without achieving the glycemic targets needed to optimally manage the disease. There is a need to determine the prevalence of and clinical factors that can lead to overbasalization. This study aimed to assess the prevalence of and characterize the patient variables associated with overbasalization in a family medicine practice.
Collapse
Affiliation(s)
- Autumn Stewart-Lynch
- Heritage Valley Family Medicine Center, Beaver Falls, PA
- Pharmacy Practice Division, Duquesne University, School of Pharmacy, Pittsburgh, PA
| | - Rebekah Meyers
- Pharmacy Practice Division, Duquesne University, School of Pharmacy, Pittsburgh, PA
| | - Dina Sidig
- Heritage Valley Family Medicine Center, Beaver Falls, PA
| | | | - Lindsay Heiple
- Heritage Valley Family Medicine Center, Beaver Falls, PA
| |
Collapse
|
3
|
Builes-Montaño C, Wandurraga E, Ramírez A, Ordóñez JE. Simplification of Complex Insulin Regimens with IdegLira in People with Type 2 Diabetes: Literature Review and Clinical Recommendations. Diabetes Ther 2023; 14:1959-1976. [PMID: 37736786 PMCID: PMC10570232 DOI: 10.1007/s13300-023-01471-9] [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: 06/21/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION This study developed a simple algorithm based on clinical results described in medical literature and which allows one to simplify complex insulin regimes with IdegLira to avoid adverse events related to the complexity of some insulin treatments. METHODS We conducted a systematic review of the literature that allowed us to identify studies that evaluated the clinical result of simplifying complex insulin regimes. The authors reviewed the common factors these simpler regimes had, including the type of patients who used them. RESULTS We found nine clinical studies published between 2017 and 2022, eight performed in Europe and one in Latin America. The monitoring time of the studies ranged between 3 and 18 months. The size of the study populations was between 61 and 611 patients (the latter was in five countries). In all studies, HbA1c decreased by 0.6-1.7% and the weight decreased by 0.1-3.11 kg. CONCLUSIONS On the basis of the findings of these studies, we made some recommendations for clinical practice to simplify treatment. The results of these studies support an algorithm that simplifies the treatment of complex insulin regimens.
Collapse
Affiliation(s)
- C Builes-Montaño
- University of Antioquia Faculty of Medicine, Medellin, Colombia
- Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia
| | - E Wandurraga
- Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - A Ramírez
- Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | | |
Collapse
|
4
|
Polonsky WH, Guzman SJ, Fisher L. The Hypoglycemic Fear Syndrome: Understanding and Addressing This Common Clinical Problem in Adults With Diabetes. Clin Diabetes 2023; 41:502-509. [PMID: 37849521 PMCID: PMC10577500 DOI: 10.2337/cd22-0131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Although a broad literature on fear of hypoglycemia and its impact on people with type 1 or type 2 diabetes has accumulated over the past three decades, there has been surprisingly little guidance concerning how best to tackle this problem in clinical care. The aim of this article is to begin filling this gap by describing the "hypoglycemic fear syndrome," which we define as hypoglycemic fear that has become so overwhelming that it leads to avoidance behaviors and chronically elevated glucose levels. We begin by presenting several illustrative cases, describing the syndrome and how it is most commonly presented in clinical care, and detailing its most common precipitants. We then offer practical, evidence-based strategies for clinical intervention, based on the literature and our clinical experience.
Collapse
Affiliation(s)
- William H. Polonsky
- Behavioral Diabetes Institute, San Diego, CA
- University of California, San Diego, San Diego, CA
| | | | - Lawrence Fisher
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
5
|
ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S140-S157. [PMID: 36507650 PMCID: PMC9810476 DOI: 10.2337/dc23-s009] [Citation(s) in RCA: 390] [Impact Index Per Article: 390.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
6
|
Shah VN, Akturk HK, Vigers T, Pyle L, Oliver N, Klonoff DC. Relationship Between Daytime Versus Nighttime Continuous Glucose Monitoring Metrics with A1C in Adults with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:62-68. [PMID: 36306519 DOI: 10.1089/dia.2022.0365] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To evaluate influence of daytime versus nighttime continuous glucose monitoring (CGM)-based metrics on A1C in adults with type 1 diabetes (T1D). Research Design and Methods: CGM data from 407 adults with T1D (age 39 ± 15 years, diabetes duration 20 ± 12 years, A1C 7.3% ± 1.4% and 53% female) from two studies were included in this analysis. The association between daytime (6 AM-10.59 PM) and nighttime (11 PM-5.59 AM) CGM variables such as mean glucose, time in range (TIR; 70-180 mg/dL), time in tight target range (TTIR; 70-140 mg/dL), and time above range (TAR >180 mg/dL) was examined within five A1C categories (<7%, 7%-7.9%, 8%-8.9%, 9%-9.9%, and ≥10%). Results: Although mean glucose was increasing with higher A1C, there was no statistical difference in mean glucose between daytime versus nighttime within five A1C groups (143.2 ± 22.7 vs. 143.6 ± 25.0 for A1C <7%, 171.4 ± 17.3 vs. 175.3 ± 28.8 for A1C 7.0%-7.9%, 193.4 ± 19.4 vs. 195.3 ± 29.5 for A1C 8.0%-8.9%, 214.9 ± 28.8 vs. 219.7 ± 36.1 for A1C 9.0%-9.9% and 244.0 ± 39.0 vs. 239.9 ± 50.9 for A1C ≥10%, P > 0.05). Similarly, there was no difference between various CGM metrics by daytime versus nighttime within five A1C groups. Differences between five A1C groups' daytime versus nighttime mean glucose, TIR, TTIR, and TAR were also not statistically significant (all P > 0.05) Conclusion: Daytime versus nighttime glycemic control has similar influence on A1C in adults with T1D.
Collapse
Affiliation(s)
- Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Halis K Akturk
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tim Vigers
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Laura Pyle
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nick Oliver
- Imperial College London, London, United Kingdom
| | - David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, California, USA
| |
Collapse
|
7
|
Nedogoda SV, Barykina IN, Salasyuk AS, Lutova VO, Popova EA. Individualisation of basal insulin therapy of type 2 diabetes: evidence from large randomized controlled trials. DIABETES MELLITUS 2022. [DOI: 10.14341/dm12774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Initiation of insulin therapy with basal insulin analogues has become the standard of care for type 2 diabetes mellitus (T2DM). Timely administration of insulin allows not only to slow down the progression of type 2 diabetes, but also to reduce the frequency and severity of complications associated with it. This paper reviews the efficacy and safety of the use of the latest basal insulin analogues in type 2 diabetes from the perspective of current clinical guidelines, and also reviews updated data on the efficacy and safety of therapy by various members of the class. In this paper a review of the efficacy and safety of latest basal insulin analogues use in T2DM from the standpoint of current clinical guidelines has been carried out, and updated data on the efficacy and safety of therapy by various members of the class have been reviewed, taking into account their impact on the risk of hypoglycemia and glycemic variability. The available data indicate that insulin degludec 200 U/mL may be the drug of choice for those at high risk of developing severe forms of hypoglycemia. Since severe hypoglycemia and high glycemic variability are important risk factors for cardiovascular events and mortality, it has been shown that a differentiated approach to insulin therapy in the treatment of T2DM is currently advisable, taking into account the effect on the risk of hypoglycemia and glycemic variability.
Collapse
|
8
|
Cowart K, Vascimini A, Kumar A, Tsalatsanis A, Saba Y, Carris NW. Impact of Overbasalization on Clinical Outcomes in Patients With Type 2 Diabetes: A Post Hoc Analysis of a Large Randomized Controlled Trial. Clin Diabetes 2022; 41:147-153. [PMID: 37092152 PMCID: PMC10115611 DOI: 10.2337/cd22-0046] [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] [Indexed: 11/13/2022]
Abstract
The American Diabetes Association's Standards of Medical Care in Diabetes emphasize the need for awareness regarding overbasalization (basal insulin doses >0.5 units/kg/day without bolus insulin) in the treatment of type 2 diabetes. However, outcomes data on the impact of overbasalization are limited. This post hoc analysis of a large randomized controlled trial suggests that an insulin therapy regimen involving overbasalization compared with a basal-bolus insulin regimen that avoids overbasalization is less effective at lowering A1C and may be associated with increased cardiovascular risk. Clinicians should consider alternative approaches to glycemic control before increasing basal insulin doses to >0.5 units/kg/day.
Collapse
Affiliation(s)
- Kevin Cowart
- USF Health Taneja College of Pharmacy, University of South Florida, Tampa, FL
| | - Angelina Vascimini
- USF Health Taneja College of Pharmacy, University of South Florida, Tampa, FL
| | - Ambuj Kumar
- USF Health Morsani College of Medicine, University of South Florida, Tampa, FL
| | | | - Yalda Saba
- USF Health Taneja College of Pharmacy, University of South Florida, Tampa, FL
| | - Nicholas W. Carris
- USF Health Taneja College of Pharmacy, University of South Florida, Tampa, FL
| |
Collapse
|
9
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
10
|
Affiliation(s)
- Kevin Cowart
- Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, FL
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
- College of Public Health, University of South Florida, Tampa, FL
- Corresponding author: Kevin Cowart,
| | - Nicholas W. Carris
- Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, FL
- Department of Family Medicine, Morsani College of Medicine; University of South Florida, Tampa, FL
| |
Collapse
|
11
|
Abstract
With the concept of patient-centered care in mind, this article outlines the current diabetes medications available for glucose lowering and the characteristics of each of these medications that need to be considered in shared decision-making for durable and effective therapy. Important patient characteristics such as weight, risk for hypoglycemia, cost, social determinants of health, and medical literacy need to be considered. The evidence-base informing the use of antihyperglycemic agents has changed dramatically due to 2008 FDA guidance for cardiovascular safety and cardiorenal protection with antihyperglycemic agents. New evidence supports an approach to diabetes management that addresses pre-existing cardiorenal disease.
Collapse
Affiliation(s)
- Layla A Abushamat
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, MS 8106, 12801 East 17th Avenue, Room 7103, Aurora, CO 80045, USA.
| | - Jane E B Reusch
- Division of Endocrinology, Metabolism, and Diabetes, University of Colorado School of Medicine, MS 8106, 12801 East 17th Avenue, Room 7103, Aurora, CO 80045, USA; Ludeman Family Center for Women's Health Research, 12348 East Montview Boulevard, Mail Stop C-263, Aurora, CO 80045 USA; Rocky Mountain Regional Veteran Affairs Medical Center, 1700 North Wheeling Street, Aurora, CO 80045, USA
| |
Collapse
|
12
|
|
13
|
Cowart K, Updike WH, Pathak R. Prevalence of and Characteristics Associated With Overbasalization Among Patients With Type 2 Diabetes Using Basal Insulin: A Cross-Sectional Study. Clin Diabetes 2021; 39:173-175. [PMID: 33986570 PMCID: PMC8061546 DOI: 10.2337/cd20-0080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article describes a cross-sectional analysis of 655 patients to determine the prevalence of and patient-specific characteristics associated with overbasalization in patients with type 2 diabetes. Overbasalization was defined as uncontrolled A1C (>8%) plus a basal insulin dose >0.5 units/kg/day. The period prevalence of overbasalization was found to be 38.1, 42.7, and 42% for those with an A1C >8, ≥9, and ≥10%, respectively. Those with an A1C ≥9% had the greatest likelihood of experiencing overbasalization. These results suggest that overbasalization may play a role in patients not achieving optimal glycemic control in type 2 diabetes.
Collapse
Affiliation(s)
- Kevin Cowart
- Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, FL
- Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Wendy H. Updike
- Department of Pharmacotherapeutics & Clinical Research, Taneja College of Pharmacy, University of South Florida, Tampa, FL
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Rashmi Pathak
- College of Public Health, University of South Florida, Tampa, FL
| |
Collapse
|
14
|
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|