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Raghavan A, Nanditha A, Satheesh K, Susairaj P, Vinitha R, Nair DR, Snehalatha C, Ramachandran A. A prospective, multicentre, randomized, open-label comparison of a long-acting basal insulin analog glargine plus glulisine with premixed insulin in insulin naïve patients with Type 2 diabetes - A study from India. Prim Care Diabetes 2024; 18:210-217. [PMID: 38267312 DOI: 10.1016/j.pcd.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
AIMS We aimed to compare the effectiveness of Glargine plus Glulisine to premixed insulin analogue, as measured by HbA1c ≤ 7.0% in insulin naive Type 2 Diabetes (T2D) patients with elevated fasting and/or postprandial plasma glucose. METHODS Insulin-naive T2D patients (116 men, 84 women) on ≥ 2 oral hypoglycemic agents with inadequate glycemic control were randomized either to group 1 (insulin Glargine plus Glulisine, n = 101) or group 2 (Premixed Insulin analogue, n = 99). RESULTS In the intention to treat analysis, at week 24, percentage of patients with good glycaemic control (HbA1c ≤ 7.0%) was similar between the two groups (16.8% in Group 1 vs. 13.1% in Group 2, χ2 - 0.535, p = 0.47). Significant reductions in fasting and postprandial levels were observed in groups 1 and 2 at both post-baseline time points (Week 12 and 24). In group 1, reduction in HbA1c from baseline to week 12 was 0.6 ± 0.1 and 0.7 ± 0.2 at week 24, p < 0.0001 for all. In group 2, no significant change in HbA1c was observed. In group 1, 83.2% required an additional dose of glulisine and in group 2, 88.9% required an additional dose of premixed insulin. Hypoglycemic events were similar in both groups (0.12 events per person-year in group 1 and 0.13 events per person-year in group 2). Weight gain was non-significant in both groups. CONCLUSIONS Glargine plus Glulisine, though in higher dose was effective as premixed insulin in lowering HbA1c. Hypoglycemic events per person-year were similar in both groups.
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Affiliation(s)
- Arun Raghavan
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Arun Nanditha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Krishnamoorthy Satheesh
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Priscilla Susairaj
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ramachandran Vinitha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Dhruv Rajesh Nair
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Chamukuttan Snehalatha
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Ambady Ramachandran
- India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
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Deshmukh V, Chaudhury T, Chadha M, Chawla M, Mukherjee S, Pitale S, Basu D, Gadekar A, Menon S, Trivedi C, Salvi V, Ramakrishnan S, Goyal G. LIVE INDIA: Effectiveness of Gla-100 in a Post hoc Pooled Analysis of FINE ASIA and GOAL Registries. Diabetes Ther 2023; 14:2075-2088. [PMID: 37789213 PMCID: PMC10597908 DOI: 10.1007/s13300-023-01469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Real-world evidence on insulin glargine 100 U/ml (Gla-100) initiation in Indian type 2 diabetes mellitus (T2DM) individuals is limited. The present study aimed to evaluate the effectiveness of Gla-100 in insulin-naïve T2DM participants from India. METHODS This post hoc analysis includes real-world data of insulin-naïve Indian participants with T2DM who started Gla-100 treatment in two Asian registries: FINE ASIA and GOAL. Changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), body weight, insulin dose, and incidence of hypoglycemia from baseline to 6 months were assessed. RESULTS A total of 955 participants with T2DM were identified and analyzed. The mean [standard deviation (SD)] age and duration of diabetes were 54.7 (9.8) years and 9.8 (6.3) years, respectively. Mean HbA1c and FPG were significantly reduced after 6 months of Gla-100 treatment [- 2.07 (1.4) %; - 94.4 (65.2) mg/dl, respectively]. HbA1c targets of < 7.0% and < 7.5% were achieved by 292 (30.6%) and 589 (61.7%) study participants, respectively. The overall incidence of hypoglycemia was low (n = 52; 5.4%); only two participants (0.2%) reported severe hypoglycemia. Insulin was titrated with a mean (SD) increment of 2.5 (5.6) U/day after 6 months, leading to a mean Gla-100 dose of 18.2 (8.9) U/day. Mean body weight remained unchanged from baseline to 6 months (- 0.1 kg). CONCLUSION In routine clinical practice, Gla-100 significantly improved glycemic parameters after 6 months of treatment with a low risk of hypoglycemia and no weight change in participants with T2DM.
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Affiliation(s)
- Vaishali Deshmukh
- Deshmukh Clinic and Research Centre, Second Floor, Pinnacle Prestige, Landmark: Next to Durvankur Hotel, Near Cosmos Bank, Tilak Road, Pantancha Gate, Sadashiv Peth, Pune, Maharashtra, 411030, India.
| | | | - Manoj Chadha
- P.D. Hinduja Hospital and Research Centre, Mumbai, India
| | | | | | | | | | | | | | | | | | | | - Ghanshyam Goyal
- S K Diabetes Research and Education Centre, S V S Marwari Hospital Campus, Kolkata, India
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Repetto P, Ayago D. Clinical impact after implementing an insulin protocol involving a switch to insulin glargine 300 U/ml as basal insulin for inpatient glycaemic control: A retrospective single-centre study. J Diabetes Complications 2023; 37:108584. [PMID: 37595369 DOI: 10.1016/j.jdiacomp.2023.108584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 08/20/2023]
Abstract
AIMS To evaluate the benefit and safety of a switch in the basal insulin protocol to glargine 300 U/ml (Gla-300) on inpatients' overall dysglycemic events. Efficacy and safety data on insulin Gla-300 in the inpatient setting are limited. METHODS Retrospective observational study conducted on 7455 patients admitted to acute care (n = 5414) or geriatric and social healthcare (n = 2041) units of the Regional Hospital of Amposta (Spain) between January 2017 and December 2020 who received basal insulin during hospitalization. Hypo- and hyperglycaemic events were indirectly assessed through hospital pharmacy usage of intravenous glucose and vials of rapid-acting intravenous insulin for 27 months after the switch, and the impact on overall dysglycemic events was analysed. RESULTS After protocol implementation, patients were mostly treated with Gla-300 (83.06 % in acute care; and 83.44 % in geriatric and social healthcare), and presented a significant decrease in the use of intravenous insulin (-60.80 %, P = 0.005) and glucose (-62.13 %, P < 0.001), which translated into a significantly reduced overall dysglycemic events (-62.25 %, P < 0.001), with a good safety and tolerability profile. CONCLUSIONS Overall inpatient dysglycemic events were improved upon the introduction of the new insulin protocol, which calls for the use of Gla-300 as one of the choices of basal insulin for inpatient care.
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Affiliation(s)
- Pablo Repetto
- Servicio de Medicina Interna, Hospital Comarcal de Amposta, Tarragona, Spain.
| | - Daria Ayago
- Servicio de Farmacia, Hospital Comarcal de Amposta, Tarragona, Spain
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Fleeman L, Gilor C. Insulin Therapy in Small Animals, Part 1: General Principles. Vet Clin North Am Small Anim Pract 2023; 53:615-633. [PMID: 36906469 DOI: 10.1016/j.cvsm.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Understanding the pharmacology of insulin and how it relates to the pathophysiology of diabetes can lead to better clinical outcomes. No insulin formulation should be considered "best" by default. Insulin suspensions (NPH, NPH/regular mixes, lente, and PZI) as well as insulin glargine U100 and detemir are intermediate-acting formulations that are administered twice daily. For a formulation to be an effective and safe basal insulin, its action should be roughly the same every hour of the day. Currently, only insulin glargine U300 and insulin degludec meet this standard in dogs, whereas in cats, insulin glargine U300 is the closest option.
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Affiliation(s)
- Linda Fleeman
- Animal Diabetes Australia, Melbourne, Victoria, Australia.
| | - Chen Gilor
- Small Animal Internal Medicine, Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, 2015 Southwest 16th Avenue, Gainesville, FL 32608, USA
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Wang J, Ji X, Liu T, Zhao N. Maternal and neonatal outcomes with the use of long acting, compared to intermediate acting basal insulin (NPH) for managing diabetes during pregnancy: a systematic review and meta-analysis. Diabetol Metab Syndr 2022; 14:154. [PMID: 36271431 PMCID: PMC9585834 DOI: 10.1186/s13098-022-00925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the impact of long-acting insulin analogues, compared to intermediate acting neutral protamine Hagedron (NPH), on maternal, perinatal and neonatal outcomes. METHODS Studies for inclusion in the review were identified using a structured search strategy in PubMed, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) database. Studies that were randomized controlled trials or observational in design were considered for inclusion. Eligible studies should have compared the maternal, perinatal and neonatal outcomes between pregnant women with gestational diabetes mellitus (GDM) managed by intermediate acting (NPH) and by long-acting insulin analogues. Statistical analysis was performed using STATA software. RESULTS We found 17 studies to be eligible for inclusion. The mean gestational weight gain and risk of maternal hypoglycaemia, hypertensive disorder, caesarean delivery, spontaneous abortion, endometritis and wound infection or dehiscence were similar among pregnant women with GDM managed using long-acting insulin analogues and NPH. Those receiving long-acting insulin analogues had significantly lower HbA1c values in the second (WMD - .09, 95% CI 0.12, - 0.06; N = 4) and third trimester (WMD - 0.08, 95% CI - 0.14, - 0.02; N = 12). The mean gestational age and birth weight and risk of perinatal mortality, prematurity, large for gestational age, small for gestational age, shoulder dystocia and congenital abnormalities was similar among babies in both groups. No statistically significant differences in risk of admission to neonatal intensive care unit, respiratory distress, neonatal hypoglycaemia, 5 min APGAR score of < 7, neonatal hyperbilirubinemia and sepsis was observed. The quality of pooled evidence, as per GRADE criteria, was judged to be "very low" for all the maternal and neonatal outcomes considered. CONCLUSIONS Findings suggest no significant differences in the maternal, perinatal and neonatal outcomes between intermediate and long-acting insulin analogues. The results provide support for use of long-acting insulin analogues in women with GDM. However, evidence is still needed from high quality randomized controlled trials to arrive at a recommendation for inclusion in routine clinical care.
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Affiliation(s)
- Jijiao Wang
- The Second Affiliated Hospital of Dalian Medical University, No 467, Zhongshan Road, Dalian, 116021, Liaoning Province, China
| | - Xiaochen Ji
- The Second Affiliated Hospital of Dalian Medical University, No 467, Zhongshan Road, Dalian, 116021, Liaoning Province, China
| | - Ting Liu
- The Second Affiliated Hospital of Dalian Medical University, No 467, Zhongshan Road, Dalian, 116021, Liaoning Province, China.
| | - Nan Zhao
- The Second Affiliated Hospital of Dalian Medical University, No 467, Zhongshan Road, Dalian, 116021, Liaoning Province, China.
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Singh AK, Singh A, Singh R, Misra A. Once-weekly basal insulin icodec: Looking ONWARDS from pharmacology to clinical trials. Diabetes Metab Syndr 2022; 16:102615. [PMID: 36108418 DOI: 10.1016/j.dsx.2022.102615] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Insulin icodec is currently the most advanced candidate insulin suitable for once-weekly administration. We aim to conduct a systematic review of the literature to find out the efficacy and safety of insulin icodec in patients with diabetes mellitus. METHODS We systematically searched the electronic database of PubMed, and Google Scholar from inception until August 20, 2022, using MeSH keywords. Ongoing trials of insulin icodec were additionally searched from the ClinicalTrials.Gov. We retrieved all the available granular details of phase 1 to phase 3 studies of insulin icodec in both type 1 and type 2 diabetes. RESULTS Phase 1 study showed insulin icodec having a half-life of 196 h (>1 week) while a steady state is achieved after 3 to 4 weekly injections. Phase 2 studies compared once-weekly icodec to insulin glargine (U-100) and found a similar glucose control with no significantly greater hypoglycemia risks. Top-line results from the five phase 3 studies reported better glucose control with once-weekly icodec compared to both once-daily insulin glargine (ONWARDS 1) and once-daily degludec (in both ONWARDS 2 and 4) with similar rates of hypoglycemia in type 2 diabetes, although there was a higher hypoglycemic event with insulin icodec in type 1 diabetes (ONWARDS 6) compared to once-daily degludec despite a similar glycemic control. CONCLUSION A brighter prospect of once-weekly insulin icodec is on the card in particular in type 2 diabetes in terms of reducing injection pricks by >85% vs. once-daily basal insulin analogs, although few unknowns still exist.
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Affiliation(s)
| | - Akriti Singh
- Jawaharlal Nehru Medical College & Hospital, Kalyani, West Bengal, India
| | - Ritu Singh
- G. D Hospital & Diabetes Institute, Kolkata, West Bengal, India
| | - Anoop Misra
- Fortis C-DOC Hospital for Diabetes & Allied Sciences, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Abstract
Treatment with basal insulins is a fundamental part of management in many patients with type 2 diabetes mellitus. Multiple management schemes may be indicated in these individuals, for example, the use of oral antihyperglycemic agents with basal insulins (basal-supported oral therapy) or the combinations of basal insulins with glucagon-like peptide-1 receptor agonists; each of these strategies makes it easier to achieve glycemic control goals. A basic knowledge of the physiology, pharmacodynamic and pharmacokinetic aspects of the different basal insulins is essential to achieve treatment goals and compliance. This review addresses the principles of management with basal insulins.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Popayan, Colombia.
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Vargas-Uricoechea H, Aschner P. Comparative efficacy and safety of basal insulins: A review. Diabetes Metab Syndr 2021; 15:102318. [PMID: 34695771 DOI: 10.1016/j.dsx.2021.102318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM To provide an update on the usefulness of basal insulin in patients with type 2 diabetes mellitus. METHODS We conducted a literature search using PubMed and MEDLINE, BIOSIS, Scopus, EMBASE, ClinicalTrials.gov, Google Scholar, and Springer Online Archives Collection until June 2021. RESULTS All basal insulins are similar in efficacy, with only small differences among them in terms of the risk of hypoglycemia. CONCLUSIONS For type 2 diabetes mellitus, all basal insulins have a similar efficacy, with some advantage of Glar-300 and Deg-100 in reducing the risk of hypoglycemia compared to Glar-100.
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Affiliation(s)
- Hernando Vargas-Uricoechea
- Director of Metabolic Diseases Study Group, Department of Internal Medicine, Universidad del Cauca, Carrera 5 # 13N-36, Popayán, Cauca, Colombia.
| | - Pablo Aschner
- Pontificia Universidad Javeriana, Research Advisor of the San Ignacio University Hospital and Scientific Director of the Colombian Diabetes Association, Colombia
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Rosanio FM, Mozzillo E, Cimbalo C, Casertano A, Sepe A, Raia V, Franzese A, Tosco A. Diabetes outbreak during COVID19 lock-down in a prediabetic patient with cystic fibrosis long treated with glargine. Ital J Pediatr 2021; 47:121. [PMID: 34078438 PMCID: PMC8170445 DOI: 10.1186/s13052-021-01076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cystic Fibrosis Related Diabetes (CFRD) is a frequent comorbidity of patients with Cystic Fibrosis (CF). A worsening of clinical conditions appears before CFRD. It has been demonstrated a decline in pulmonary function and nutritional status also in patients with prediabetes. Few trials show that insulin may be beneficial in prediabetic CF patients, to date guidelines do not recommend for this condition. CASE PRESENTATION We report a case of a patient treated with insulin glargine at 13 years, due to glycemic intolerance, and with Lumacaftor/Ivacaftor at 15 years. A reduction of pulmonary exacerbations was observed after glargine therapy, also confirmed after the starting of Lumacaftor/ Ivacaftor in this patient. Pulmonary function improved only after the first year of glargine therapy, then a deterioration appeared due to the natural history of CF lung damage. During the COVID-19 lockdown, poor adherence to care contributed to diabetes mellitus onset needing high insulin requirements. After two weeks the patient returned to prediabetic condition and his previous dose of glargine. CONCLUSIONS our case highlights firstly that insulin glargine has contributed to preserve him from further clinical worsening due to prediabetes in the years before pandemic, secondly the negative impact of COVID-19 lockdown on the clinical course of a chronic disease as CF.
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Affiliation(s)
- Francesco Maria Rosanio
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Enza Mozzillo
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy.
| | - Chiara Cimbalo
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Alberto Casertano
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Angela Sepe
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Valeria Raia
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Adriana Franzese
- Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
| | - Antonella Tosco
- Regional Center of Cystic Fibrosis, Department of Translational Medical Science, Section of Pediatrics, Federico II University of Naples, Naples, Italy
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Gourdy P, Bahloul A, Boultif Z, Gouet D, Guerci B. Efficacy and Safety of Switching Patients Inadequately Controlled on Basal Insulin to Insulin Glargine 300 U/mL: The TRANSITION 2 Study. Diabetes Ther 2020; 11:147-159. [PMID: 31782050 PMCID: PMC6965550 DOI: 10.1007/s13300-019-00734-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION This study aimed to determine, in close to real-life conditions, the efficacy and safety of switching from any basal insulin to insulin glargine 300 U/mL (Gla-300) in patients with uncontrolled type 2 diabetes (T2D). METHODS This was an interventional, multicenter, single-arm, prospective study with a 24-week treatment phase. Adult patients with T2D treated with basal insulin with or without other antidiabetics, HbA1c > 7.5%, and fasting self-monitored blood glucose (F-SMBG) > 130 mg/dL (mean of three measures) at baseline were included. Insulin dose was titrated to reach F-SMBG 90-130 mg/dL. Efficacy and safety were assessed at 12 weeks (W12) and 24 weeks (W24). The main outcome parameter was HbA1c change between baseline and W24. Safety parameters included self-reported hypoglycemia (any type). Patients' satisfaction with the treatment was assessed by the Diabetes Treatment Satisfaction Questionnaire (DTSQ). RESULTS A total of 140 patients were included and 137 were treated. Mean HbA1c decreased from 8.64% at baseline to 8.14% at W12 (mean difference [95% CI] - 0.51% [- 0.64; - 0.38]) and 8.01% at W24 (- 0.64% [- 0.81; - 0.46]). Target F-SMBG was reached in 35.0% of the patients at W12 and 38.4% at W24. The percentages of patients reaching HbA1c levels < 7.0%, < 7.5%, and < 8.0% at W24 were 11.4%, 29.5%, and 50.8%, respectively, while only 31.6% had an HbA1c value < 8.0% at baseline. HbA1c reduction was greater in patients with higher baseline levels. During the treatment phase, 46.0% of the participants had at least one hypoglycemia event; 31.4% documented symptomatic hypoglycemia, 2.2% severe hypoglycemia, and 12.2% nocturnal hypoglycemia. Treatment satisfaction increased by 20% between baseline and W24. CONCLUSION These data, derived from close to real-life practice in France, confirm the reassuring results of randomized trials on the efficacy and safety of Gla-300. TRIAL REGISTRATION EudraCT number 2015-002416-33.
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Affiliation(s)
- Pierre Gourdy
- Service de diabétologie, maladies métaboliques et nutrition, CHU et Université de Toulouse, Toulouse, France.
| | | | | | - Didier Gouet
- Centre Hospitalier de La Rochelle, La Rochelle, France
| | - Bruno Guerci
- Service d'Endocrinologie, Diabétologie et Nutrition, CHRU de Nancy & Université de Lorraine, Nancy, France
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Bajaj S, Das AK, Kalra S, Sahay R, Saboo B, Das S, Shunmugavelu M, Jacob J, Priya G, Khandelwal D, Dutta D, Chawla M, Surana V, Tiwaskar M, Joshi A, Shrestha PK, Bhattarai J, Bhowmik B, Latt TS, Aye TT, Vijayakumar G, Baruah M, Jawad F, Unnikrishnan AG, Chowdhury S, Pathan MF, Somasundaram N, Sumanathilaka M, Raza A, Bahendeka SK, Coetzee A, Ruder S, Ramaiya K, Lamptey R, Bavuma C, Shaikh K, Uloko A, Chaudhary S, Abdela AA, Akanov Z, Rodrìguez-Saldaña J, Faradji R, Tiago A, Reja A, Czupryniak L. BE-SMART (Basal Early Strategies to Maximize HbA1c Reduction with Oral Therapy): Expert Opinion. Diabetes Ther 2019; 10:1189-1204. [PMID: 31102253 PMCID: PMC6612329 DOI: 10.1007/s13300-019-0629-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Indexed: 12/12/2022] Open
Abstract
The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi.
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Affiliation(s)
- Sarita Bajaj
- Department of Medicine, MLN Medical College, Allahabad, India
| | - A K Das
- Department of Medicine, JIPMER, Puducherry, India
| | - Sanjay Kalra
- Department of Diabetes and Endocrinology, Bharti Hospital, Karnal, India.
| | - Rakesh Sahay
- Department of Endocrinology, Osmania Medical College and Hospital, Hyderabad, India
| | - Banshi Saboo
- Diacare-Diabetes Care and Hormone Clinic, Ahmedabad, India
| | - Sambit Das
- Department of Endocrinology, Apollo Hospitals, Bhubaneswar, India
| | - M Shunmugavelu
- Trichy Diabetes Speciality Centre (P) Ltd., Trichy, India
| | - Jubbin Jacob
- Endocrine and Diabetes Unit, Department of Medicine, Christian Medical College and Hospital, Ludhiana, India
| | | | - Deepak Khandelwal
- Department of Endocrinology, Maharaja Agrasen Hospital, Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Diabetology and Metabolic Disorders, Venkateshwar Hospital, New Delhi, India
| | - Manoj Chawla
- Lina Diabetes Care and Mumbai Diabetes Research Centre, Mumbai, India
| | | | | | - Ameya Joshi
- Bhaktivedanta Hospital and Research Institute, Thane, India
| | | | | | - Bishwajit Bhowmik
- Centre for Global Health Research, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | | | - Than Than Aye
- University of Medicine 2, Myanmar Society of Endocrinology and Metabolism (MSEM), Yangon, Myanmar
| | - G Vijayakumar
- Apollo Specialty Hospital and Diabetes Medicare Centre, Chennai, India
| | | | - Fatema Jawad
- Journal of Pakistan Medical Association, Karachi, Pakistan
| | | | | | - Md Faruqe Pathan
- Department of Endocrinology, BIRDEM General Hospital, Dhaka, Bangladesh
| | - Noel Somasundaram
- Diabetes and Endocrine Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Manilka Sumanathilaka
- National Hospital of Sri Lanka, Sri Lanka College of Endocrinologists, Colombo, Sri Lanka
| | - Abbas Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Silver K Bahendeka
- Mother Kevin Postgraduate Medical School, Martyrs University, St. Francis Hospital, Kampala, Uganda
| | - Ankia Coetzee
- Division of Endocrinology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Society for Endocrinology, Diabetes and Metabolism, Cape Town, South Africa
| | - Sundeep Ruder
- Life Fourways Hospital, University of the Witwatersrand, Cape Town, South Africa
| | | | - Roberta Lamptey
- Korle Bu Teaching Hospital, University of Ghana School of Medicine and Dentistry, Accra, Ghana
| | - Charlotte Bavuma
- College of Medicine and Health Science, University of Rwanda, Kigali, Rwanda
| | - Khalid Shaikh
- Department of Diabetes, Faculty of Internal Medicine, Royal Oman Police Hospital, Muscat, Oman
| | - Andrew Uloko
- College of Health Sciences, Bayero University, Kano, Nigeria
| | | | - Abdurezak Ahmed Abdela
- Department of Internal Medicine, School of Medicine, CHS, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zhanay Akanov
- Kazakh Society for Study of Diabetes, Almaty, Kazakhstan
| | | | - Raquel Faradji
- Clinica EnDi, RENACED Diabetes Tipo 1, Escuela de Medicina, TEC-ABC, Centro Médico ABC, Sociedad Mexicana de Nutrición y Endocrinología, Mexico City, Mexico
| | - Armindo Tiago
- Mozambican Diabetic Association, Maputo Central Hospital, Maputo, Mozambique
| | - Ahmed Reja
- Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Central University Hospital, Warsaw Medical University, Warsaw, Poland
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Nagel N, Graewert MA, Gao M, Heyse W, Jeffries CM, Svergun D, Berchtold H. The quaternary structure of insulin glargine and glulisine under formulation conditions. Biophys Chem 2019; 253:106226. [PMID: 31376619 DOI: 10.1016/j.bpc.2019.106226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 06/18/2019] [Accepted: 07/10/2019] [Indexed: 11/17/2022]
Abstract
The quaternary structures of insulin glargine and glulisine under formulation conditions and upon dilution using placebo or water were investigated using synchrotron small-angle X-ray scattering. Our results revealed that insulin glulisine in Apidra® is predominantly hexameric in solution with significant fractions of dodecamers and monomers. Upon dilution with placebo, this equilibrium shifts towards monomers. Insulin glargine in Lantus® and Toujeo® is present in a stable hexamer/dimer equilibrium, which is hardly affected by dilution with water down to 1 mg/ml insulin concentration. The results provide exclusive insight into the quaternary structure and thus the association/dissociation properties of the two insulin analogues in marketed formulations.
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Affiliation(s)
- Norbert Nagel
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, 65926 Frankfurt, Germany.
| | - Melissa A Graewert
- European Molecular Biology Laboratory, Hamburg Unit, c/o DESY, Notkestraße 85, 22603 Hamburg, Germany; BioSAXS GmbH c/o DESY, Notkestraße 85, 22603 Hamburg, Germany
| | - Mimi Gao
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, 65926 Frankfurt, Germany
| | - Winfried Heyse
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, 65926 Frankfurt, Germany
| | - Cy M Jeffries
- European Molecular Biology Laboratory, Hamburg Unit, c/o DESY, Notkestraße 85, 22603 Hamburg, Germany
| | - Dmitri Svergun
- European Molecular Biology Laboratory, Hamburg Unit, c/o DESY, Notkestraße 85, 22603 Hamburg, Germany.
| | - Harald Berchtold
- Sanofi-Aventis Deutschland GmbH, R&D, Industriepark Höchst, 65926 Frankfurt, Germany
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13
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Philis-Tsimikas A, Astamirova K, Gupta Y, Haggag A, Roula D, Bak BA, Fita EG, Nielsen AM, Demir T. Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus. Diabetes Res Clin Pract 2019; 147:157-165. [PMID: 30448451 DOI: 10.1016/j.diabres.2018.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/11/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023]
Abstract
AIMS To confirm non-inferiority of insulin degludec/insulin aspart (IDegAsp) once-daily (OD) versus insulin glargine (IGlar) U100 OD + insulin aspart (IAsp) OD for HbA1c after 26 weeks, and compare efficacy and safety between groups at W26 + W38. METHODS A 38-week, randomised, open-label, treat-to-target (HbA1c < 7.0%) trial in adults with type 2 diabetes mellitus (on basal insulin ± oral antidiabetic drugs; HbA1c 7.0-10.0%). Randomisation (1:1): IDegAsp or IGlar U100 + IAsp. Intensification to IDegAsp twice daily (BID) was permitted at W26 + W32, or with additional IAsp injections at W26 (maximum IAsp BID) or W32 (maximum IAsp three-times daily). RESULTS For W0-W26, mean percentage-change (standard deviation) HbA1c was: IDegAsp, -1.1 (0.9); IGlar U100 + IAsp, -1.1 (0.8); estimated treatment difference: 0.07% (95% confidence interval [CI]: -0.06; 0.21) confirmed non-inferiority. At W26 and W38, target HbA1c achievement, and mean fasting and postprandial glucose were similar across groups. At W38, more subjects achieved target HbA1c without hypoglycaemia with IDegAsp (22.5%) than with IGlar U100 + IAsp (21.1%), with significantly fewer nocturnal episodes (W0-W38, estimated rate ratio: 0.61 [95% CI: 0.40; 0.93]). Safety profiles were similar across treatment groups throughout. CONCLUSIONS IDegAsp OD/BID are effective treatment intensification options versus multiple injection basal-bolus therapies, achieving similar glycaemic control, with significantly less nocturnal hypoglycaemia.
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Affiliation(s)
| | - K Astamirova
- Saint-Petersburg Territorial Diabetic Centre, Saint-Petersburg, Russia
| | - Y Gupta
- All India Institute of Medical Sciences, New Delhi, India
| | - A Haggag
- Anaheim Clinical Trials, Anaheim, CA, USA
| | - D Roula
- Salah Boubnider University, Constantine, Algeria
| | - B A Bak
- Novo Nordisk A/S, Søborg, Denmark
| | - E G Fita
- Novo Nordisk A/S, Søborg, Denmark
| | | | - T Demir
- Dokuz Eylül Üniversity, İzmir, Turkey
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14
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Siegmund T, Borck A, Zisman A, Bramlage P, Kress S. A higher blood glucose level pre-breakfast in comparison to bedtime is a contraindication for intensification of prandial insulin therapy in patients with type 2 diabetes - The impact of a negative BeAM value. J Clin Transl Endocrinol 2018; 14:34-38. [PMID: 30416973 PMCID: PMC6214867 DOI: 10.1016/j.jcte.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/27/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023] Open
Abstract
Aims The BeAM value refers to the difference between a patient’s blood glucose level at bedtime (Be) and the following morning before breakfast (AM). The clinical impact of a negative BeAM value (AM blood glucose reading compared to that taken at bedtime) is unknown. Methods T2DM patients of the OPAL and POC trials were pooled and their BeAM values calculated. Results From a total of 358 patients, 31 were calculated as having a negative BeAM value at baseline, while 182 had a high value. Patients in the negative BeAM group were younger, had shorter diabetes duration, and lower HbA1c levels. Fasting blood glucose levels were higher in the negative BeAM group, and these increased to a greater extent during the trial periods. No significant differences in hypoglycaemia occurrence were observed. Multivariate adjusted analysis indicated no association between a negative BeAM value and achievement of HbA1c < 7%, or composite endpoints that additionally included no hypoglycaemia and no weight gain. Conclusions Supplementation of BOT with prandial insulin is not beneficial for patients who have a higher blood glucose reading before breakfast in comparison to before bedtime. Further investigation into the cause of the high morning reading in these patients is indicated.
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Affiliation(s)
- Thorsten Siegmund
- Städt. Klinikum München GmbH, Klinikum Bogenhausen, Germany
- Corresponding author at: Klinik für Endokrinologie, Diabetologie und Angiologie, Klinikum München Bogenhausen, Städt. Klinikum München GmbH, Englschalkinger Straße 77, 81925 München, Germany.
| | - Anja Borck
- Sanofi-Aventis Deutschland GmbH, Berlin, Germany
| | - Ariel Zisman
- The Endocrine Center of Aventura, Aventura, FL, USA
| | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany
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Li J, Wang L, Chen F, Xia D, Miao L. Switching from glargine+insulin aspart to glargine+insulin aspart 30 before breakfast combined with exercise after dinner and dividing meals for the treatment of type 2 diabetes patients with poor glucose control - a prospective cohort study. BMC Endocr Disord 2018; 18:69. [PMID: 30285711 PMCID: PMC6167858 DOI: 10.1186/s12902-018-0297-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 09/23/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND This study aimed to examine the switch from glargine+once daily insulin aspart (1 + 1 regimen) to glargine+insulin aspart 30 before breakfast combined with exercise and in patients with type 2 diabetes mellitus (T2DM) with poorly controlled blood glucose levels. METHODS Consecutive patients with poorly controlled T2DM (n = 182) were switched from the 1 + 1 regimen to glargine+insulin aspart 30 before breakfast in combination with exercise after dinner and dividing meals in two (same final calories intake). The insulin doses were adjusted according to blood glucose levels within 4 weeks after the switch and maintained for 12 weeks. Fasting blood glucose (FBG), 2-hpostprandial glucose (2hPG), glycosylated hemoglobin (HbA1c), body mass index (BMI), daily insulin dose, and hypoglycemia events were assessed. RESULTS Sixteen weeks after the switch, 2 h PG levels and HbA1c levels (from 8.5 to 7.4%, P = 0.001) were improved. The proportions of patients reaching the HbA1c targets of 7.5% were improved (from 22.5 to 58.7%, P = 0.001). Among the 182 patients, 24 (13.2%) divided one meal into two meals, and 23 (12.6%) divided two meals into four meals. Among all patients, 8.5% had to reuse insulin aspart before dinner after the study. One patient with diarrhea and poor appetite experienced severe hypoglycemia. The rate of hypoglycemia was 3.76 events/patient-year. The daily insulin Aspart 30 dose was higher than the original insulin aspart dose (P = 0.001). CONCLUSIONS For patients with poorly controlled T2DM under the 1 + 1 regimen, switching to glargine+insulin aspart 30 before breakfast combined with exercise after dinner and dividing meals showed promising benefits.
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Affiliation(s)
- Jing Li
- Department of Endocrinology, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China.
| | - Liming Wang
- Department of Endocrinology, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Fen Chen
- Department of Endocrinology, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Dongxia Xia
- Department of Endocrinology, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
| | - Lingling Miao
- Department of Endocrinology, The Affiliated Hospital of Medical School of Ningbo University, Zhejiang, China
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Miyagi M, Uchino H, Kumashiro N, Higa M, Shin K, Sasamoto M, Kitazato H, Tamaki M, Matsuhisa M, Hirose T. Up-Titration Strategy After DPP-4 Inhibitor-Based Oral Therapy for Type 2 Diabetes: A Randomized Controlled Trial Shifting to a Single-Dose GLP-1 Enhancer Versus Adding a Variable Basal Insulin Algorithm. Diabetes Ther 2018; 9:1959-1968. [PMID: 30121725 PMCID: PMC6167274 DOI: 10.1007/s13300-018-0486-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION It is unclear whether adding basal insulin or enhancing incretin signaling with a glucagon-like peptide-1 receptor agonist (GLP-1RA) is more effective as an up-titration strategy after dipeptidyl peptidase-4 inhibitor (DPP-4i)-based oral antidiabetic drug (OAD) therapy. GLP-1RAs can be injected without dose adjustment, unlike basal insulin. Our objective was to examine the efficacy of changing patients inadequately controlled with oral DPP-4i-based OAD therapy to injectable GLP-1RA and discontinuing the DPP4i versus adding basal insulin glargine (IGlar) with the continuation of the oral DPP4i. METHODS Sixty patients with type 2 diabetes (T2DM) and glycated hemoglobin (HbA1c) between 7.0% and 10.0% on DPP-4i-based OAD therapy were randomized to either adding IGlar and remaining on the DPP-4i or liraglutide and discontinuing the DPP-4i for 24 weeks. Patients in the IGlar group started with 0.1 unit/kg and were titrated according to the algorithm. In the liraglutide group, the DPP-4i was replaced with liraglutide 0.9 mg/day, the maximum dose in Japan. We evaluated HbA1c, glycated albumin (GA), and anthropometrics. RESULTS HbA1c was significantly lower at week 24 (- 1.0 ± 0.9% in the IGlar group and - 0.6 ± 0.8% in the liraglutide group), but the difference between groups was not significant. Changes in GA were similar (- 2.9 ± 3.2% vs. - 2.6 ± 3.2%) in both groups. Body weight (BW) was significantly lower only in the liraglutide group (+ 0.5 ± 2.6 kg vs. - 2.2 ± 2.0 kg). The rate of minor hypoglycemic episodes was similar for both groups. CONCLUSION For poorly controlled T2DM on DPP-4i-based OAD therapy, switching to single-dose liraglutide to enhance incretin signaling is as effective as dose-titrated basal IGlar, but significant BW reduction was only seen in the liraglutide group. These results suggest that enhancing incretin signaling with a single-dose injectable GLP-1 RA might be an alternative to dose-titrated basal insulin therapy in patients with T2DM poorly controlled with DPP-4i-based OAD therapy. These findings should be confirmed in a longer and larger trial. TRIAL REGISTRATION Trial Registry (UMIN-CTR) as UMIN000012224.
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Affiliation(s)
- Masahiko Miyagi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, Japan.
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Mariko Higa
- Division of Diabetes and Endocrinology, Saiseikai Yokohama-city Tobu Hospital, Kanagawa, Japan
| | | | | | - Hiroji Kitazato
- Division of Diabetes and Endocrinology, Omori Red-Cross Hospital, Tokyo, Japan
| | - Motoyuki Tamaki
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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Abstract
PURPOSE OF REVIEW The DEVOTE study compared the cardiovascular safety of two basal insulins, degludec, and glargine U100 in patients with type 2 diabetes (T2D) at high risk for cardiovascular disease (CVD). In this review, we summarize the results of DEVOTE and provide a clinical perspective. RECENT FINDINGS DEVOTE was a phase 3b, multicenter, international, treat-to-target, double-blind, event-driven trial. Patients with T2D > 50 years of age with prior CVD or > 60 years of age with CVD risk factors were randomly assigned to receive either degludec (n = 3818) or insulin glargine U100 (n = 3819) and were followed until at least 633 positively adjudicated major adverse cardiovascular events (MACE; cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) accrued. At baseline, the mean age of the subjects was 65.0 years, the mean duration of diabetes was 16.4 years, and the mean HbA1c was 8.4 ± 1.7%. After a median follow-up of 2 years, HbA1c had decreased to 7.5 ± 1.2% in each group. Degludec was non-inferior to insulin glargine U100 with respect to the primary MACE outcome (hazard ratio 0.91; 95% CI 0.78-1.06). Significantly, lower rates of severe hypoglycemia and nocturnal severe hypoglycemia were observed with degludec compared to glargine U100 (rate ratios of 0.60; 95% CI 0.48-0.76 and 0.47; 95% CI 0.31 to 0.73, respectively). DEVOTE demonstrated that the cardiovascular safety of degludec was comparable to that of insulin glargine U100 in patients with T2D at high risk for CVD. Additionally, degludec was superior to insulin glargine U100 with respect to the risk for severe hypoglycemia. These results suggest that degludec might be preferred in patients at risk for severe hypoglycemia, including the elderly, those with CVD and/or those with chronic kidney disease.
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Affiliation(s)
- Anika Bilal
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA
| | - Richard E Pratley
- Florida Hospital Translational Research Institute for Metabolism and Diabetes, 301 East Princeton Street, Orlando, FL, 32804, USA.
- Florida Hospital Diabetes Institute, Orlando, FL, USA.
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Bonabello LA, Maggi D, Fiorini S, Tozzo V, Cordera R. Switching from Glargine to Degludec is not associated with an overt change in glucose control in a cohort of patients with type 1 diabetes: a CGM analysis. Acta Diabetol 2018. [PMID: 29525984 DOI: 10.1007/s00592-018-1121-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Affinito Bonabello
- Department of Internal Medicine (DIMI), University of Genova and Ospedale Policlinico San Martino, viale Benedetto XV 6, 16132, Genoa, Italy
| | - Davide Maggi
- Department of Internal Medicine (DIMI), University of Genova and Ospedale Policlinico San Martino, viale Benedetto XV 6, 16132, Genoa, Italy
| | - Samuele Fiorini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Via Dodecaneso 35, Genoa, Italy
| | - Veronica Tozzo
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genova, Via Dodecaneso 35, Genoa, Italy
| | - Renzo Cordera
- Department of Internal Medicine (DIMI), University of Genova and Ospedale Policlinico San Martino, viale Benedetto XV 6, 16132, Genoa, Italy.
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Saborido-Cansino C, Santos-Ramos B, Carmona-Saucedo C, Rodríguez-Romero MV, González-Martín A, Palma-Amaro A, Rojas-Lucena IM, Almeida-González C, Sánchez-Fidalgo S. [Effectiveness of an intervention strategy in the biosimilar glargine prescription pattern in primary care]. Aten Primaria 2018; 51:350-358. [PMID: 29861115 PMCID: PMC6839203 DOI: 10.1016/j.aprim.2018.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/22/2018] [Accepted: 02/06/2018] [Indexed: 11/05/2022] Open
Abstract
Objetivos Evaluar el impacto de una estrategia de intervención en el patrón de prescripción de la insulina glargina biosimilar (IGBio) respecto al compuesto de referencia y analizar la influencia del perfil del prescriptor y su repercusión económica. Diseño Estudio cuasiexperimental de tipo antes/después, con un grupo control. Emplazamiento Dos áreas de gestión sanitaria (AGS) de Sevilla: AGS Sur (área intervención) y AGS Osuna (área control). Participantes La totalidad de los médicos de atención primaria de cada área: 220 y 100, respectivamente. Intervención Se realizaron sesiones formativas, se envió un boletín farmacoterapéutico e informes de retroalimentación mensual durante los 6 meses tras la intervención formativa. El estudio fue llevado a cabo desde la comercialización del biosimilar, en octubre de 2015, hasta febrero de 2016 (pre-intervención) y desde febrero hasta agosto de 2016 (intervención). Mediciones principales Los indicadores analizados han sido porcentaje de pacientes y porcentaje de dosis diaria definida (DDD) con IGBio respecto al total y el coste. Los médicos han sido analizados por subgrupos de edad, sexo, formación, tipo de contrato, años de experiencia y cupo. Resultados principales Ambos indicadores aumentan al mismo nivel en ambas áreas antes de la intervención. Sin embargo, después de la intervención fueron significativamente diferentes entre las áreas (p < 0,0005), intervalo de confianza al 95% (2,5-4,7). La razón del porcentaje de incremento relativo acumulado de ambas variables entre áreas fue 3,73 veces mayor tras la intervención. En el área intervención no se encontraron diferencias para los subgrupos de médicos evaluados. Conclusiones Estrategias encaminadas a la formación/información, así como el seguimiento a los profesionales sanitarios, inciden en el patrón de prescripción y pueden tener una repercusión económica. Nuestros resultados no se han visto influenciados por el perfil del prescriptor.
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Affiliation(s)
| | | | | | | | | | - Ana Palma-Amaro
- UGC Dos Hermanas, Centro de Salud Los Montecillos , Dos Hermanas, Sevilla, España
| | | | - Carmen Almeida-González
- Bioestadística, Hospital Universitario Valme, Sevilla, España; Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España
| | - Susana Sánchez-Fidalgo
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Sevilla, Sevilla, España.
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Li HQ, Lu CF, Wang J, Yin GP, Sun R, Xu XH, Liu BL, Li FF, Jing T, Lee KO, Ye L, Ma JH, Su XF. A comparison of clinical efficacy and economic value in Basalin- and Lantus-treated patients with type 2 diabetes using continuous glucose monitoring system. J Endocrinol Invest 2018. [PMID: 28643298 DOI: 10.1007/s40618-017-0712-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To determine the clinical non-inferiority of recombinant glargine-Basalin vs glargine-Lantus, in treatment of type 2 diabetes mellitus (T2DM) using continuous glucose monitoring system (CGMS). METHODS One hundred patients with T2DM were recruited. They were either regularly taking Basalin (Basalin group) or Lantus (Lantus group) (n = 50 each). CGMS was employed to real-time monitor blood glucose profile for 4 days (from day 1 to day 5). To exclude the effect of patient background, the study design was to have a blinded crossover from glargine-Basalin to glargine-Lantus on day 3, and vice versa. 24-hour mean blood glucose (24hMBG), 24-hour standard deviation of blood glucose (24hSDBG), 24-hour mean amplitude of glycemic excursion (24hMAGE), and number of glycemic excursion (NGE) every 24 h (24hNGE) were calculated for each glargine from 100 patients. RESULTS No significant difference of 24hMBG, 24hSDBG, 24hMAGE, and 24hNGE (p > 0.05 for all) was found between Basalin and Lantus treatments. The glucose area under the curve and time when blood glucose was below 3.9 mmol/L, between 3.9 and 10.0 mmol/L, or above 10.0 mmol/L were similar between Basalin and Lantus treatment. The frequency of hypoglycemic episodes was also similar. However, the mean cost of Basalin was only 72% of Lantus's in one treatment course. CONCLUSION Glargine-Basalin is non-inferior in clinical efficacy compared to glargine-Lantus. In view of the large difference in the cost of glargine-Basalin, it would be much more cost-effective for our patients.
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Affiliation(s)
- H Q Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - C F Lu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - J Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - G P Yin
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - R Sun
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - X H Xu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - B L Liu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - F F Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - T Jing
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China
| | - K O Lee
- Division of Endocrinology, Department of Medicine, National University of Singapore, Singapore, Singapore
| | - L Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - J H Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China.
| | - X F Su
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210029, China.
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Papademetriou V, Nylen ES, Doumas M, Probstfield J, Mann JFE, Gilbert RE, Gerstein HC. Chronic Kidney Disease, Basal Insulin Glargine, and Health Outcomes in People with Dysglycemia: The ORIGIN Study. Am J Med 2017; 130:1465.e27-1465.e39. [PMID: 28842165 DOI: 10.1016/j.amjmed.2017.05.047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 05/26/2017] [Accepted: 05/29/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Early stages of chronic kidney disease are associated with an increased cardiovascular risk in patients with established type 2 diabetes and macrovascular disease. The role of early stages of chronic kidney disease on macrovascular outcomes in prediabetes and early type 2 diabetes mellitus is not known. In the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial, the introduction of insulin had no effect on cardiovascular outcomes compared with standard therapy. In this post hoc analysis of ORIGIN, we compared cardiovascular outcomes in subjects without to those with mild (Stages 1-2) or moderate chronic kidney disease (Stage 3). METHODS Τwo co-primary composite cardiovascular outcomes were assessed. The first was the composite end point of nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes; and the second was a composite of any of these events plus a revascularization procedure, or hospitalization for heart failure. Several secondary outcomes were prespecified, including microvascular outcomes, incident diabetes, hypoglycemia, weight, and cancers. RESULTS Complete renal function data were available in 12,174 of 12,537 ORIGIN participants. A total of 8114 (67%) had no chronic kidney disease, while 4060 (33%) had chronic kidney disease stage 1-3. When compared with nonchronic kidney disease participants, the risk of developing the composite primary outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) in those with mild to moderate chronic kidney disease was 87% higher; hazard ratio (HR) 1.87; 95% confidence interval (CI), 1.71-2.04 (P < .0001). The presence of chronic kidney disease 1-3 was also associated with a greater than twofold higher risk for both all-cause mortality (HR 2.17; 95% CI, 1.98-2.38; P < .0001) and cardiovascular mortality (HR 2.39; 95% CI, 2.13-2.69; P < .0001). Moreover, patients with mild to moderate chronic kidney disease had significantly higher risk for nonfatal myocardial infarction (50%), nonfatal stroke (68%), any stroke (84%), the above composite primary end point plus revascularization or heart failure requiring hospitalization (59%), or a major coronary artery disease event (56%). Furthermore, in patients with chronic kidney disease and early diabetes mellitus type 2, the primary end point occurred 83% more frequently as compared with nonchronic kidney disease participants (HR 1.83; 95% CI, 1.67-2.01; P < .001) and in patients with prediabetes and chronic kidney disease 67% more frequently (HR 1.67; 95% CI,1.25-2.24; P < .001). CONCLUSIONS In high-risk patients with dysglycemia (prediabetes and early diabetes), mild and moderate chronic kidney disease significantly increased cardiovascular events.
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Affiliation(s)
- Vasilios Papademetriou
- Veterans Administration Medical Center, Washington, DC; Georgetown University Medical Center, Washington, DC.
| | - Eric S Nylen
- Veterans Administration Medical Center, Washington, DC; George Washington University Medical Centers, Washington, DC
| | - Michael Doumas
- George Washington University Medical Centers, Washington, DC; Aristotle University of Thessaloniki, Greece
| | | | | | | | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Ramos A, Zapata L, Vera P, Betbese AJ, Pérez A. Transition from intravenous insulin to subcutaneous long-acting insulin in critical care patients on enteral or parenteral nutrition. ACTA ACUST UNITED AC 2017; 64:552-556. [PMID: 29179857 DOI: 10.1016/j.endinu.2017.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 06/01/2017] [Accepted: 08/01/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The optimal initial dose of subcutaneous (SC) insulin after intravenous (IV) infusion is controversial, especially in patients receiving continuous enteral nutrition (EN) or total parenteral nutrition (TPN). The aim of this study was to evaluate the strategy used at our hospital intensive care unit (ICU) in patients switched from IV insulin to SC insulin glargine while receiving EN or TPN. DESIGN AND METHODS A retrospective analysis was made of 27 patients on EN and 14 on TPN switched from IV infusion insulin to SC insulin. The initial dose of SC insulin was estimated as 50% of the daily IV insulin requirements, extrapolated from the previous 12h. A corrective dose of short-acting insulin (lispro) was used when necessary. RESULTS Mean blood glucose (BG) level during SC insulin treatment was 136±35mg/dL in the EN group and 157±37mg/dL in the TPN group (p=0.01). In the TPN group, mean BG was >180mg/dL during the first three days after switching, and a 41% increase in the glargine dose was required to achieve the target BG. In the EN group, mean BG remained <180mg/dL throughout the days of transition and the dose of glargine remained unchanged. CONCLUSIONS In the transition from IV to SC insulin therapy, initial insulin glargine dose estimated as 50% of daily IV insulin requirements is adequate for patients on EN, but inadequate in those given TPN.
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Affiliation(s)
- Analía Ramos
- Department of Endocrinology & Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Lluis Zapata
- Department of Critical Care Medicine, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Paula Vera
- Department of Critical Care Medicine, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Antoni J Betbese
- Department of Critical Care Medicine, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Pérez
- Department of Endocrinology & Nutrition, Hospital Santa Creu i Sant Pau, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain; CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Spain.
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Fattorusso V, Casale A, Raia V, Mozzillo E, Franzese A. Long-Term Follow-Up in a Girl with Cystic Fibrosis and Diabetes Since the First Year of Life. Diabetes Ther 2017; 8:1187-1190. [PMID: 28770464 PMCID: PMC5630546 DOI: 10.1007/s13300-017-0289-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Indexed: 11/25/2022] Open
Abstract
Diabetes mellitus is the most common comorbidity in cystic fibrosis (CF). Recently, more attention has been paid to early glucose metabolism derangements (GMDs). The subject of this report is a female patient, affected by CF since 3 months of age. She presented with intermittent diabetes during early childhood. At the age of 10 years, oral glucose tolerance test (OGTT) was performed and showed glucose intolerance (IGT) status; glargine insulin therapy was started. At the age of 13 years, CF-related diabetes with fasting hyperglycemia occurred, so rapid insulin at meals was added. During the following year, clinical and nutritional status improved. Stable clinical conditions were observed in the following 3 years. This is the first case of very long-term follow-up concerning a CF patient with GMDs. Our case confirms the importance of paying attention to early GMDs in very young CF patients and seems to suggest that earlier therapy could ameliorate CF natural history.
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Affiliation(s)
- Valentina Fattorusso
- Section of Pediatrics, Department of Translational Medical Science (DISMET), University of Naples Federico II, Naples, Italy.
| | - Alida Casale
- Section of Pediatrics, Department of Translational Medical Science (DISMET), University of Naples Federico II, Naples, Italy
| | - Valeria Raia
- Section of Pediatrics, Department of Translational Medical Science (DISMET), University of Naples Federico II, Naples, Italy
| | - Enza Mozzillo
- Section of Pediatrics, Department of Translational Medical Science (DISMET), University of Naples Federico II, Naples, Italy
| | - Adriana Franzese
- Section of Pediatrics, Department of Translational Medical Science (DISMET), University of Naples Federico II, Naples, Italy
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But A, De Bruin ML, Bazelier MT, Hjellvik V, Andersen M, Auvinen A, Starup-Linde J, Schmidt MK, Furu K, de Vries F, Karlstad Ø, Ekström N, Haukka J. Cancer risk among insulin users: comparing analogues with human insulin in the CARING five-country cohort study. Diabetologia 2017; 60:1691-1703. [PMID: 28573394 PMCID: PMC5552833 DOI: 10.1007/s00125-017-4312-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 04/24/2017] [Indexed: 12/28/2022]
Abstract
AIMS/HYPOTHESIS The aim of this work was to investigate the relationship between use of certain insulins and risk for cancer, when addressing the limitations and biases involved in previous studies. METHODS National Health Registries from Denmark (1996-2010), Finland (1996-2011), Norway (2005-2010) and Sweden (2007-2012) and the UK Clinical Practice Research Datalink database (1987-2013) were used to conduct a cohort study on new insulin users (N = 327,112). By using a common data model and semi-aggregate approach, we pooled individual-level records from five cohorts and applied Poisson regression models. For each of ten cancer sites studied, we estimated the rate ratios (RRs) by duration (≤0.5, 0.5-1, 1-2, 2-3, 3-4, 4-5, 5-6 and >6 years) of cumulative exposure to insulin glargine or insulin detemir relative to that of human insulin. RESULTS A total of 21,390 cancer cases occurred during a mean follow-up of 4.6 years. No trend with cumulative treatment time for insulin glargine relative to human insulin was observed in risk for any of the ten studied cancer types. Of the 136 associations tested in the main analysis, only a few increased and decreased risks were found: among women, a higher risk was observed for colorectal (RR 1.54, 95% CI 1.06, 2.25) and endometrial cancer (RR 1.78, 95% CI 1.07, 2.94) for ≤0.5 years of treatment and for malignant melanoma for 2-3 years (RR 1.92, 95% CI 1.02, 3.61) and 4-5 years (RR 3.55, 95% CI 1.68, 7.47]); among men, a lower risk was observed for pancreatic cancer for 2-3 years (RR 0.34, 95% CI 0.17, 0.66) and for liver cancer for 3-4 years (RR 0.36, 95% CI 0.14, 0.94) and >6 years (RR 0.22, 95% CI 0.05, 0.92). Comparisons of insulin detemir with human insulin also showed no consistent differences. CONCLUSIONS/INTERPRETATION The present multi-country study found no evidence of consistent differences in risk for ten cancers for insulin glargine or insulin detemir use compared with human insulin, at follow-up exceeding 5 years.
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Affiliation(s)
- Anna But
- Department of Public Health Clinicum, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014, Helsinki, Finland.
| | - Marie L De Bruin
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands.
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark.
| | - Marloes T Bazelier
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
| | - Vidar Hjellvik
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Morten Andersen
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Anssi Auvinen
- Department of Epidemiology, School of Health Sciences, University of Tampere, Tampere, Finland
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital THG, Aarhus, Denmark
| | - Marjanka K Schmidt
- Division of Molecular Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Kari Furu
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Frank de Vries
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, the Netherlands
- The Netherlands Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands
- The Netherlands Research Institute CAPHRI, Maastricht University, Maastricht, the Netherlands
- The Netherlands MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Øystein Karlstad
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Nils Ekström
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jari Haukka
- Department of Public Health Clinicum, University of Helsinki, Tukholmankatu 8B, P.O. Box 20, 00014, Helsinki, Finland
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Iga R, Uchino H, Kanazawa K, Usui S, Miyagi M, Kumashiro N, Yoshino H, Ando Y, Hirose T. Glycemic Variability in Type 1 Diabetes Compared with Degludec and Glargine on the Morning Injection: An Open-label Randomized Controlled Trial. Diabetes Ther 2017; 8:783-792. [PMID: 28547206 PMCID: PMC5544606 DOI: 10.1007/s13300-017-0269-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Optimal adjustment of basal insulin to overcome hypoglycemia and glycemic variability (GV) depends on its duration of action and peak-less profile. Owing to the ability of long-acting basal insulin to avoid hypoglycemia, we titrated pre-meal glucose to normal fasting blood glucose, 80-110 mg/dL (4.5-6.1 mmol/L), and post-meal glucose to 80-140 mg/dL (4.5-7.8 mmol/L). The purpose of this study was to evaluate two basal insulin analogues degludec (IDeg) and glargine (IGlar), injected in the morning, for GV using continuous glucose monitoring (CGM) in type 1 diabetes (T1DM). METHODS In this crossover study, 20 Japanese patients with T1DM (age 54 ± 16 years, disease duration 16 ± 8 years, BMI 24 ± 4 kg/m2, HbA1c 7.4 ± 0.8%) were randomized into one of two different starting regimens, and CGM was conducted on three consecutive days during the last week of each 12-week titration period. Treatment satisfaction was assessed at the end of each treatment period using the Diabetes Therapy-Related Quality of Life Questionnaire (DTR-QOL). RESULTS There were no differences in HbA1c, total insulin dosage, body weight changes, and basal to bolus ratio between the IDeg and IGlar arms. The day-to-day variability in fasting interstitial GV on the CGM curves was significantly less in the IDeg than IGlar treatment period (25.9 ± 22.0 vs. 43.8 ± 30.1 mg/dl, p = 0.04). Other markers of GV, calculated by the EasyGV software, including mean amplitude of glycemic excursions (MAGE), J-index, total and nocturnal hypoglycemia were not different between the two treatment periods. The score of "satisfaction with treatment", a subdomain of the DTR-QOL system, was higher in the IDeg period. CONCLUSION Thus, the morning injection of the two long-acting insulin analogues seemed similar with regard to the magnitude of hypoglycemia in T1DM, but treatment with IDeg was associated with lower day-to-day variation in glucose level. These results suggest that IDeg is safe with minimal morning GV in patients with T1DM. CLINICAL TRIAL REGISTRATION Japanese Clinical Trials Registry, UMIN000012358.
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Affiliation(s)
- Ryo Iga
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Hiroshi Uchino
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan.
| | - Ken Kanazawa
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Shuki Usui
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Masahiko Miyagi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Naoki Kumashiro
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Hiroshi Yoshino
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Yasuyo Ando
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan
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Iuchi H, Sakamoto M, Matsutani D, Suzuki H, Horiuchi R, Utsunomiya K. The Durability of Basal Insulin Affects Day-to-Day Glycemic Variability Assessed by Continuous Glucose Monitoring in Type 2 Diabetes Patients: A Randomized Crossover Trial. Diabetes Technol Ther 2017; 19:457-462. [PMID: 28605286 DOI: 10.1089/dia.2017.0028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Not only within-day glycemic variability but also day-to-day glycemic variability is a risk factor for diabetic patients. However, the ways of controlling day-to-day glycemic variability are unclear. We hypothesized that the durability of basal insulin plays an important role in controlling day-to-day glycemic variability in type 2 diabetes patients, and we therefore aimed to evaluate whether glargine U300, which exhibits prolonged absorption compared with glargine U100 but the same composition as glargine U100, would lead to improved day-to-day glycemic variability. MATERIALS AND METHODS This was a single-center, randomized, open-label, crossover study in type 2 diabetes patients using basal insulin therapy. After switching from 4 weeks of treatment with glargine U100 or U300, the patients performed continuous glucose monitoring (CGM) for 72 h in an environment with routine activities and mealtimes. The mean of daily difference (MODD) was assessed as day-to-day glycemic variability. RESULTS We enrolled 22 patients, and 17 patients completed the study. The MODD assessed as day-to-day glycemic variability was significantly lower with glargine U300 than with glargine U100 (1.8 ± 0.6 mmol/L vs. 2.4 ± 0.9 mmol/L, P = 0.006). No significant difference was observed in short-term glycemic variability between the two glargine formulations as measured by the standard deviation, coefficient of variation, mean amplitude of glucose excursion. CONCLUSIONS Compared with glargine U100 treatment, glargine U300 treatment improved the MODD as assessed by CGM in type 2 diabetes patients. These findings suggest that the durability of basal insulin may be associated with day-to-day glycemic variability in type 2 diabetes patients.
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Affiliation(s)
- Hiroyuki Iuchi
- 1 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
| | - Masaya Sakamoto
- 1 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
| | - Daisuke Matsutani
- 1 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
| | - Hirofumi Suzuki
- 1 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
| | | | - Kazunori Utsunomiya
- 1 Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine , Tokyo, Japan
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Fiesselmann A, Wiesner T, Fleischmann H, Bramlage P. Real-world therapeutic benefits of patients on insulin glargine versus NPH insulin. Acta Diabetol 2016; 53:717-26. [PMID: 27093968 DOI: 10.1007/s00592-016-0862-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/29/2016] [Indexed: 10/21/2022]
Abstract
AIMS The addition of a single injection of insulin to the oral drugs (basal supported oral therapy; BOT) has been shown to greatly reduce blood glucose levels. The intermediate-acting NPH insulin (NPH) and the long-acting insulin glargine (Lantus(®)) have been compared for use in BOT in numerous clinical trials; however, their efficacy and safety in a real-life setting have not been described. METHODS TIP (therapeutic benefits of patients on insulin glargine vs. NPH insulin being poorly controlled on prior short-time basal-insulin supported therapy with NPH insulin or insulin glargine) is a non-interventional, multicentre, observational study over 24 weeks. A total of 2629 patients were enrolled and 1931 were fully evaluable (1614 insulin glargine, 303 NPH insulin). Propensity scoring (PSM) was used to match 570 patients into 2 similar cohorts of 285 patients. RESULTS In the PSM cohort, a slightly greater reduction in FBG and HbA1c levels was seen in the insulin glargine group compared to the NPH group. A weight loss, which was slightly more pronounced in insulin glargine patients despite receiving a lower insulin dose relative to the NPH group, was seen in both the groups. Additionally, hypoglycaemia, including nocturnal and severe events, was more prevalent in the patients receiving BOT with NPH. The occurrence of new micro- or macro-vascular complications and adverse events was low for both groups. A large proportion of patients changed from NPH therapy to insulin glargine therapy during the study, which was mainly attributable to insufficient glucose modulation. Improvements in quality of life and treatment satisfaction were found for both types of insulin. CONCLUSIONS This observational study provides evidence from a real-life setting that BOT with insulin glargine provides slightly greater reductions in weight, FBG and HbA1c levels, with a lower risk of hypoglycaemia than patients receiving NPH. This conclusion indicates that insulin glargine may be preferable to NPH insulin for BOT.
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Affiliation(s)
| | - Tobias Wiesner
- MVZ Stoffwechselmedizin Leipzig, Prager Str. 34, 04317, Leipzig, Germany
| | | | - Peter Bramlage
- Institut für Pharmakologie und Präventive Medizin, Menzelstrasse 21, 15831, Mahlow, Germany.
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Ghosal S, Sinha B, Gangopadhyay KK. Insulin glargine versus insulin degludec in patients failing on oral therapy in type 2 diabetes: A retrospective real world comparative data from India. Diabetes Metab Syndr 2016; 10:161-165. [PMID: 26822462 DOI: 10.1016/j.dsx.2016.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/09/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the changes in various glycemic parameters in insulin-naïve type 2 diabetes mellitus (DM) patients who were initiated on insulin glargine or insulin degludec in a real world setting. METHODS Retrospective data were analyzed in consecutive type 2 DM patients in a real world setting, who failed oral therapy (at least 2 oral anti-diabetic drugs) and were initiated with either insulin glargine or insulin degludec. The parameters assessed were the changes in HbA1c, fasting plasma glucose, body weight, dose of Insulin and the total number of patient reported hypoglycemic episodes up to 6 months after initiation. RESULT At baseline, insulin glargine and insulin degludec groups were similar in terms of gender, age, weight, HbA1c and duration of diabetes. After 6 months follow up the change in HbA1c (-1.09 versus -1.45 P=0.124), change in FPG (-72.81mg/dl [-4mmol/L] versus -75.88mg/dl [-4.2mmol/L] P=0.755), and the change in body weight (+1.65 versus +0.85 P=0.082) were similar in glargine and degludec groups, respectively. Patients in insulin degludec group experienced significantly lesser patient reported hypoglycemic episodes (12 versus 40) and required significantly lesser dose (25.68Units versus 18.61Units per day; P=0.002) compared to insulin glargine. 41% of the patients reached HbA1C target of ≤7% with insulin glargine compared to 69% with insulin degludec within the specified time period. CONCLUSION Results from this real world analysis suggest that among type 2 DM patients who were initiated on insulin degludec as compared to insulin glargine may be associated with significantly lesser patient reported hypoglycemic episodes and lesser dose of insulin while achieving similar glycemic control. This study is however limited by the retrospective nature of the data collection.
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Affiliation(s)
| | - Binayak Sinha
- Department of Endocrinology, AMRI Hospital, Salt Lake, Kolkata, India.
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Marra LP, Araújo VE, Silva TBC, Diniz LM, Guerra Junior AA, Acurcio FA, Godman B, Álvares J. Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis. Diabetes Ther 2016; 7:241-58. [PMID: 27048292 PMCID: PMC4900976 DOI: 10.1007/s13300-016-0166-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The use of insulin analogs for the treatment of type 1 diabetes mellitus (T1DM) is widespread; however, the therapeutic benefits still require further evaluation given their higher costs. The objective of this study was to evaluate the effectiveness and safety of analog insulin glargine compared to recombinant DNA (rDNA) insulin in patients with T1DM in observational studies, building on previous reviews of randomized controlled trials comparing neutral protamine Hagedorn insulin and insulin glargine. METHODS A systematic review with a meta-analysis was performed. The review included cohort studies and registries available on PubMed, LILACS, and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as manual and gray literature searches. The meta-analysis was conducted in Review Manager 5.3 software. The primary outcomes were glycated hemoglobin (Hb1Ac), weight gain, and hypoglycemia. Methodological quality was assessed using the Newcastle-Ottawa scale. RESULTS Out of 796 publications, 11 studies were finally included. The meta-analysis favored insulin glargine in HbA1c outcomes (adult patients) and hypoglycemic episodes (P < 0.05), but without reaching glycemic control (Hb1Ac to approximately 7%). The methodological quality of the studies was moderate, noting that 45% of studies were funded by pharmaceutical companies. CONCLUSION Given the high heterogeneity of the studies, the discrete value presented by the estimated effect on effectiveness and safety, potential conflicts of interest of the studies, and the appreciable higher cost of insulin glargine, there is still no support for recommending first-line therapy with analogs. The role of analogs in the treatment of T1DM could be better determined by further observational studies of good methodological quality to assess their long-term effectiveness and safety, as well as their cost-effectiveness.
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Affiliation(s)
- Lays P. Marra
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Vania E. Araújo
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Thales B. C. Silva
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Leonardo M. Diniz
- School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Augusto A. Guerra Junior
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Francisco A. Acurcio
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Liverpool Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Juliana Álvares
- School of Pharmacy, Graduate Program in Medicines and Pharmaceutical Assistance, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais Brazil
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Van Der Gugten JG, Wong S, Holmes DT. Quantitation of Insulin Analogues in Serum Using Immunoaffinity Extraction, Liquid Chromatography, and Tandem Mass Spectrometry. Methods Mol Biol 2016; 1378:119-130. [PMID: 26602124 DOI: 10.1007/978-1-4939-3182-8_14] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Insulin analysis is used in combination with glucose, C-peptide, beta-hydroxybutyrate, and proinsulin determination for the investigation of adult hypoglycemia. The most common cause is the administration of too much insulin or insulin secretagogue to a diabetic patient or inadequate caloric intake after administration of either. Occasionally there is a question as to whether hypoglycemia has been caused by an exogenous insulin-whether by accident, intent, or even malicious intent. While traditionally this was confirmed by a low or undetectable C-peptide in a hypoglycemic specimen, this finding is not entirely specific and would also be expected in the context of impaired counter-regulatory response, fatty acid oxidation defects, and liver failure-though beta-hydroxybutyrate levels can lend diagnostic clarity. For this reason, insulin is often requested. However, popular automated chemiluminescent immunoassays for insulin have distinctly heterogeneous performance in detecting analogue synthetic insulins with cross-reactivities ranging from near 0 % to greater than 100 %. The ability to detect synthetic insulins is vendor-specific and varies between insulin products. Liquid Chromatography and Tandem Mass Spectrometry (LC-MS/MS) offers a means to circumvent these analytical issues and both quantify synthetic insulins and identify the specific type. We present an immunoaffinity extraction and LC-MS/MS method capable of independent identification and quantitation of native sequence insulins (endogenous, Insulin Regular, Insulin NPH), and analogues Glargine, Lispro, Detemir, and Aspart with an analytical sensitivity for endogenous insulin of between 1 and 2 μU/mL in patient serum samples.
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Affiliation(s)
- J Grace Van Der Gugten
- Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Sophia Wong
- Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Daniel T Holmes
- Department of Pathology and Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
- Department of Pathology and Laboratory Medicine, St. Paul's Hospital, 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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Abstract
This article describes a number-based system for the classification of insulin regimes. It utilizes a patient-centered variable (number of injections per day) and pharmacokinetic/dynamic characteristics to craft a taxonomic system that is able to incorporate all available insulin preparations and coformulations. This framework of systematics is robust enough to include various molecules that have been recently developed. It serves to enhance understanding of the subject, and facilitates the practical or clinical usage of theoretical knowledge. We propose that number-based insulin taxonomic models should be used in clinical guidelines and recommendations rather than restricting ourselves to pharmaceutical-based classifications. PubMed articles including both review articles and clinical trials published since the year 1990 were searched, to gather evidence and information on the various types of insulins available, and how they can be used, based on the number or frequency of injections prescribed per day.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India.
| | - Yashdeep Gupta
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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Jaiswal M, Martin CL, Brown MB, Callaghan B, Albers JW, Feldman EL, Pop-Busui R. Effects of exenatide on measures of diabetic neuropathy in subjects with type 2 diabetes: results from an 18-month proof-of-concept open-label randomized study. J Diabetes Complications 2015; 29:1287-94. [PMID: 26264399 PMCID: PMC4656068 DOI: 10.1016/j.jdiacomp.2015.07.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 07/10/2015] [Accepted: 07/11/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Experimental studies have reported potential benefit of glucagon-like peptide-1(GLP-1) receptor agonists in preventing diabetic peripheral neuropathy (DPN). We therefore performed a proof-of-concept pilot study to evaluate the effect of exenatide, a GLP-1 agonist, on measures of DPN and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS Forty-six T2D subjects (age 54±10years, diabetes duration 8±5years, HbA1c 8.2±1.3%) with mild to moderate DPN at baseline were randomized to receive either twice daily exenatide (n=22) or daily insulin glargine (n=24). The subjects, with similar HbA1c levels, were followed for 18months. The primary end point was the prevalence of confirmed clinical neuropathy (CCN). Changes in measures of CAN, other measures of small fiber neuropathy such as intra-epidermal nerve fiber density (IENFD), and quality of life were also analyzed. RESULTS Glucose control was similar in both groups during the study. There were no statistically significant treatment group differences in the prevalence of CCN, IENFD, measures of CAN, nerve conductions studies, or quality of life indices. CONCLUSIONS In this pilot study of patients with T2D and mild to moderate DPN, 18months of exenatide treatment had no significant effect on measures of neuropathy compared with glargine treatment.
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Affiliation(s)
- Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Catherine L Martin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Morton B Brown
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Brian Callaghan
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - James W Albers
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
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Okada M, Okada M, Nishigami J, Yamaaki N, Furukawa K, Ohyama K, Shimada T, Sai Y. Effect of switching basal insulin regimen to degludec on quality of life in Japanese patients with type 1 and type 2 diabetes mellitus. J Pharm Health Care Sci 2015; 1:26. [PMID: 26819737 PMCID: PMC4728762 DOI: 10.1186/s40780-015-0027-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/21/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Maintainance of a stable basal insulin level is important for glycemic control in treatment of diabetes mellitus. Recently introduced insulin degludec has the longest duration of action among basal insulin formulations. The purpose of this study was to assess changes in quality of life (QOL) associated with switching the basal insulin regimen to degludec in patients with type 1 and type 2 diabetes mellitus. METHODS This 24-week open-label intervention study included type 1 (n = 10) and type 2 (n = 20) diabetes mellitus patients, with adequately controlled hemoglobin A1c (HbA1c), who had received insulin glargine or detemir for at least 6 months. The primary outcome was change of QOL from baseline, as assessed by the Diabetes Therapy-Related QOL (DTR-QOL) application, after switching from glargine or detemir to degludec. HbA1c and other parameters were also assessed as secondary outcomes. RESULTS QOL and HbA1c in patients with type 1 diabetes mellitus were unchanged during this study. In patients with type 2 diabetes mellitus, HbA1c did not change, but total DTR-QOL score was significantly improved from baseline after switching to degludec. The DTR-QOL Factor 2, "Anxiety and dissatisfaction with treatment", was significantly improved in patients with type 2 diabetes mellitus and especially in the subgroup receiving basal supported oral therapy (BOT). CONCLUSIONS Switching of the basal insulin regimen from glargine or detemir to degludec significantly improved the QOL of patients with type 2 diabetes mellitus who were receiving BOT, by reducing mental stress or anxiety about their treatment.
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Affiliation(s)
- Morihiro Okada
- Department of Pharmacy, Japan Community Healthcare Organization Kanazawa Hospital, Ha-15 Oki-machi, Kanazawa, 920-8610 Japan ; Department of Medicinal Informatics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Masae Okada
- Department of Pharmacy, Japan Community Healthcare Organization Kanazawa Hospital, Ha-15 Oki-machi, Kanazawa, 920-8610 Japan
| | - Jun Nishigami
- Department of Pharmacy, Japan Community Healthcare Organization Kanazawa Hospital, Ha-15 Oki-machi, Kanazawa, 920-8610 Japan
| | - Naoto Yamaaki
- Department of Internal Medicine, Japan Community Healthcare Organization Kanazawa Hospital, Ha-15 Oki-machi, Kanazawa, 920-8610 Japan
| | - Kenji Furukawa
- Department of Internal Medicine, Japan Community Healthcare Organization Kanazawa Hospital, Ha-15 Oki-machi, Kanazawa, 920-8610 Japan
| | - Kiminori Ohyama
- Department of Internal Medicine, Japan Community Healthcare Organization Kanazawa Hospital, Ha-15 Oki-machi, Kanazawa, 920-8610 Japan
| | - Tsutomu Shimada
- Department of Medicinal Informatics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan ; Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
| | - Yoshimichi Sai
- Department of Medicinal Informatics, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan ; Department of Hospital Pharmacy, University Hospital, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641 Japan
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Ahmad M, Wafai ZA, Mathur SK, Lodha S, Khan ZY, Bansal A. Evaluation of Glycemia Control Achieved by Glargine and Lispro Versus Detemir and Aspart Insulin Regimes in Type 2 Diabetics Undergoing Surgery. Open Cardiovasc Med J 2015; 9:58-61. [PMID: 26312079 PMCID: PMC4541298 DOI: 10.2174/1874192401509010058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/22/2015] [Accepted: 02/28/2015] [Indexed: 12/01/2022] Open
Abstract
There is paucity of scientific literature regarding the clinical outcome of long lasting basal insulin and rapid acting mealtime insulin regimes in surgical situations although employed in non-surgical situations. This study has evaluated the clinical outcome of two subcutaneous split-mixed Glargine+Lispro and Detemir+Aspart insulin regimes in type 2 diabetics undergoing surgery.
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Affiliation(s)
- Mushtaq Ahmad
- Department of Pharmacology, Punjab Institute of Medical Sciences, Jalandhar
| | - Z A Wafai
- Department of Clinical Pharmacology, Sheri-I- Kashmir Institute of Medical Sciences, Srinagar
| | - S K Mathur
- Department of Endocrinology, S. M. S. Medical College & Hospital, Jaipur
| | - S Lodha
- Department of Endocrinology, Fortis Escorts Hospital, Jaipur
| | - Z Y Khan
- Department of Endocrinology, S. M. S. Medical College & Hospital, Jaipur
| | - Alka Bansal
- Department of Endocrinology, S. M. S. Medical College & Hospital, Jaipur
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Asias BD, Stock EM, Small NL, Getchell KE, Patel JR, Krause JD, Cavness S, Dzenowski CL, Ta M. Clinical and financial outcomes of switching insulin glargine to insulin detemir in a veteran population with type 2 diabetes. J Diabetes Metab Disord 2015; 14:53. [PMID: 26120575 PMCID: PMC4482160 DOI: 10.1186/s40200-015-0180-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 06/08/2015] [Indexed: 01/20/2023]
Abstract
Background Although glargine and detemir are both FDA-approved in the U.S. as long-acting insulin analogues, inherent differences in the insulins may lead to varying outcomes. This study examined changes in clinical measures and associated costs for veterans with type 2 diabetes on insulin therapy converted from insulin glargine to insulin detemir. Methods A retrospective before-and-after comparison study was performed at a single-site medical center located in the southwestern U.S., comprising 133 Veterans diagnosed with type 2 diabetes receiving insulin therapy with glargine and converted to insulin detemir using a 1:1 unit dosage ratio. Patients’ A1c, weight, body mass index, total daily dose, and estimated monthly insulin costs during and after conversion were compared employing Wilcoxon signed-rank tests. These measures were similarly assessed in patients at A1c goal (<7 %) prior to conversion. Results When switched from insulin glargine to insulin detemir, an increase in A1c (median of 7.7 % to 8.3 %, p < 0.01) and total daily dose (TDD: 40 to 46 units/day, p < 0.01) resulted. Monthly insulin costs decreased 19 % ($47 to $38, p < 0.01), or roughly a one-year savings of $110 per patient. An increase in A1c was similarly observed for patients at-goal prior to conversion but remained at-goal post-conversion (6.5 % to 6.7 %, p = 0.02). Conclusion The increase in A1c and TDD following conversion from insulin glargine to insulin detemir suggests that glargine requires a smaller amount of units to reach the same glycemic-lowering ability compared to detemir. Despite the observed insulin cost savings associated with detemir, future studies should also determine overall costs (including indirect) and benefits associated with switching from glargine to detemir among Veteran with Type 2 diabetes.
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Affiliation(s)
- Bernadette D Asias
- Department of Pharmacy Services, Memorial Hermann Health Care System - Texas Medical Center, Houston, TX 77030 USA ; Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Eileen M Stock
- Center for Applied Health Research, Central Texas Veterans Health Care System in collaboration with Baylor Scott & White Health, Temple, TX 76502 USA ; Texas A&M Health Science Center, College of Medicine, Bryan, TX 77807 USA
| | - Nancy L Small
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Katerine E Getchell
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Jagruti R Patel
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Jennifer D Krause
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Staci Cavness
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Cassidy L Dzenowski
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
| | - Mia Ta
- Central Texas Veterans Health Care System, Department of Veterans Affairs, Temple, TX 76504 USA
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Leite EB, Pedrosa HC, Casulari LA. Results of glycated hemoglobin during treatment with insulin analogues dispensed in the public health system of Federal District in Brazil. Diabetol Metab Syndr 2015; 7:66. [PMID: 26288660 PMCID: PMC4539715 DOI: 10.1186/s13098-015-0061-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/03/2015] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Diabetes treatment requires specialized multi-professional teams, supplies for blood glucose monitoring and training for self-injections of human insulin or insulin analogues. The State Health Secretariat of the Federal District (SHS-FD) has dispensed insulin analogues by means of clinical validated protocols since 2004. However, data on outcomes of follow-up are still unknown. OBJECTIVE To evaluate the results of glycated hemoglobin (HbA1c) among diabetic patients treated with insulin analogues. METHODS It is a retrospective cohort study involving data of type 1(DM1) and type 2 diabetes (DM2) patients 18 years old and above who were registered to participate at the insulin analogues dispense program of the SHS-FD. Evaluation of criteria of insulin treatment continuity was based on HbA1c values achieved in the follow-up period: in the target, <7 %, patients between 18 and 65 years old; <8 % for those above 65 years old; out of target, when values were superior these cut off points for both age groups; and minimum 0.5 % reduction of two HbA1c values during follow-up. RESULTS Two hundred and fifteen formularies were analyzed: Type 2 patients (63.7 %) and female sex were the most prevalent (63.7 %), (p < 0.05). Mean age and SD were 41.5 ± 23.5 years among DM1 and 60.5 ± 28.5 in those with DM2. HbA1c in the target was found in 26 %, 48 % were out of target and 26 % achieved 0.5 % minimum reduction in HbA1c value (p < 0.05). The main clinical characteristics associated with HbA1c found to be in the target were older age (>65 years), more than three medical appointments in the follow-up and lower mean HbA1c in the patient selection for inclusion criteria in the dispense program (p < 0.05). CONCLUSION The low number of patients using insulin analogues in the target group, considered to be in good control, implies the need to reevaluate both level of patients self-care knowledge and glucose monitoring prior their inclusion in the insulin analogue dispense program. Reinforcement and training of health professional teams in enrollment procedures should be on mandatory basis to avoid protocol failure or deviations.
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Affiliation(s)
- Eliziane Brandão Leite
- />Diabetes Central Coordination, State Health Secretariat of Federal District, SQS 304 Bloco F Apto 403, Brasília, DF 70337-060 Brazil
| | - Hermelinda Cordeiro Pedrosa
- />Research Centre, Foundation of Teaching and Research on Health Sciences, Brasília, DF Brazil
- />Unit of Endocrinology, Taguatinga Regional Hospital-HRT, Brasília, DF Brazil
| | - Luiz Augusto Casulari
- />Endocrinology Service, University Hospital (HUB) and University of Brasília (UnB), Brasília, DF Brazil
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Abstract
AIM: To assess the efficacy of glargine in the management of hepatogenic diabetes.
METHODS: Eighty-two patients with hepatogenic diabetes treated with glargine were included in the study. The insulin dose was adjusted according to fasting blood glucose (FBG) till discharge. FBG, 2 h postprandial blood glucose (2 h PBG) and glycosylated hemoglobin (HbAlc) were monitored for 24 wk. HbAlc and blood glucose levels were compared before and after treatment.
RESULTS: The FBG, 2 h PBG and HbAlc were significantly decreased after treatment (FBG: 6.35 mmol/L ± 1.47 mmol/L vs 10.52 mmol/L ± 3.13 mmol/L, P < 0.05; 2 h PBG: 9.81 mmol/L ± 3.14 mmol/L vs 17.51 mmol/L ± 4.33 mmol/L, P < 0.05; HbA1c: 7.54% ± 1.31% vs 10.65% ± 1.43%, P < 0.05). There were no significant differences in the above parameters between 12 and 24 wk after treatment (FBG: 6.47 mmol/L ± 1.25 mmol/L vs 6.35 mmol/L ± 1.47 mmol/L, P > 0.05; 2 h PBG: 8.91 mmol/L ± 2.76 mmol/L vs 9.81 mmol/L ± 3.14 mmol/L, P > 0.05; HbA1c: 7.28% ± 1.12% vs 7.54% ± 1.31%, P > 0.05). The incidence of hypoglycemia was low, which occurred only once.
CONCLUSION: Glargine therapy is effective and safe for hepatogenic diabetes.
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Rosenstock J, Fonseca V, Schinzel S, Dain MP, Mullins P, Riddle M. Reduced risk of hypoglycemia with once-daily glargine versus twice-daily NPH and number needed to harm with NPH to demonstrate the risk of one additional hypoglycemic event in type 2 diabetes: Evidence from a long-term controlled trial. J Diabetes Complications 2014; 28:742-9. [PMID: 24856612 PMCID: PMC4802045 DOI: 10.1016/j.jdiacomp.2014.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 02/09/2023]
Abstract
AIMS This analysis evaluated HbA1c-adjusted hypoglycemia risk with glargine versus neutral protamine Hagedorn (NPH) over a 5-year study in patients with Type 2 diabetes mellitus (T2DM). Clinical significance was assessed using number needed to harm (NNH) to demonstrate the risk of one additional patient experiencing at least one hypoglycemic event. METHODS Individual patient-level data for symptomatic documented hypoglycemia and HbA1c values from a 5-year randomized study comparing once-daily glargine (n=513) with twice-daily NPH (n=504) were analyzed. Symptomatic hypoglycemia was categorized according to concurrent self-monitoring blood glucose levels and need for assistance. Hypoglycemic events per patient-year as a function of HbA1c were fitted by negative binomial regression using treatment and HbA1c at endpoint as independent variables. An estimate of NNH was derived from logistic regression models. RESULTS The cumulative number of symptomatic hypoglycemia events was consistently lower with glargine compared with NPH over 5years. Compared with twice-daily NPH, once-daily glargine treatment resulted in significantly lower adjusted odds ratios (OR) for all daytime hypoglycemia (OR 0.74; p=0.030) and any severe event (OR 0.64; p=0.035), representing a 26% and 36% reduction in the odds of daytime and severe hypoglycemia, respectively. Our model predicts that, if 25 patients were treated with NPH instead of glargine, then one additional patient would experience at least one severe hypoglycemic event. CONCLUSIONS This analysis of long-term insulin treatment confirms findings from short-term studies and demonstrates that glargine provides sustained, clinically meaningful reductions in risk of hypoglycemia compared with NPH in patients with T2DM.
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Affiliation(s)
- Julio Rosenstock
- Dallas Diabetes and Endocrine Center at Medical City, Dallas, TX, USA.
| | - Vivian Fonseca
- Tulane University Health Sciences Center, New Orleans, LA, USA
| | | | | | - Peter Mullins
- Department of Statistics, University of Auckland, Auckland, New Zealand
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Wangnoo SK, Ghosal S, Akhtar S, Shetty R, Tripathi S. Clinical experience of switching from glargine or neutral protamine Hagedorn insulin to insulin detemir in type 2 diabetes: Observations from the Indian cohort in the A1chieve study. Indian J Endocrinol Metab 2014; 18:715-720. [PMID: 25285292 PMCID: PMC4171898 DOI: 10.4103/2230-8210.139239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIM To explore the clinical safety and effectiveness of insulin detemir (IDet) in a subgroup of Indian patients with type 2 diabetes (T2D) switched from either insulin glargine (IGlar) or neutral protamine Hagedorn (NPH) insulin in the 24-week, non-interventional A1chieve study. MATERIALS AND METHODS Indian patients with T2D switching from pre-study IGlaror NPH insulin to IDet were included. Safety and effectiveness outcomes were evaluated by the physicians in local clinical settings. RESULTS A total of 102 patients switched from IGlar to IDet (GLA group) and 39 patients switched from NPH insulin to IDet (NEU group). At baseline, the mean glycated hemoglobin A1c (HbA1c) levels were 9.9 ± 1.8% in the GLA group and 9.1 ± 1.2% in the NEU group. No serious adverse drug reactions, serious adverse events, or major hypoglycemic events were reported in either group throughout the study. At baseline and Week 24, 11.8% and 7.5% of patients, respectively, reported overall hypoglycemic events in the GLA group. No hypoglycemic events were reported at Week 24 in the NEU group. At Week 24, the mean HbA1c levels were 7.6 ± 0.9% in the GLA group and 7.3 ± 0.7% in the NEU group. The mean fasting plasma glucose, postprandial plasma glucose and quality of life also appeared to improve over 24 weeks. CONCLUSION Switching to IDet therapy from IGlar and NPH insulin was well-tolerated and appeared to be associated with improved glycogenic control in Indian patients.
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Affiliation(s)
| | - Samit Ghosal
- Nightingale Hospital, Kolkata, West Bengal, India
| | - Shahid Akhtar
- Novo Nordisk India Private Limited, Bangalore, Karnataka, India
| | - Raman Shetty
- Novo Nordisk India Private Limited, Bangalore, Karnataka, India
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Bounthavong M, Tran JN, Golshan S, Piland NF, Morello CM, Blickensderfer A, Best JH. Retrospective cohort study evaluating exenatide twice daily and long-acting insulin analogs in a Veterans Health Administration population with type 2 diabetes. Diabetes Metab 2014; 40:284-91. [PMID: 25059703 DOI: 10.1016/j.diabet.2014.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/04/2014] [Accepted: 06/05/2014] [Indexed: 11/25/2022]
Abstract
AIM This was a retrospective cohort study that evaluated the differences in glycated haemoglobin (HbA1c) and body mass index (BMI) in veterans with type 2 diabetes mellitus (T2DM), prescribed exenatide twice daily (BID) versus long-acting insulin analog (LAIA) two years after initiation in the United States (US) veteran population. MATERIALS AND METHODS Patients were included if they were ≥ 18 years old with T2DM, and initiated exenatide BID or LAIA at the Veterans Health Administration between January 1, 2006 and December 31, 2010. Multivariate models were used to evaluate the changes in HbA1c and BMI between groups, controlling for potential confounders. Logistic regression was used to evaluate the odds of achieving ≥ 0.5% HbA1c reduction based on baseline HbA1c stratifications: low,<7%; moderate, 7% to<9%; and high,≥ 9%. RESULTS A total of 446 exenatide BID and 51,531 LAIA patients met inclusion/exclusion criteria. On average, exenatide BID patients were significantly older (64 versus 60 years) with a higher BMI (37.8 versus 32.9 kg/m(2)). Baseline HbA1c was 8.2% and 8.8% for exenatide BID and LAIA patients, respectively (P<0.001); otherwise, patients were similar for all other characteristics. Exenatide BID treatment was significantly associated with a 0.32% (95%CI: 0.18-0.47%) greater reduction in HbA1c at two years compared with LAIA. Similar findings were observed for BMI reduction (0.68 kg/m(2); 95%CI: 0.42-0.95 kg/m(2)). Exenatide BID patients with moderate baseline HbA1c had significantly higher odds of achieving ≥ 0.5% HbA1c reduction compared with LAIA patients (OR=1.5; 95%CI: 1.2-2.0). CONCLUSIONS Veterans treated with exenatide BID had significantly greater reduction in HbA1c and BMI compared with patients treated with LAIA patients two years after initiation.
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Affiliation(s)
- M Bounthavong
- Veterans Affairs San Diego Healthcare System, San Diego, USA.
| | - J N Tran
- Clinical Analytics and Outcomes Research, OptumRX, Irvine, CA, USA.
| | - S Golshan
- Advanced Center for Innovation in Services and Intervention Research (ACISIR), University of California, Department of Psychiatry, San Diego, CA, USA.
| | - N F Piland
- Idaho State University, Institute of Rural Health, Pocatello, Idaho, USA.
| | - C M Morello
- UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California, USA.
| | - A Blickensderfer
- Medical Relations & Information, Amylin Pharmaceuticals, LLC., a fully-owned subsidiary of Bristol-Myers Squibb, San Diego, California, USA.
| | - J H Best
- Health Outcomes, Amylin Pharmaceuticals, LLC., a fully-owned subsidiary of Bristol-Myers Squibb, San Diego, California, USA; University of Washington, Seattle, Washington, USA.
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Lucidi P, Porcellati F, Candeloro P, Cioli P, Andreoli AM, Marzotti S, Schmidt R, Bolli GB, Fanelli CG. Glargine metabolism over 24 h following its subcutaneous injection in patients with type 2 diabetes mellitus: a dose-response study. Nutr Metab Cardiovasc Dis 2014; 24:709-716. [PMID: 24702815 DOI: 10.1016/j.numecd.2014.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/29/2014] [Accepted: 02/10/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND AIMS After subcutaneous injection insulin glargine is rapidly metabolized to M1 and M2. In vitro, both M1 and M2 have metabolic effects and bind to IGF-1R similarly to human insulin, whereas glargine exhibits a higher affinity for the IGF-1R and greater mitogenetic effects. The present study was specifically designed to establish the dose-response metabolism of glargine over 24 h following s.c. injection in T2DM subjects on long-term use of glargine. METHODS AND RESULTS Ten subjects with T2DM were studied during 24 h after s.c. injection of 0.4 (therapeutic) and 0.8 (high dose) U/kg of glargine on two separate occasions during euglycaemic clamps (cross-over design). Glargine, M1 and M2 over 24 h period were determined in appropriately processed plasma samples by a specific liquid chromatography-tandem mass spectrometry assay. Plasma M1 concentration (AUC0-24 h) was detected in all subjects and increased by increasing the glargine dose from therapeutic to high dose (p = 0.008). Glargine was detectable in 6 (therapeutic dose) and 9 (high dose) out of the 10 subjects and also increased by increasing the dose (p = 0.031). However, glargine concentration (AUC0-24 h--high dose) represented at most only 9.7% (4.6-15%) of the total amount of insulin measured in the blood. M2 was not detected at all. CONCLUSION In T2DM people on long-term use of insulin glargine, even with higher doses (0.8 U/kg), glargine is nearly totally metabolized to the active metabolite M1. Glargine is often detectable in plasma, but its concentration remains well below that needed in vitro to potentiate IGF-1R binding and mitogenesis.
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Affiliation(s)
- P Lucidi
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - F Porcellati
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - P Candeloro
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - P Cioli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | | | - S Marzotti
- Department of Internal Medicine, University of Perugia, Perugia, Italy
| | - R Schmidt
- Diabetes Division, Sanofi, Frankfurt, Germany
| | - G B Bolli
- Department of Internal Medicine, University of Perugia, Perugia, Italy.
| | - C G Fanelli
- Department of Internal Medicine, University of Perugia, Perugia, Italy
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Hattori N, Duhita MR, Mukai A, Matsueda M, Shimatsu A. Development of insulin antibodies and changes in titers over a long-term period in patients with type 2 diabetes. Clin Chim Acta 2014; 433:135-8. [PMID: 24642342 DOI: 10.1016/j.cca.2014.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/02/2014] [Accepted: 03/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, insulin analogs have become widely used for the treatment of diabetes. The aim of this study was to determine differences in the antigenicity of insulin analogs and long-term changes in titers in patients with type 2 diabetes. METHODS Insulin antibodies were examined using polyethylene glycol and protein G methods in 381 patients with type 2 diabetes. RESULTS Insulin antibodies were detected in 48 of 118 patients (40.7%) who used insulin, and insulin glargine and aspart were more antigenic. Insulin antibodies were unexpectedly found in seven of 263 patients (2.7%) who had never used insulin. Serum insulin concentrations in patients with insulin antibodies were significantly higher than those without them. Two years after the initial evaluation, insulin antibodies were still positive in 92.7% of patients who used insulin; while, they disappeared in all patients who had never used insulin. A patient who stopped insulin injections 6years ago was found to be positive for insulin antibodies at the first evaluation as well as 2years later. CONCLUSIONS Insulin glargine and aspart induced insulin antibodies more frequently, and insulin antibodies remained in patients for a long time. Insulin antibodies should be suspected even in patients not currently on insulin therapy.
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Smiley D, Umpierrez GE, Hermayer K, Newton C, Jacobs S, Olson DE, Khan A, Rizzo M, Peng L, Reyes D, Cardona S, Fonseca V. Differences in inpatient glycemic control and response to subcutaneous insulin therapy between medicine and surgery patients with type 2 diabetes. J Diabetes Complications 2013; 27:637-41. [PMID: 23911535 PMCID: PMC4416966 DOI: 10.1016/j.jdiacomp.2013.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/03/2013] [Accepted: 05/30/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine differences in inpatient glycemic control and response to two different glargine-based insulin regimens in general medicine and surgery patients with type 2 diabetes (T2D). METHODS This is a post-hoc analysis of a prospective, multicenter, randomized trial of 298 non-ICU medicine and surgery patients with T2D treated with Basal Bolus regimen with glargine once daily and glulisine before meals and with Basal Plus regimen with glargine once daily and supplemental doses of glulisine before meals for blood glucose (BG)>140mg/dl. Major study outcomes included differences in mean daily BG, frequency of treatment failures (defined as >2 consecutive BG>240mg/dl or a mean daily BG>240mg/dl), and hypoglycemia between the medicine and surgery cohorts. RESULTS Patients treated with Basal Bolus or with Basal Plus experienced similar improvement in mean daily BG after 1st day of therapy (p=0.16), number of treatment failures (p=0.11) and hypoglycemic events (p=0.50). Compared to surgery patients (n=130), medicine patients (n=168) had higher admission BG (p=0.01) and HbA1c levels (p<0.01); however, they had similar response to either treatment regimen without differences in mean daily BG after 1st day of therapy (p=0.18), number of treatment failures (p=0.58), daily insulin requirements (p=0.36), or in the frequency of hypoglycemia (p=0.79). CONCLUSION The Basal Plus regimen with glargine once daily and correction doses with glulisine before meals resulted in similar glycemic control to basal bolus regimen. We observed no differences in response to either basal insulin regimen between medicine and surgery patients with type 2 diabetes.
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Affiliation(s)
- Dawn Smiley
- Department of Medicine, Division of Endocrinology at Emory University, Atlanta, GA, USA.
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Mellbin LG, Rydén L, Riddle MC, Probstfield J, Rosenstock J, Díaz R, Yusuf S, Gerstein HC. Does hypoglycaemia increase the risk of cardiovascular events? A report from the ORIGIN trial. Eur Heart J 2013; 34:3137-44. [PMID: 23999452 DOI: 10.1093/eurheartj/eht332] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIMS Hypoglycaemia caused by glucose-lowering therapy has been linked to cardiovascular (CV) events. The ORIGIN trial provides an opportunity to further assess this relationship. METHODS AND RESULTS A total of 12 537 participants with dysglycaemia and high CV-risk were randomized to basal insulin glargine titrated to a fasting glucose of ≤ 5.3 mmol/L (95 mg/dL) or standard glycaemic care. Non-severe hypoglycaemia was defined as symptoms confirmed by glucose ≤ 54 mg/dL and severe hypoglycaemia as a requirement for assistance or glucose ≤ 36 mg/dL. Outcomes were: (i) the composite of CV death, non-fatal myocardial infarction or stroke; (ii) mortality; (iii) CV mortality; and (iv) arrhythmic death. Hazards were estimated before and after adjustment for a hypoglycaemia propensity score. During a median of 6.2 years (IQR: 5.8-6.7), non-severe hypoglycaemic episodes occurred in 41.7 and 14.4% glargine and standard group participants, respectively, while severe episodes occurred in 5.7 and 1.8%, respectively. Non-severe hypoglycaemia was not associated with any outcome following adjustment. Conversely, severe hypoglycaemia was associated with a greater risk for the primary outcome (HR: 1.58; 95% CI: 1.24-2.02, P < 0.001), mortality (HR: 1.74; 95% CI: 1.39-2.19, P < 0.001), CV death (HR: 1.71; 95% CI: 1.27-2.30, P < 0.001) and arrhythmic death (HR: 1.77; 95% CI: 1.17-2.67, P = 0.007). Similar findings were noted for severe nocturnal hypoglycaemia for the primary outcome and mortality. The severe hypoglycaemia hazard for all four outcomes was higher with standard care than with insulin glargine. CONCLUSION Severe hypoglycaemia is associated with an increased risk for CV outcomes in people at high CV risk and dysglycaemia. Although allocation to insulin glargine vs. standard care was associated with an increased risk of severe and non-severe hypoglycaemia, the relative risk of CV outcomes with hypoglycaemia was lower with insulin glargine-based glucose-lowering therapy than with the standard glycaemic control. Trial Registration (ORIGIN ClinicalTrials.gov number NCT00069784).
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Bhattacharyya R, Banerjee D. A docking study of insulin with LI-CR-L2 ecto domain of insulin receptor: an easy way for preliminary screening of novel anti-diabetic peptides. Bioinformation 2012; 8:1082-6. [PMID: 23251042 PMCID: PMC3523222 DOI: 10.6026/97320630081082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 09/27/2012] [Indexed: 12/02/2022] Open
Abstract
Although interaction of human insulin with its receptor is studied to considerable extent such studies are currently lacking with recombinant insulin in-spite of its rampant clinical use. It is known that at molecular level the interaction of recombinant insulin with insulin receptor is similar to human insulin but not exactly same. With the increasing incidence of diabetes throughout the globe use of recombinant insulin is also increasing at a considerable rate. Therefore it is need of the hour to explore the recombinant insulin- insulin receptor interaction by all possible means. In this paper we have studied insulin receptor binding of lispro and glargine; the two commonly used recombinant insulins using tools of computational biology. We have observed that the binding pattern of insulin receptor (L1-CR-L2 ectodomain) with lispro and glargine is different when compared with human insulin. Analyzing the ligand receptor interactions we have hypothesized that the tail region of insulin beyond B26 is a critical regulator of insulin insulin receptor interactions detail of which cannot be understandable from docking studies due to lack of consideration of the flexibility of the tail region while docking studies. We have recommended experimental validation of our study. However, our docking procedure may also be explored for preliminary screening of novel anti-diabetic peptide.
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Affiliation(s)
- Rajasri Bhattacharyya
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012
| | - Dibyajyoti Banerjee
- Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012
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Li WG, Yuan YZ, Qiao MM, Zhang YP. High dose glargine alters the expression profiles of microRNAs in pancreatic cancer cells. World J Gastroenterol 2012; 18:2630-9. [PMID: 22690071 PMCID: PMC3369999 DOI: 10.3748/wjg.v18.i21.2630] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 02/29/2012] [Accepted: 03/20/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of high dose glargine on the expression profiles of microRNAs in human pancreatic cancer cells.
METHODS: Real-time polymerase chain reaction array (RT-PCR) was applied to investigate miRNAs differentially expressed in Sw1990 cells treated with or without 100 IU/L glargine. Stem-loop RT-PCR was used to confirm the results of the array assay in Sw1990 and Panc-1 cells. The effects of miR-95 on cell growth, apoptosis, invasion and migration abilities were respectively examined by CCK8 assay, apoptosis assay, Matrigel invasion and migration assay in Sw1990 and Panc-1 cells. Nude mice xenograft models with Sw1990 cells were built to investigate pancreatic cancer growth in vivo after transfection by the lentivirus pGLV3-GFP- miR-95.
RESULTS: Ten miRNAs were significantly up-regulated and 2 miRNAs down-regulated in glargine treated Sw1990 cells when compared with non-treated cells (2.48-fold changes on average, P < 0.01). miR-95, miR-134 and miR-34c-3p are the top three miRNAs regulated by glargine (3.65-fold, 2.67-fold and 2.60-fold changes respectively, P < 0.01) in Sw1990 cells. Stem-loop RT-PCR confirmed that high dose glargine up-regulated the expression of miR-95 and miR-134 in both Sw1990 and Panc-1 cells. The most obvious change is the apparent increase of miR-95. Forced expression of miR-95 significantly increased cell proliferation (Sw1990: 2.510 ± 0.129 vs 2.305 ± 0.187, P < 0.05; Panc-1: 2.439 ± 0.211 vs 2.264 ± 0.117, P < 0.05), invasion (Sw1990: 67.90 ± 12.33 vs 47.30 ± 5.89, P < 0.01; Panc-1: 37.80 ± 8.93 vs 30.20 ± 5.14, P < 0.01), migration (Sw1990: 101 ± 6.00 vs 51.20 ± 8.34, P < 0.01; Panc-1: 91.80 ± 9.22 vs 81.50 ± 7.47, P < 0.01) and inhibited cell apoptosis (Sw1990: 22.05% ± 1.92% vs 40.32% ± 1.93%, P < 0.05; Panc-1: 20.17% ± 0.85% vs 45.60% ± 1.43%, P < 0.05) when compared with paired negative controls, whereas knockdown of miR-95 obtained the opposite effect. Nude mice xenograft models confirmed that miR-95 promoted the growth of pancreatic cancer in vivo when compared with negative control (tumor volume: 373.82 ± 23.67 mL vs 219.69 ± 17.82 mL, P < 0.05).
CONCLUSION: These observations suggested that modulation of miRNA expression may be an important mechanism underlying the biological effects of glargine.
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Abstract
Pancreatic diabetes is secondary diabetes followed by progressions of pancreatic exocrine diseases, such as chronic pancreatitis, pancreatic neoplasm and post-pancreatectomy. Because of destruction and reduction of the pancreatic endocrine and exocrine functional compartments, patients with pancreatic diabetes frequently show malnutrition from maldigestion and malabsorption by insufficiencies in pancreatic digestive enzymes, and show unstable glycemic control and prolonged hypoglycemia by insufficiencies in synthesis and secretion of insulin and glucagon. Epidemiological studies have suggested that the incidence and development of pancreatic diabetes in patients with chronic pancreatitis (CP) depends on several risk factors, such as alcohol intake, the presence of pancreatic calcification and the long-term duration of CP. The clinical management of pancreatic diabetes is divided into two parts: one is the supplementation of pancreatic digestive enzymes and the other is the achievement of appropriate glycemic control. The appropriate and sufficient pancreatic exocrine replacement therapy is important for the maintenance of better nutrient conditions for patients with pancreatic diabetes. Furthermore, the intensive insulin therapy combined with short- or ultra-short-acting insulin and long-acting insulin glargine can be achieved for stable glycemic control and reduction of severe frequent hypoglycemia in patients with pancreatic diabetes. These current advanced management techniques against insufficiencies of pancreatic exocrine endocrine functions are beneficial for improving and maintaining the quality of life in patients with pancreatic diabetes.
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Affiliation(s)
- Ken Kawabe
- Department of Medicine and Bioregulatory Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan
| | - Tetsuhide Ito
- Department of Medicine and Bioregulatory Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
| | - Hisato Igarashi
- Department of Medicine and Bioregulatory Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan
| | - Ryoichi Takayanagi
- Department of Medicine and Bioregulatory Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan
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Edwards KL, Irons BK, Xu T. Cost-effectiveness of intermediate or long-acting insulin versus Exenatide in type 2 diabetes mellitus patients not optimally controlled on dual oral diabetes medications. Pharm Pract (Granada) 2006; 4:129-33. [PMID: 25214899 PMCID: PMC4156845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To better understand exenatide's role in the treatment of type 2 diabetes, this analysis assessed its cost-effectiveness in comparison to an intermediate (NPH) and long-acting insulin (glargine). Exenatide is a recently approved medication for the treatment of type 2 diabetes for use in addition to frequently used oral diabetes medications. METHODS Two studies were identified by a Medline search (1996-Oct 2005) that were similar in study duration, baseline glycemic control, population size, and primary outcomes to appropriately assess the cost-effectiveness of either insulin in comparison to exenatide on both glycemic and weight control. RESULTS Both NPH and glargine appear to be more cost effective than exenatide with respect to glycemic control (incremental CE ratios -1,968 and - 65,520 respectively). Exenatide appears to be more cost effective for reductions in body weight than either NPH (CE ratio 235) or glargine (CE ratio 128). CONCLUSIONS Compared to intermediate and long-acting insulin therapies, exenatide does not appear to be as cost effective for the treatment of type 2 diabetes.
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Affiliation(s)
- Krystal L. Edwards
- Assistant Professor. Department of Pharmacy Practice and Veterans Administration North Texas
Health Care System. School of Pharmacy Texas Tech University Health
Sciences Center. Dallas, TX (USA)
| | - Brian K. Irons
- Division Head - Primary Care. Assistant Professor. Department of Pharmacy Practice, School of
Pharmacy. Texas Tech University Health Sciences Center. Dallas, TX
(USA)
| | - Tom Xu
- Department of Family and Community Medicine, School of Medicine. Texas Tech
University Health Sciences Center. Dallas, TX (USA)
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