Fasting plasma glucose 6-12 weeks after starting insulin glargine predicts likelihood of treatment success: a pooled analysis

AIMS

To evaluate whether fasting plasma glucose values measured early during insulin therapy can identify patients with Type 2 diabetes who may not achieve adequate glycaemic control after 6 months and will require additional treatment.

METHODS

Patient-level data from seven prospective, randomized, controlled studies using treat-to-target methods were pooled to evaluate the efficacy of insulin glargine. Fasting plasma glucose was measured at baseline, week 6 or 8 (6/8) and week 12. HbA(1c) was measured at week 24 to assess glycaemic control.

RESULTS

One thousand and thirty-six patients (56% male, 81% white) were included in the analysis (mean age 56.3 years; duration of diabetes 8.4 years). Baseline mean fasting plasma glucose was 11.2 mmol/l and mean HbA(1c) was 73 mmol/mol (8.8%). After 24 weeks of treatment, mean HbA(1c) decreased to 53 mmol/mol (7.0%); 56% of patients reached a target HbA(1c) ≤ 53 mmol/mol (7.0%). Significant correlations with week 24 HbA(1c) were obtained for fasting plasma glucose measured at week 6/8 and week 12 (r = 0.32; P < 0.0001 for both). Patients with fasting plasma glucose > 10 mmol/l at week 6/8 or week 12 were significantly less likely to achieve the HbA(1c) target at the end of treatment than patients with fasting plasma glucose < 8.9 mmol/l (P < 0.0001 for both). If fasting plasma glucose was > 10 mmol/l at week 6/8 or week 12, patients had only a 27% chance of reaching the HbA(1c) goal.

CONCLUSIONS

Fasting plasma glucose remaining > 10 mmol/l after 6-12 weeks of glargine therapy indicates that reaching target HbA(1c) ≤ 53 mmol/mol (7.0%) is unlikely and calls for individualized attention to consider further therapeutic options.

Amidox, an inhibitor of ribonucleotide reductase, potentiates the action of Ara-C in HL-60 human promyelocytic leukemia cells

Amidox (3,4-dihydroxybenzamidoxime), a new polyhydroxy-substituted benzoic acid derivative, is a potent inhibitor of the enzyme ribonucleotide reductase (RR), which catalyses the de novo synthesis of DNA. RR is considered to be an excellent target for cancer chemotherapy. In the present study we investigated the antineoplastic effects of Amidox alone and in combination with Arabinofuranosylcytosine (Ara-C) in HL-60 human promyelocytic leukemia cells. In growth inhibition experiments Amidox yielded an IC50 of 30 microM, colony formation was inhibited at an IC50 of 20 microM as determined by a soft agar assay. Exposure of the cells to 75 and 100 microM Amidox for 24 hours was shown to significantly decrease intracellular dCTP, dGTP and dATP pools, whereas dTTP concentration increased, as determined by HPLC. The combination of Amidox with Ara-C yielded more than additive cytotoxic effects both in growth inhibition assays and in soft agar assays. We could show that--after preincubating the cells with 75 and 100 microM Amidox and subsequent exposure to Ara-C--intracellular Ara-CTP levels increased by 576% and 1143%, respectively. In conclusion, Amidox might offer an additional option for the treatment of leukemia and thus be further investigated in vitro and in vivo.

Maternal responsiveness of socially high-risk mothers to the elicitation cues of their 7-month-old infants

This descriptive study of 19 socially high-risk mother-infant dyads in naturalistic interaction focused on maternal response to infant elicitation cues. Maternal response behavior was coded on a continuum from underresponsive to adequate to overresponsive. Maternal affect was rated separately using selected items from an existing scale. As a whole, the maternal sample was emotionally depressed and largely underresponsive to infant cues. When placed by maternal response into adequate, overresponsive, and underresponsive subgroups, adequate mothers more often responded appropriately to infant cues, were never physically unavailable to their infants, showed no anxiety, and were more positively responsive to their infants' smiles and cries. Adequate mothers scored higher in all affective areas. Maternal depression was associated with both overresponse and underresponse. Angry maternal mood was significantly related to underresponse. Considerable maternal strength lies in this high-risk sample and could be the basis for therapeutic intervention to normalize parenting.

The consequence of maternal depression for early mother-infant interaction: a nursing issue

Adequate mother-infant interaction during the first year of a child's life is critical for secure attachment and basic to development of the child's lifelong emotional competence. Maternal depression can have decidedly deleterious effects on this delicate process. This article will explore the consequences that maternal depression can have for early maternal-child interaction. It will offer the nurse clinician specific recommendations for assessment and intervention to support the normalization of depressed mothers' parenting.