Intensive Insulin Therapy in Patients with Type 1 Diabetes Mellitus

Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Court, A140, Aurora, CO 80045, USA.
Endocrinology and metabolism clinics of North America (Impact Factor: 3.4). 03/2012; 41(1):89-104. DOI: 10.1016/j.ecl.2011.12.001
Source: PubMed


There has been a significant increase in the prevalence of type 1 diabetes mellitus and type 2 diabetes mellitus in the past decade. The International Diabetes Foundation reported that there will be more than a half-billion people with diabetes by 2030, largely in emerging economies. Improved glucose control reduces microvascular and macrovascular complications and can be accomplished with intensive diabetes management. Continuous glucose monitors allow further improvement. The best way to emulate normal physiology is the development of an artificial pancreas. Early versions of closed-loop technology may be available in the United States in the next 3 to 5 years.

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    • "Intensive insulin treatment is an important advancement in diabetes management that can facilitate optimal glucose control in both adults [1] and children [2] with type 1 diabetes. Despite this, both continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) are still far from being effective in all patients. "
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    ABSTRACT: This study aimed to investigate the effect of carbohydrate counting (carbC), with or without an automated bolus calculator (ABC), in children with type 1 diabetes treated with multiple daily insulin injections. We evaluated 85 children, aged 9-16 years, with type 1 diabetes, divided into four groups: controls (n=23), experienced carbC (n=19), experienced carbC+ABC (n=18) and non-experienced carbC+ABC (n=25). Glycated haemoglobin (HbA1c), insulin use, and glycaemic variability - evaluated as high blood glucose index (HBGI) and low blood glucose index (LBGI) - were assessed at baseline and after 6 and 18 months. At baseline, age, disease duration, BMI, HbA1c, insulin use, and HBGI (but not LBGI; p=0.020) were similar for all groups. After 6 months, HbA1c improved from baseline, although not significantly - patients using ABC (according to manufacturer's recommendations) HbA1c 7.14±0.41% at 6 months vs. 7.35±0.53% at baseline, (p=0.136) or without carbC experience HbA1c 7.61±0.62% vs. 7.95±0.99% (p=0.063). Patients using ABC had a better HBGI (p=0.001) and a slightly worse LBGI (p=0.010) than those not using ABC. ABC settings were then personalised. At 18 months, further improvements in HbA1c were seen in children using the ABC, especially in the non-experienced carbC group (-0.42% from baseline; p=0.018). CarbC helped to improve glycaemic control in children with type 1 diabetes using multiple daily injections. ABC use led to greater improvements in HbA1c, HBGI and LBGI compared with patients using only carbC, regardless of experience with carbC.
    Diabetes research and clinical practice 01/2014; 103(3). DOI:10.1016/j.diabres.2013.12.026 · 2.54 Impact Factor
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    ABSTRACT: The new rDNA and DNA-derived "basal" insulin analogs, glargine and detemir, represent significant advancement in the treatment of diabetes compared with conventional NPH insulin. This review describes blood glucose homeostasis by insulin in people without diabetes and outlines the physiological application of exogenous insulin in patients with type 1 and type 2 diabetes. The requirements for optimal basal insulin treatment are discussed and the methods used in the evaluation of basal insulins are presented. An essential criterion in the development of an "ideal" basal insulin preparation is that the molecular modifications made to the human insulin molecule do not compromise safety. It is also necessary to obtain a clear understanding of the pharmacokinetic and pharmacodynamic characteristics of the two currently available basal insulin analogs. When comparing glargine and detemir, the different molar concentration ratios of the two insulin formulations should be considered along with the nonspecificity of assay systems used to determine insulin concentrations. However, euglycemic clamp studies in crossover study design provide a good basis for comparing the pharmacodynamic responses. When the latter is analyzed by results of intervention clinical trials, it is concluded that both glargine and detemir are superior to NPH in type 1 and type 2 diabetes. However, there is sufficient evidence to demonstrate that these two long-acting insulin analogs are different in both their pharmacokinetic and pharmacodynamic profiles. These differences should be taken into consideration when the individual analogs are introduced to provide basal insulin supplementation to optimize blood glucose control in patients with type 1 and type 2 diabetes as well. PubMed-Medline was searched for articles relating to pharmacokinetics and pharmacodynamics of glargine and detemir. Articles retrieved were reviewed and selected for inclusion if (1) the euglycemic clamp method was used with a duration >or=24 h, (2) a single subcutaneous dose of glargine/detemir was used, and (3) area under the curve for insulin concentrations or glucose infusion rates were calculated.
    Diabetes Technology &amp Therapeutics 11/2008; 10(5):333-49. DOI:10.1089/dia.2008.0023 · 2.11 Impact Factor
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    ABSTRACT: A new borate polymer PAA-ran-PAAPBA that can specifically adsorb glucose was introduced in the glucose measurement based on surface plasmon resonance, and the high-precision specific detection of glucose concentration was realized. Six layers and twelve layers of borate polymer were respectively bound onto the SPR sensors through the layer-by-layer self-assembly binding method, and the effect of different layers of borate polymer on the glucose surface plasmon resonance measurement was studied. The experiment was conducted in the concentration range of 1-10 mg x dL(-1) (interval delta = 1 mg x dL(-1)), 10-100 mg x dL(-1) (interval delta = 10 mg x dL(-1)), and 100-1 000 mg x dL(-1) (interval delta = 100 mg x dL(-1)), experiment data was fitted by quadric curve and the fitting degree of refractive index difference deltaRU and glucose concentration was obtained. Results showed that the 12-layer-polymer sensor was better than the 6-layer-polymer sensor in the first two smaller ranges, and the measuring result was not significantly affected by layers in the third range, indicating that for the small concentrations increasing polymer layer can dramatically improve the measurement.
    Guang pu xue yu guang pu fen xi = Guang pu 04/2013; 33(1):142-6. DOI:10.3964/j.issn.1000-0593(2013)01-0142-05 · 0.29 Impact Factor
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