Early insulin: an important therapeutic strategy.

Diabetes Care (Impact Factor: 8.57). 02/2005; 28(1):220-1. DOI: 10.2337/diacare.28.1.220
Source: PubMed
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    ABSTRACT: There are a variety of oral hypoglycemic agents available for use in type 2 diabetes. Despite the increasing choices of oral agents, insulin therapy remains the most effective means to lower blood glucose and often must be used. There is some controversy as to the best approach to the initiation of insulin treatment in type 2 diabetes. The approach we favor begins with basal insulin with later addition of premeal rapid-acting insulin. Drug Dev Res 69:116–118, 2008. © 2008 Wiley-Liss, Inc.
    Drug Development Research 05/2008; 69(3). · 0.87 Impact Factor
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    ABSTRACT: Abstract Purpose: Hypoglycemia is a frequent side effect induced by insulin treatment of type 1 (T1DM) and type 2 diabetes (T2DM). Limited data exist on the associated healthcare resource use and patient impact of hypoglycemia, particularly at a country-specific level. This study investigated the effects of self-reported non-severe hypoglycemic events (NSHE) on use of healthcare resources and patient wellbeing. Methods: Patients with T1DM or insulin-treated T2DM diabetes from seven European countries were invited to complete four weekly questionnaires. Data were collected on patient demographics, NSHE occurrence in the last 7 days, hypoglycemia-related resource use and patient impact. NSHE were defined as events with hypoglycemia symptoms, with or without blood glucose measurement, or low blood glucose measurement without symptoms, which the patient could manage without third-party assistance. Results: 3959 respondents completed at least one wave of the survey, with 57% completing all four questionnaires. 3827 respondents were used for data analyses. Overall, 2.3% and 8.9% of NSHE in patients with T1DM and T2DM, respectively, resulted in healthcare professional contact. Across countries, there was a mean increase in blood glucose test use of 3.0 tests in the week following a NSHE. Among respondents who were employed (48%), loss of work-time after the last hypoglycemic event was reported for 9.7% of NSHE. Overall, 10.2% (daytime) and 8.0% (nocturnal) NSHE led to work-time loss, with a mean loss of 84.3 (daytime) and 169.6 (nocturnal) minutes among patients reporting work-time loss. Additionally, patients reported feeling tired, irritable and having negative feelings following hypoglycemia. Limitations: Direct comparisons between studies must be interpreted with caution because of different definitions of hypoglycemia severity, duration of the studies and methods of data collection. Conclusions: NSHE were associated with use of extra healthcare resources and work-time loss in all countries studied, suggesting that NSHE have considerable impact on patients/society.
    Journal of Medical Economics 10/2013;
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    ABSTRACT: To investigate whether duration of diabetes has an impact on the effectiveness of insulinization in diabetes management. This open-label, noninterventional, observational registry was conducted at >500 centers in Korea. Patients with diabetes, on oral antidiabetic drugs, with HbA1c ≥7 % (53 mmol/mol) in the preceding 3 months, being considered for initiation of basal insulin by their physicians, were included. Data were collected at baseline and at 3 and 6 months. Of 6,616 patients evaluated, 62.5 % had diabetes for <10 years, while only 6.5 % patients had diabetes for ≥20 years. At the end of study, average HbA1c in patients with diabetes for <10 years, for 10 to <20 years, and for ≥20 years was 7.3 ± 1.0 % (56 ± 10.9 mmol/mol), 7.4 ± 1.0 % (57 ± 10.9 mmol/mol), and 7.6 ± 1.1 % (60 ± 12.0 mmol/mol), respectively. Over half the patients (50.7 %) with diabetes <10 years achieved HbA1c <7 % (53 mmol/mol) by the end of study, while only 42.1 and 35.1 % patients with diabetes for 10 to <20 and ≥20 years, respectively, achieved their target. The average insulin dosage required for per unit HbA1c reduction was significantly different among the groups according to duration of type 2 diabetes mellitus (p < 0.05). Among patients who achieved HbA1c <7 %, proportion of patients with hypoglycemia in the ≥20 years group was higher than that in the <10 years, 10 to <20 years groups. Early insulin administration provided a better glycemic control with less insulin dosage and lower frequency of hypoglycemic events. Thus, early insulinization might hold the key to better management of type 2 diabetes mellitus.
    Acta Diabetologica 02/2014; 51(4):655-661. · 4.63 Impact Factor