Type 2 Diabetes: Treat to Target

Michigan Diabetes Research and Training Center, Ann Arbor, Mich, USA.
The Nurse Practitioner 02/2004; 29(1):11-5, 19-23; quiz 23-5. DOI: 10.1097/00006205-200401000-00008
Source: PubMed


Traditionally, practitioners have reserved insulin therapy for patients with type 2 diabetes until diet, exercise, and treatment with oral agents have failed to maintain glycemic control. Increasing evidence, however, supports advancing insulin therapy earlier in treating diabetes, not only to normalize glycemic control and emulate normal physiologic insulin secretion, but also to delay or prevent disease-associated comorbidity.

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    • "Recent clinical studies (American Diabetes Association 2003, Riddle et al. 2003, Funnel & Kruger 2004, Kruger 2007, White 2007) have promoted the 'Treat-to-Target' approach that has been integrated into the multidisciplinary patient care plans. This model of care focuses on an HbA1c of less than 7%, and the reduction of the risk factors associated with complications such as myocardial infarction, stroke and renal damage. "
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    ABSTRACT: elliott-kemp y, ahern k & ostini r (2011) Journal of Nursing and Healthcare of Chronic Illness 3, 352–360 Glargine prescribing practices for Type 2 diabetes: is there room for improvement? Aim. This study investigated Glargine prescribing practices at an outpatient clinic in a tertiary hospital. Background. Treatment outcomes for people with Type 2 diabetes have improved with the introduction of the basal insulin Glargine. However, to achieve optimal therapeutic results in a safe fashion, this insulin must be titrated in accordance with the manufacturer’s recommendation. Method. Medical records of patients with Type 2 diabetes who had attended an outpatient clinic between 2007–2008 were reviewed. Data collected included the age and gender of the patient, whether the patient’s insulin dose had been titrated, the Haemoglobin A1c (HbA1c) percentage on prescription of Glargine and follow-up HbA1c results and the time elapsed between the initial and follow-up HbA1c. Findings. Only 14·6% of all patients had their Glargine insulin prescription adjusted according to the manufacturer’s recommendation. Despite this, prescription of Glargine insulin resulted in 43% of patients reducing their HbA1c result by at least 1%. Conclusion. Findings suggest that Glargine insulin was a contributing factor in the reduction of the patient’s HbA1c. Relevance to clinical practice. This study indicates that Glargine insulin is not consistently prescribed as per the manufacturer’s recommendation. Patient or clinician factors could explain why such a small percentage of patients had their Glargine prescription adjusted appropriately. Individualisation of Glargine insulin adjustment regimes, particularly in patients over the age of 75 years is vital to ensure positive patient outcomes.
    Full-text · Article · Dec 2011 · Journal of Nursing and Healthcare of Chronic Illness
    • "Combination of MET and GLI is beneficial in terms of its convenience to patient compliances. Scientific evidences were proved the efficacy of MET and GLI, through the monitoring of plasma drugs concentration during the antidiabetic therapy in diabetic patients[2-4]. "
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    ABSTRACT: Present study reports the development and validation of a simultaneous estimation of metformin and gliclazide in human plasma using supercritical fluid chromatography followed by tandem mass spectrometry. Acetonitrile:water (80:20) mixture was used as a mobile phase along with liquid CO<sub> 2</sub> in supercritical fluid chromatography and phenformin as an internal standard. The modified plasma samples were analyzed by electro-spray ionization method in selective reaction monitoring mode in tandem mass spectrometry. Supercritical fluid chromatographic separation was performed using nucleosil C<sub> 18</sub> containing column as a stationary phase. The separated products were identified by characteristic peaks and specific fragments peaks in tandem mass spectrometry as m/z 130 to 86 for metformin, m/z 324 to 110 for gliclazide and m/z 206 to 105 for phenformin. The present method was found linear in the concentration ranges of 6.0-3550 ng/ml and 7.5-7500 ng/ml for metformin and gliclazide, respectively. Pharmacokinetic study was performed after an oral administration of dispersible tablets containing 500 mg of metformin and 80 mg of gliclazide using same techniques.
    No preview · Article · Mar 2010 · Indian Journal of Pharmaceutical Sciences
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    • "come patient concerns (Funnell & Kruger, 2004; Polonsky & Jackson, 2004). Concerns surrounding insulin therapy are not limited to patients. "
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    ABSTRACT: Purpose: To highlight the pharmacology, clinical data, and practical application for the use of insulin detemir, a new long-acting insulin analog in the treatment of type 2 diabetes.Data sources: Published clinical, pharmacokinetic, and pharmacodynamic studies of insulin detemir, as well as contemporary studies and reviews about the management of patients with type 2 diabetes.Conclusions: Insulin therapy, if titrated appropriately, is the most physiological and effective intervention for lowering blood glucose and may help preserve β-cell function in patients with type 2 diabetes. Insulin detemir, in comparative clinical trials, has been shown to provide effective glycemic control and a consistent blood glucose–lowering response for up to 24 h, a decreased incidence of nocturnal hypoglycemia, and less weight gain than other basal insulin formulations.Implications for practice: Insulin therapy is often met with resistance from both patients and healthcare providers because of concerns about its effectiveness, hypoglycemia, injections, and weight gain. Insulin detemir, designed to closely mimic basal insulin secretion, may help overcome some of the barriers to effective diabetes management, i.e., hypoglycemia and weight gain, and lead to better outcomes.
    Full-text · Article · Sep 2007 · Journal of the American Academy of Nurse Practitioners
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