[Show abstract][Hide abstract] ABSTRACT: The prevalence of type 1 diabetes continues to increase worldwide at a rate higher than previously projected, while the number of patients achieving American Diabetes Association (ADA) glycated hemoglobin (A1c) goals remains suboptimal. There are numerous barriers to patients achieving A1c targets including increased frequency of severe hypoglycemia associated with lowering plasma glucose as measured by lower A1c values. Continuous glucose monitoring (CGM) was first approved for retrospective analysis and now has advanced to the next step in diabetes management with the approval of real-time glucose sensing. Real-time CGM, in short term studies, has been shown to decrease A1c values, improve glucose variability (GV), and minimize the time and number of hypoglycemic events in patients with type 1 diabetes. These products are approved for adjunctive use to self-monitoring of blood glucose (SMBG), but future long-term studies are needed to document their safety, efficacy, ability to replace SMBG as a tool of monitoring, and ultimately utility into closed-loop insulin delivery systems. New algorithms will need to be developed that account for rapid changes in the glucose values, so that accuracy of the sensor data can be maintained. In addition, for better clinical care and usage, algorithms also need to be developed for both patients and the providers to guide them for their ongoing diabetes care.
No preview · Article · Sep 2008 · Current diabetes reviews
[Show abstract][Hide abstract] ABSTRACT: Insulin therapy is underutilized in the treatment of diabetes mellitus for many reasons, including both patient and provider resistance. Targeting postprandial blood glucose control in patients with either type 1 or type 2 diabetes has been demonstrated to improve overall glycemic control, but the reluctance to use injectable insulin demonstrates the need for the development of alternative routes for insulin delivery. The development of inhaled insulin systems was designed to improve the ease of insulin use for patients and help alleviate fears they may have with injectable insulin. Human insulin inhalation powder (HIIP) (Eli Lilly, Indianapolis, IN/Alkermes, Cambridge, MA) has been demonstrated in Phase 2 studies to have similar effects on glycemic profiles compared to both insulin lispro and regular insulin. Hypoglycemia during HIIP was similar to that of regular insulin but was associated with greater hypoglycemic risk compared to insulin lispro. In addition, the AIR Inhaled Insulin system (Lilly/Alkermes), which delivers HIIP, has been demonstrated to be easy to use and requires minimal patient education, which may improve overall medication compliance. Phase 3 studies are ongoing to further evaluate safety and efficacy of HIIP.