Latest & greatest articles for insulin

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Top results for insulin

1. Sliding scale insulin for non-critically ill hospitalised adults with diabetes mellitus.

Sliding scale insulin for non-critically ill hospitalised adults with diabetes mellitus. BACKGROUND: Diabetes mellitus is a metabolic disorder resulting from a defect in insulin secretion, function, or both. Hyperglycaemia in non-critically ill hospitalised people is associated with poor clinical outcomes (infections, prolonged hospital stay, poor wound healing, higher morbidity and mortality). In the hospital setting people diagnosed with diabetes receive insulin therapy as part (...) of their treatment in order to achieve metabolic control. However, insulin therapy can be provided by different strategies (sliding scale insulin (SSI), basal-bolus insulin, and other modalities). Sliding scale insulin is currently the most commonly used method, however there is uncertainty about which strategy provides the best patient outcomes. OBJECTIVES: To assess the effects of SSI for non-critically ill hospitalised adults with diabetes mellitus. SEARCH METHODS: We identified eligible trials by searching

Cochrane2018

2. Insulin pumps offer little value over multiple injections for children at the onset of diabetes

Insulin pumps offer little value over multiple injections for children at the onset of diabetes Insulin pumps or multiple injections for children at onset of diabetes Dissemination Centre Discover Portal NIHR DC Discover Insulin pumps offer little value over multiple injections for children at the onset of diabetes Published on 20 November 2018 doi: Young people newly diagnosed with type 1 diabetes achieve similar blood glucose control by 12 months if they are treated with multiple daily (...) insulin injections or continuously via an insulin pump. Adverse events are rare and occur at similar rates. Pumps are more expensive with no clear benefit to quality of life. Both regimens are used in the management of type 1 diabetes, and the number of children using insulin pumps is rising. This NIHR-funded trial suggests that at an additional cost of £1,863 per patient annually with equivalent outcomes, the high costs of insulin pumps seem unjustified at this stage of the condition. However

NIHR Dissemination Centre2018

3. Insulin pumps offer little value over multiple injections for children at the onset of diabetes

Insulin pumps offer little value over multiple injections for children at the onset of diabetes Insulin pumps or multiple injections for children with diabetes Dissemination Centre Discover Portal NIHR DC Discover Insulin pumps offer little value over multiple injections for children at the onset of diabetes Published on 20 November 2018 doi: Young people newly diagnosed with type 1 diabetes achieve similar blood glucose control by 12 months if they are treated with multiple daily insulin (...) injections or continuously via an insulin pump. Adverse events are rare and occur at similar rates. Pumps are more expensive with no clear benefit to quality of life. Both regimens are used in the management of type 1 diabetes, and the number of children using insulin pumps is rising. This NIHR-funded trial suggests that at an additional cost of £1,863 per patient annually with equivalent outcomes, the high costs of insulin pumps seem unjustified at this stage of the condition. However, continuous

NIHR Dissemination Centre2018

4. Fast-acting insulin aspart versus insulin aspart in the setting of insulin degludec-treated type 1 diabetes: Efficacy and safety from a randomized double-blind trial

Fast-acting insulin aspart versus insulin aspart in the setting of insulin degludec-treated type 1 diabetes: Efficacy and safety from a randomized double-blind trial 30259644 2018 11 14 1463-1326 20 12 2018 Dec Diabetes, obesity & metabolism Diabetes Obes Metab Fast-acting insulin aspart versus insulin aspart in the setting of insulin degludec-treated type 1 diabetes: Efficacy and safety from a randomized double-blind trial. 2885-2893 10.1111/dom.13545 To evaluate the efficacy and safety (...) of mealtime or post-meal fast-acting insulin aspart (faster aspart) vs mealtime insulin aspart (IAsp), both in combination with insulin degludec, in participants with type 1 diabetes (T1D). This multicentre, treat-to-target trial (Clinical trial registry: NCT02500706, ClinicalTrials.gov) randomized participants to double-blind mealtime faster aspart (n = 342) or IAsp (n = 342) or open-label post-meal faster aspart (n = 341). The primary endpoint was change from baseline in HbA1c 26 weeks post

EvidenceUpdates2018

5. Efficacy of an Education Program for People With Diabetes and Insulin Pump Treatment (INPUT): Results From a Randomized Controlled Trial

Efficacy of an Education Program for People With Diabetes and Insulin Pump Treatment (INPUT): Results From a Randomized Controlled Trial 30305343 2018 10 11 1935-5548 2018 Oct 10 Diabetes care Diabetes Care Efficacy of an Education Program for People With Diabetes and Insulin Pump Treatment (INPUT): Results From a Randomized Controlled Trial. dc180917 10.2337/dc18-0917 Continuous subcutaneous insulin infusion (CSII) is the most advanced form of insulin delivery, but it requires structured (...) education to provide users with the necessary knowledge/skills and to support their motivation. Currently, no structured education program designed to provide this training has been evaluated. We developed a CSII-specific, structured education program (Insulin Pump Treatment [INPUT]) and evaluated its impact on glycemic control, behavior, and psychosocial status. This was a multicenter, randomized, parallel trial with a 6-month follow-up. Eligible participants (16-75 years) currently were treated

EvidenceUpdates2018

6. Empagliflozin as Adjunctive to Insulin Therapy in Type 1 Diabetes: The EASE Trials

Empagliflozin as Adjunctive to Insulin Therapy in Type 1 Diabetes: The EASE Trials 30287422 2018 10 05 1935-5548 2018 Oct 04 Diabetes care Diabetes Care Empagliflozin as Adjunctive to Insulin Therapy in Type 1 Diabetes: The EASE Trials. dc181749 10.2337/dc18-1749 To evaluate the safety and efficacy of empagliflozin 10- and 25-mg doses plus a unique lower dose (2.5 mg) as adjunct to intensified insulin in patients with type 1 diabetes (T1D). The EASE (Empagliflozin as Adjunctive to inSulin (...) thErapy) program ( N = 1,707) included two double-blind, placebo-controlled phase 3 trials: EASE-2 with empagliflozin 10 mg ( n = 243), 25 mg ( n = 244), and placebo ( n = 243), 52-week treatment; and EASE-3 with empagliflozin 2.5 mg ( n = 241), 10 mg ( n = 248), 25 mg ( n = 245), and placebo ( n = 241), 26-week treatment. Together they evaluated empagliflozin 10 mg and 25 mg, doses currently approved in treatment of type 2 diabetes, and additionally 2.5 mg on 26-week change in glycated hemoglobin

EvidenceUpdates2018

7. A post-hoc pooled analysis to evaluate the risk of hypoglycaemia with insulin glargine 300 U/mL (Gla-300) versus 100 U/mL (Gla-100) over wider nocturnal windows in individuals with type 2 diabetes on a basal-only insulin regimen

A post-hoc pooled analysis to evaluate the risk of hypoglycaemia with insulin glargine 300 U/mL (Gla-300) versus 100 U/mL (Gla-100) over wider nocturnal windows in individuals with type 2 diabetes on a basal-only insulin regimen 30160030 2018 10 03 1463-1326 2018 Aug 29 Diabetes, obesity & metabolism Diabetes Obes Metab A post-hoc pooled analysis to evaluate the risk of hypoglycaemia with insulin glargine 300 U/mL (Gla-300) versus 100 U/mL (Gla-100) over wider nocturnal windows in individuals (...) with type 2 diabetes on a basal-only insulin regimen. 10.1111/dom.13515 The EDITION trials in type 2 diabetes demonstrated comparable glycaemic control with less nocturnal and anytime (24-hour) hypoglycaemia for insulin glargine 300 U/mL (Gla-300) versus glargine 100 U/mL (Gla-100). However, the predefined nocturnal window (0:00-5:59 AM) may not be the most relevant for clinical practice. This post-hoc analysis compared expansions of the predefined nocturnal interval during basal insulin treatment without prandial

EvidenceUpdates2018

8. Efficacy and safety of once-weekly dulaglutide versus insulin glargine in mainly Asian patients with type 2 diabetes mellitus on metformin and/or a sulphonylurea: A 52-week open-label, randomized phase III trial

Efficacy and safety of once-weekly dulaglutide versus insulin glargine in mainly Asian patients with type 2 diabetes mellitus on metformin and/or a sulphonylurea: A 52-week open-label, randomized phase III trial 30129089 2018 10 08 1463-1326 2018 Aug 21 Diabetes, obesity & metabolism Diabetes Obes Metab Efficacy and safety of once-weekly dulaglutide versus insulin glargine in mainly Asian patients with type 2 diabetes mellitus on metformin and/or a sulphonylurea: A 52-week open-label (...) , randomized phase III trial. 10.1111/dom.13506 To compare the efficacy and safety of once-weekly dulaglutide with that of insulin glargine in combination with metformin and/or a sulphonylurea in mainly Asian patients with type 2 diabetes mellitus (T2DM). In this 52-week, randomized, parallel-arm open-label study, we enrolled patients aged ≥18 years with T2DM for at least 6 months and a glycated haemoglobin (HbA1c) concentration ≥53.0 mmol/mol (7.0%) and ≤96.7 mmol/mol (11.0%). The primary outcome

EvidenceUpdates2018

9. Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes

Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes Signal - Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes Dissemination Centre Discover Portal NIHR DC Discover Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes Published on 11 July 2017 People with type 1 diabetes offered insulin pumps did not achieve better blood glucose control compared with those using (...) multiple daily injections. Education remains important. While both groups saw improvements in blood glucose levels and fewer hypoglycaemic episodes (very low blood sugar) over two years, only one in four participants met NICE blood glucose targets. Insulin pump users showed some modest improvements in satisfaction, dietary freedom and daily hassle. All participants in this NIHR trial attended a training course on managing their insulin levels before randomisation. This is important because previously

NIHR Dissemination Centre2018

10. Continuous insulin pumps may help manage poorly controlled type 2 diabetes

Continuous insulin pumps may help manage poorly controlled type 2 diabetes Signal - Continuous insulin pumps may help manage poorly controlled type 2 diabetes Dissemination Centre Discover Portal NIHR DC Discover Continuous insulin pumps may help manage poorly controlled type 2 diabetes Published on 18 July 2017 Continuous subcutaneous insulin infusions, or pumps, reduced the amount of daily insulin required by 24 units for people with advanced type 2 diabetes compared to multiple daily insulin (...) injections. Average weight did not differ between treatments. This review compared the two treatments in 590 people from five trials and found that the pumps were linked to slightly better control for people on higher doses of insulin and those with poorer glucose control. However, looking at all the people with diabetes in these studies, there was no difference in overall control between the different forms of treatment. One main challenge in controlling type 2 diabetes is the low adherence to treatment

NIHR Dissemination Centre2018

11. XULTOPHY (insulin degludec/liraglutide), antidiabetic

XULTOPHY (insulin degludec/liraglutide), antidiabetic Haute Autorité de Santé - XULTOPHY (insuline degludec/liraglutide), antidiabétique Développer la qualité dans le champ sanitaire, social et médico-social Recherche Évaluation & Recommandation La HAS Accréditation & Certification Outils, Guides & Méthodes Agenda Avis sur les Médicaments XULTOPHY (insuline degludec/liraglutide), antidiabétique Substance active (DCI) insuline degludec liraglutide DIABETOLOGIE - Mise au point Nature de la (...) demande Modification des conditions d'inscription Avis de la CT du 06 décembre 2017 Intérêt clinique important chez les diabétiques de type 2 mais pas d’avantage clinique démontré en cas d’échec du contrôle glycémique de l’association metformine / insuline basale XULTOPHY a l’AMM dans le traitement du diabète de type 2 de l’adulte pour améliorer le contrôle glycémique en association aux antidiabétiques oraux lorsque ceux-ci, seuls ou associés à une insuline basale, ne permettent pas d’obtenir un

Haute Autorite de sante2018

12. Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild-to-moderate renal impairment

Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild-to-moderate renal impairment 30003642 2018 08 30 1463-1326 2018 Jul 13 Diabetes, obesity & metabolism Diabetes Obes Metab Glycaemic control and hypoglycaemia benefits with insulin glargine 300 U/mL extend to people with type 2 diabetes and mild-to-moderate renal impairment. 10.1111/dom.13470 To investigate the impact of renal function on the safety and efficacy of insulin (...) glargine 300 U/mL (Gla-300) and insulin glargine 100 U/mL (Gla-100). A meta-analysis was performed using pooled 6-month data from the EDITION 1, 2 and 3 trials (N = 2496). Eligible participants, aged ≥18 years with a diagnosis of type 2 diabetes (T2DM), were randomized to receive once-daily evening injections of Gla-300 or Gla-100. Pooled results were assessed by two renal function subgroups: estimated glomerular filtration rate (eGFR) <60 and ≥60 mL/min/1.73 m 2 . The decrease in glycated haemoglobin

EvidenceUpdates2018

13. Heart Failure After Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone

Heart Failure After Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone 29934374 2018 08 17 1524-4539 2018 Jun 22 Circulation Circulation Heart Failure After Ischemic Stroke or TIA in Insulin-Resistant Patients Without Diabetes Treated with Pioglitazone. CIRCULATIONAHA.118.034763 10.1161/CIRCULATIONAHA.118.034763 Background -The Insulin Resistance Intervention after Stroke (IRIS) trial demonstrated that pioglitazone reduced risk for both (...) cardiovascular events and diabetes in insulin resistant patients. However, concern remains that pioglitazone may increase risk for heart failure (HF) in susceptible individuals. Methods -In IRIS, patients with insulin resistance but without diabetes were randomized to pioglitazone or placebo (1:1) within 180 days of an ischemic stroke or TIA and followed for up to 5 years. To identify patients at higher HF risk with pioglitazone we performed a secondary analysis of IRIS participants without HF history at

EvidenceUpdates2018

14. Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial.

Closed-loop insulin delivery in suboptimally controlled type 1 diabetes: a multicentre, 12-week randomised trial. BACKGROUND: The achievement of glycaemic control remains challenging for patients with type 1 diabetes. We assessed the effectiveness of day-and-night hybrid closed-loop insulin delivery compared with sensor-augmented pump therapy in people with suboptimally controlled type 1 diabetes aged 6 years and older. METHODS: In this open-label, multicentre, multinational, single-period (...) , parallel randomised controlled trial, participants were recruited from diabetes outpatient clinics at four hospitals in the UK and two centres in the USA. We randomly assigned participants with type 1 diabetes aged 6 years and older treated with insulin pump and with suboptimal glycaemic control (glycated haemoglobin [HbA 1c ] 7·5-10·0%) to receive either hybrid closed-loop therapy or sensor-augmented pump therapy over 12 weeks of free living. Training on study insulin pump and continuous glucose

Lancet2018

15. Insulin and glucose-lowering agents for treating people with diabetes and chronic kidney disease.

Insulin and glucose-lowering agents for treating people with diabetes and chronic kidney disease. BACKGROUND: Diabetes is the commonest cause of chronic kidney disease (CKD). Both conditions commonly co-exist. Glucometabolic changes and concurrent dialysis in diabetes and CKD make glucose-lowering challenging, increasing the risk of hypoglycaemia. Glucose-lowering agents have been mainly studied in people with near-normal kidney function. It is important to characterise existing knowledge (...) of glucose-lowering agents in CKD to guide treatment. OBJECTIVES: To examine the efficacy and safety of insulin and other pharmacological interventions for lowering glucose levels in people with diabetes and CKD. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 12 February 2018 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE

Cochrane2018

16. Medicines for Treatment Intensification in Type 2 Diabetes and Type of Insulin in Type 1 and Type 2 Diabetes in Low-Resource Settings: Synopsis of the World Health Organization Guidelines on Second- and Third-Line Medicines and Type of Insulin for the Con

Medicines for Treatment Intensification in Type 2 Diabetes and Type of Insulin in Type 1 and Type 2 Diabetes in Low-Resource Settings: Synopsis of the World Health Organization Guidelines on Second- and Third-Line Medicines and Type of Insulin for the Con Description: The World Health Organization developed these guidelines to provide guidance on selection of medicines for treatment intensification in type 2 diabetes and on use of insulin (human or analogue) in type 1 and 2 diabetes. The target (...) databases from 1 January 2007 to 1 March 2017. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assess the quality of the evidence and the strength of the recommendations. The guideline was peer-reviewed by 6 external reviewers. Recommendation 1: Give a sulfonylurea to patients with type 2 diabetes who do not achieve glycemic control with metformin alone or who have contraindications to metformin (strong recommendation, moderate-quality evidence

Annals of Internal Medicine2018

17. A randomized, open-label, multicentre, parallel-controlled study comparing the efficacy and safety of biphasic insulin aspart 30 plus metformin with biphasic insulin aspart 30 monotherapy for type 2 diabetes patients inadequately controlled with oral anti

A randomized, open-label, multicentre, parallel-controlled study comparing the efficacy and safety of biphasic insulin aspart 30 plus metformin with biphasic insulin aspart 30 monotherapy for type 2 diabetes patients inadequately controlled with oral anti 29961975 2018 08 03 1463-1326 2018 Jul 02 Diabetes, obesity & metabolism Diabetes Obes Metab A randomized, open-label, multicentre, parallel-controlled study comparing the efficacy and safety of biphasic insulin aspart 30 plus metformin (...) with biphasic insulin aspart 30 monotherapy for type 2 diabetes patients inadequately controlled with oral antidiabetic drugs: The merit study. 10.1111/dom.13454 To confirm non-inferiority of biphasic insulin aspart 30 (BIAsp 30) plus metformin to BIAsp 30 in lowering glycated haemoglobin (HbA1c) in Chinese patients with inadequately controlled type 2 diabetes using oral antidiabetic drugs. In this 16-week, prospective, randomized, open-label, multicentre, parallel-controlled study, patients aged 18-79

EvidenceUpdates2018

18. More Similarities Than Differences Testing Insulin Glargine 300 Units/mL Versus Insulin Degludec 100 Units/mL in Insulin-Naive Type 2 Diabetes: The Randomized Head-to-Head BRIGHT Trial

More Similarities Than Differences Testing Insulin Glargine 300 Units/mL Versus Insulin Degludec 100 Units/mL in Insulin-Naive Type 2 Diabetes: The Randomized Head-to-Head BRIGHT Trial 30104294 2018 08 28 1935-5548 2018 Aug 13 Diabetes care Diabetes Care More Similarities Than Differences Testing Insulin Glargine 300 Units/mL Versus Insulin Degludec 100 Units/mL in Insulin-Naive Type 2 Diabetes: The Randomized Head-to-Head BRIGHT Trial. dc180559 10.2337/dc18-0559 To compare insulin glargine 300 (...) units/mL (Gla-300) versus insulin degludec 100 units/mL (IDeg-100) in this first head-to-head randomized controlled trial. BRIGHT (NCT02738151) was a multicenter, open-label, active-controlled, two-arm, parallel-group, 24-week, noninferiority study in insulin-naive patients with uncontrolled type 2 diabetes. Participants were randomized 1:1 to evening dosing with Gla-300 ( N = 466) or IDeg-100 ( N = 463), titrated to fasting self-monitored plasma glucose of 80-100 mg/dL. The primary end point

EvidenceUpdates2018

19. Efficacy of iGlarLixi, a fixed-ratio combination of insulin glargine and lixisenatide, in patients with type 2 diabetes stratified as at high or low risk according to HEDIS measurements

Efficacy of iGlarLixi, a fixed-ratio combination of insulin glargine and lixisenatide, in patients with type 2 diabetes stratified as at high or low risk according to HEDIS measurements 29923361 2018 07 25 1463-1326 2018 Jun 19 Diabetes, obesity & metabolism Diabetes Obes Metab Efficacy of iGlarLixi, a fixed-ratio combination of insulin glargine and lixisenatide, in patients with type 2 diabetes stratified as at high or low risk according to HEDIS measurements. 10.1111/dom.13438 The Healthcare (...) Effectiveness Data and Information Set (HEDIS) measurements assess glycaemic goal attainment in patients with type 2 diabetes, incorporating factors including age and health status. Healthier patients are assigned a glycated haemoglobin (HbA1c) goal of <7% (low-risk [LR]) and individuals aged >65 years or with comorbidities are assigned a goal of <8% (high-risk [HR]). This post-hoc analysis assessed the safety and efficacy of iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/mL (iGlar

EvidenceUpdates2018

20. Efficacy and safety of trelagliptin in combination with insulin therapy in Japanese patients with type 2 diabetes: Results from a randomized, Phase IV study

Efficacy and safety of trelagliptin in combination with insulin therapy in Japanese patients with type 2 diabetes: Results from a randomized, Phase IV study 29862617 2018 07 02 1463-1326 2018 Jun 04 Diabetes, obesity & metabolism Diabetes Obes Metab Efficacy and safety of trelagliptin in combination with insulin therapy in Japanese patients with type 2 diabetes: Results from a randomized, Phase IV study. 10.1111/dom.13397 We aimed to explore the efficacy and safety of once-weekly trelagliptin (...) 100 mg as an add-on therapy to insulin in Japanese patients with type 2 diabetes mellitus with inadequate glycaemic control. Patients with haemoglobin A1c (HbA1c) 7.5% to 10.0% who were receiving 8 to 40 units of insulin per day were randomized to receive, with insulin, trelagliptin 100 mg (A/A, n = 116) or placebo (P/A, n = 124) for a 12-week double-blind (DB) phase, after which all received trelagliptin for a 40-week open-label phase. Primary endpoints were HbA1c change from baseline to the end

EvidenceUpdates2018