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Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes NIHR DC | Signal - Insulin pumps not much better than multiple injections for intensive control of type 1 diabetes Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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
Continuous insulin pumps may help manage poorly controlled type 2 diabetes NIHR DC | Signal - Continuous insulin pumps may help manage poorly controlled type 2 diabetes Dissemination Centre Discover Portal NIHR DC Discover NIHR Signal 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
Effect of prandial treatment timing adjustment, based on continuous glucose monitoring, in patients with type 2 diabetes uncontrolled with once-daily basal insulin: A randomized, phase IV study 29316176 2018 04 15 1463-1326 20 5 2018 May Diabetes, obesity & metabolism Diabetes Obes Metab Effect of prandial treatment timing adjustment, based on continuous glucose monitoring, in patients with type 2 diabetes uncontrolled with once-daily basal insulin: A randomized, phase IV study. 1186-1192 (...) 10.1111/dom.13214 To evaluate the glycaemic control achieved by prandial once-daily insulin glulisine injection timing adjustment, based on a continuous glucose monitoring sensor, in comparison to once-daily insulin glulisine injection before breakfast in patients with type 2 diabetes who are uncontrolled with once-daily basal insulin glargine. This was a 24-week open-label, randomized, controlled, multicentre trial. At the end of an 8-week period of basal insulin optimization, patients with HbA1c
Day-and-Night Closed-Loop Insulin Delivery in a Broad Population of Pregnant Women With Type 1 Diabetes: A Randomized Controlled Crossover Trial 29535135 2018 03 14 1935-5548 2018 Mar 13 Diabetes care Diabetes Care Day-and-Night Closed-Loop Insulin Delivery in a Broad Population of Pregnant Women With Type 1 Diabetes: A Randomized Controlled Crossover Trial. dc172534 10.2337/dc17-2534 Despite advances in technology, optimal glucose control remains elusive and neonatal complications ubiquitous (...) in type 1 diabetes (T1D) pregnancy. Our aim was to examine the safety, efficacy, and longer-term feasibility of day-and-night closed-loop insulin delivery. We recruited 16 pregnant women (mean [SD]: age 32.8 [5.0] years, T1D duration 19.4 [10.2] years, HbA 1c 8.0% [1.1%], BMI 26.6 [4.4] kg/m 2 ) to an open-label, randomized, crossover trial. Participants completed 28 days of closed-loop and sensor-augmented pump (SAP) insulin delivery separated by a washout period. Afterward, participants could
Sex Difference In the Effect of Fetal Exposure to Maternal Diabetes on Insulin Secretion 29687090 2018 11 14 2472-1972 2 5 2018 05 01 Journal of the Endocrine Society J Endocr Soc Sex Difference In the Effect of Fetal Exposure to Maternal Diabetes on Insulin Secretion. 391-397 10.1210/js.2017-00482 We previously showed that fetal exposure to maternal type 1 diabetes (T1D) is associated with altered glucose-stimulated insulin secretion in adult offspring. Here, we investigated whether this β (...) -cell defect displays a sex dimorphism. Twenty-nine adult nondiabetic offspring of T1D mothers (ODMs) were compared with 29 nondiabetic offspring of T1D fathers. We measured early insulin secretion in response to oral glucose and insulin secretion rate in response to intravenous glucose ramping. Insulin sensitivity and body composition were assessed by a euglycemic, hyperinsulinemic clamp and dual-energy X-ray absorptiometry, respectively. In response to oral glucose, male and female ODMs displayed
Increase in hepatic and decrease in peripheral insulin clearance characterize abnormal temporal patterns of serum insulin in diabetic subjects ARTICLE OPEN Increase in hepatic and decrease in peripheral insulin clearance characterize abnormal temporal patterns of serum insulin in diabetic subjects Kaoru Ohashi 1 , Masashi Fujii 1,2 , Shinsuke Uda 3 , Hiroyuki Kubota 3 , Hisako Komada 4 , Kazuhiko Sakaguchi 4 , Wataru Ogawa 4 and Shinya Kuroda 1,2,5 Insulin plays a central role in glucose (...) homeostasis, and impairment of insulin action causes glucose intolerance and leads to type 2 diabetes mellitus (T2DM). A decrease in the transient peak and sustained increase of circulating insulin following an infusion of glucose accompany T2DM pathogenesis. However, the mechanism underlying this abnormal temporal pattern of circulating insulin concentration remains unknown. Here we show that changes in opposite direction of hepatic and peripheral insulin clearance characterize this abnormal temporal
Efficacy and Safety of IDegLira Versus Basal-Bolus Insulin Therapy in Patients With Type 2 Diabetes Uncontrolled on Metformin and Basal Insulin; DUAL VII Randomized Clinical Trial 29483185 2018 02 27 1935-5548 2018 Feb 26 Diabetes care Diabetes Care Efficacy and Safety of IDegLira Versus Basal-Bolus Insulin Therapy in Patients With Type 2 Diabetes Uncontrolled on Metformin and Basal Insulin; DUAL VII Randomized Clinical Trial. dc171114 10.2337/dc17-1114 In patients with uncontrolled (...) type 2 diabetes on basal insulin, prandial insulin may be initiated. We assessed the efficacy and safety of initiating insulin degludec/liraglutide fixed-ratio combination (IDegLira) versus basal-bolus insulin. A phase 3b trial examined patients with uncontrolled type 2 diabetes on insulin glargine (IGlar U100) 20-50 units/day and metformin, randomized to IDegLira or IGlar U100 and insulin aspart four or fewer times per day. Glycated hemoglobin (HbA 1c ) decreased from 8.2% (66 mmol/mol) to 6.7% (50 mmol/mol
Weight-based carbohydrate treatment of hypoglycaemia in people with Type 1 diabetes using insulin pump therapy: a randomized crossover clinical trial 29285796 2018 02 13 1464-5491 35 3 2018 Mar Diabetic medicine : a journal of the British Diabetic Association Diabet. Med. Weight-based carbohydrate treatment of hypoglycaemia in people with Type 1 diabetes using insulin pump therapy: a randomized crossover clinical trial. 339-346 10.1111/dme.13576 To test whether weight-based treatment is more (...) effective than usual care in people with Type 1 diabetes receiving continuous subcutaneous insulin infusion therapy with regard to both hypoglycaemia and avoiding excessive rebound hyperglycaemia. Children and adults on continuous subcutaneous insulin infusion were enrolled into a study with a crossover design. Each episode of hypoglycaemia (defined as capillary glucose <4.0 mmol/l) was randomly assigned one of two treatment protocols using glucose tablets: either 0.3 g/kg body weight or usual treatment
Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association With Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. Importance: Dietary modification remains key to successful weight loss. Yet, no one dietary strategy is consistently superior to others for the general population. Previous research suggests genotype or insulin-glucose dynamics may modify the effects of diets. Objective: To determine the effect (...) of a healthy low-fat (HLF) diet vs a healthy low-carbohydrate (HLC) diet on weight change and if genotype pattern or insulin secretion are related to the dietary effects on weight loss. Design, Setting, and Participants: The Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) randomized clinical trial included 609 adults aged 18 to 50 years without diabetes with a body mass index between 28 and 40. The trial enrollment was from January 29, 2013, through April 14, 2015
Real-time continuous glucose monitoring in adults with type 1 diabetes and impaired hypoglycaemia awareness or severe hypoglycaemia treated with multiple daily insulin injections (HypoDE): a multicentre, randomised controlled trial. BACKGROUND: The effectiveness of real-time continuous glucose monitoring (rtCGM) in avoidance of hypoglycaemia among high-risk individuals with type 1 diabetes treated with multiple daily insulin injections (MDI) is unknown. We aimed to ascertain whether (...) the incidence and severity of hypoglycaemia can be reduced through use of rtCGM in these individuals. METHODS: The HypoDE study was a 6-month, multicentre, open-label, parallel, randomised controlled trial done at 12 diabetes practices in Germany. Eligible participants had type 1 diabetes and a history of impaired hypoglycaemia awareness or severe hypoglycaemia during the previous year. All participants wore a masked rtCGM system for 28 days and were then randomly assigned to 26 weeks of unmasked rtCGM
Pioglitazone Prevents Stroke in Patients With a Recent Transient Ischemic Attack or Ischemic Stroke: A Planned Secondary Analysis of the IRIS Trial (Insulin Resistance Intervention After Stroke) 29084736 2018 02 07 1524-4539 137 5 2018 Jan 30 Circulation Circulation Pioglitazone Prevents Stroke in Patients With a Recent Transient Ischemic Attack or Ischemic Stroke: A Planned Secondary Analysis of the IRIS Trial (Insulin Resistance Intervention After Stroke). 455-463 10.1161/CIRCULATIONAHA (...) .117.030458 The IRIS trial (Insulin Resistance Intervention after Stroke) demonstrated that pioglitazone reduced the risk for a composite outcome of stroke or myocardial infarction among nondiabetic patients with insulin resistance and a recent stroke or transient ischemic attack. The current planned secondary analysis uses updated 2013 consensus criteria for ischemic stroke to examine the effect of pioglitazone on stroke outcomes. Participants were randomly assigned to receive pioglitazone (45 mg/d
Newer Drugs for Type 2 Diabetes: An Emerging Adjunctive Therapy to Insulin for Type 1 Diabetes? Newer Drugs for Type 2 Diabetes: An Emerging Adjunctive Therapy to Insulin for Type 1 Diabetes? | CADTH.ca Français Français CADTH Document Viewer Newer Drugs for Type 2 Diabetes: An Emerging Adjunctive Therapy to Insulin for Type 1 Diabetes? Table of Contents Search this document Newer Drugs for Type 2 Diabetes: An Emerging Adjunctive Therapy to Insulin for Type 1 Diabetes? January 2018 Summary (...) There are two major categories of diabetes. Type 1 diabetes (T1D) is characterized by severe impairment or an absolute deficiency of insulin due to autoimmune destruction of pancreatic cells. Type 2 diabetes (T2D) is characterized by a combination of insulin resistance and decreased insulin secretion. Insulin is the mainstay of treatment for T1D. However, it may be difficult for some patients to reach target glycated hemoglobin (A1C) levels on insulin monotherapy. In some cases, hypoglycemia, excessive
GLP-1 and Insulin Recruit Muscle Microvasculature and Dilate Conduit Artery Individually But Not Additively in Healthy Humans ISSN 2472-1972 GLP-1 and Insulin Recruit Muscle Microvasculature and Dilate Conduit Artery Individually But Not AdditivelyinHealthyHumans Alvin W.K. Tan, 1,2 Sharmila C. Subaran, 1 Matthew A. Sauder, 1 Weidong Chai, 1 Linda A. Jahn, 1 Dale E. Fowler, 3 James T. Patrie, 4 Kevin W. Aylor, 1 Ananda Basu, 1 and Zhenqi Liu 1 1 Division of Endocrinology and Metabolism (...) , Department of Medicine, University of Virginia Health System, Charlottesville, Virginia 22908; 2 Department of Endocrinology, Tan Tock Seng Hospital, Singapore308433; 3 DivisionofCardiovascularMedicine,DepartmentofMedicine,UniversityofVirginia HealthSystem,Charlottesville,Virginia22908;and 4 DepartmentofPublicHealthSciences,Universityof Virginia Health System, Charlottesville, Virginia 22908 Context: Glucagon-like peptide-1 (GLP-1) and insulin increase muscle microvascular perfusion, thereby increasing
A new mechanism of action of glucagonâ€like peptideâ€1 agonist in hepatic steatosis: Promotion of hepatic insulin clearance through induction of carcinoembryonic antigenâ€related cell adhesion molecule 1 ANewMechanismofActionofGlucagon- LikePeptide-1AgonistinHepaticSteatosis: PromotionofHepaticInsulinClearance ThroughInductionofCarcinoembryonic Antigen-RelatedCellAdhesionMolecule1 SEE ARTICLE ON PAGE 35 N onalcoholic fatty liver disease (NAFLD) is one of the most prevalent liver diseases (...) in industrialized countries, with approximately 30%-40% of adults suffering from NAFLD. Of those, 15%-20% will develop to its progressive entity nonal- coholic steatohepatitis (NASH), a condition that may further progress to liver ?brosis and cirrhosis. (1) Because insulin resistance and visceral obesity are major contributors in the pathogenesis of NAFLD/ NASH, weight loss, exercise, and insulin-sensitizing drugs are considered as primary treatment regimens. Obeticholic acid, a farnesoid X nuclear receptor ago
Saxagliptin add-on therapy in Chinese patients with type 2 diabetes inadequately controlled by insulin with or without metformin: Results from the SUPER study, a randomized, double-blind, placebo-controlled trial 29144061 2017 12 21 1463-1326 2017 Nov 16 Diabetes, obesity & metabolism Diabetes Obes Metab Saxagliptin add-on therapy in Chinese patients with type 2 diabetes inadequately controlled by insulin with or without metformin: Results from the SUPER study, a randomized, double-blind (...) , placebo-controlled trial. 10.1111/dom.13161 This prospective, multicentre, phase III study (NCT02104804) evaluated the efficacy and safety of saxagliptin add-on therapy in Chinese patients with type 2 diabetes inadequately controlled by insulin ± metformin. Patients with glycated haemoglobin (HbA1c) 7.5% to 10.5% and fasting plasma glucose (FPG) <15 mmol/L (270 mg/dL) on stable insulin therapy (20-150 U/d) were randomized (1:1) to saxagliptin 5 mg once daily (N = 232) or placebo (N = 230) for 24 weeks
Premixed vs basal-bolus insulin regimen in Type 2 diabetes: comparison of clinical outcomes from randomized controlled trials and real-world data 28945928 2017 11 15 1464-5491 34 12 2017 Dec Diabetic medicine : a journal of the British Diabetic Association Diabet. Med. Premixed vs basal-bolus insulin regimen in Type 2 diabetes: comparison of clinical outcomes from randomized controlled trials and real-world data. 1728-1736 10.1111/dme.13518 To evaluate the concordance between data derived from (...) randomized controlled trial (RCT) and real-world estimates of HbA1c and weight change after 24 weeks of initiation of a basal-bolus compared with a premixed insulin regimen in people with Type 2 diabetes. Data eight RCTs were pooled after a systematic review of studies examining basal-bolus (n = 1893) or premixed (n = 1517) regimens. Real-world data were extracted from the UK primary care dataset for people on basal-bolus (n = 7483) or premixed insulin regimens (n=10 744). The mean differences between