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Wangnoo SK, Baruah MP, Lodha S, Sanyal D, Goyal R, Sooragonda BG, Chandrasekaran S, Vijay Kumar G. In-Hospital Management of Hyperglycemia: The Role of Insulin Degludec. Diabetes Ther 2025; 16:547-568. [PMID: 40014293 PMCID: PMC11925827 DOI: 10.1007/s13300-025-01707-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 02/11/2025] [Indexed: 02/28/2025] Open
Abstract
INTRODUCTION Hyperglycemia is a common and challenging condition in hospitalized patients both with and without a history of diabetes. Managing hyperglycemia effectively is critical in reducing complications, mortality, and the length of hospital stays. Insulin degludec (IDeg), an ultralong-acting basal insulin, has a well-established efficacy and safety profile in terms of managing hyperglycemia in outpatients; it has demonstrated benefits in clinical practice across various patient populations. This review aims to assess the evidence on its clinical suitability, as well as efficacy and safety, for managing hyperglycemia across different inpatient populations. The review specifically focuses on outcomes such as glycemic control, glycemic variability, safety (particularly hypoglycemia risk), dosing flexibility, ease of titration, and use in special populations. METHODS A comprehensive literature search was conducted using PubMed to identify studies published between 2014 and 2024. Eligible studies included randomized controlled trials, real-world evidence, and case series that examined the use of IDeg for hyperglycemia management in hospitalized patients. RESULTS The reviewed studies consistently demonstrated that IDeg provides stable and predictable glycemic control with low glycemic variability. The ultralong duration of action, ability to be titrated daily, and flexibility in dosing make IDeg suitable for noncritical care settings with difficult-to-maintain rigid insulin schedules. Furthermore, the risk of hypoglycemia, particularly nocturnal hypoglycemia, is low with IDeg. These attributes are beneficial across diverse inpatient populations. Practical advantages, such as ease of administration with a specialized delivery device, further support its use in hospital settings. CONCLUSIONS Unique pharmacokinetic and pharmacodynamic properties of IDeg, reduced glycemic variability, low hypoglycemia risk, ease of daily titration, and dosing flexibility make it appropriate for managing hyperglycemia in hospitalized patients.
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Affiliation(s)
| | | | - Sailesh Lodha
- Endocrinology, Eternal Hospital, Jaipur, Rajasthan, India
| | - Debmalya Sanyal
- Department of Endocrinology, KPC Medical College, Kolkata, West Bengal, India
| | - Ramesh Goyal
- Department of Diabetology and Endocrinology, Apollo Hospital International Limited, Gandhinagar, Gujarat, India
| | - Basavaraj G Sooragonda
- Department of Endocrinology, Diabetes and Metabolism, Narayana Health, Bengaluru, Karnataka, India
| | | | - G Vijay Kumar
- Apollo Speciality Hospital, Diabetes Medicare Centre, Chennai, India.
- , Vrindavan, 32 AB Block, 5 Block, Anna Nagar, Chennai, India.
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Xia Y, Hu Y, Ma JH. Premixed insulin: Advantages, disadvantages, and future. World J Diabetes 2025; 16:102526. [PMID: 40093285 PMCID: PMC11885964 DOI: 10.4239/wjd.v16.i3.102526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/30/2024] [Accepted: 01/08/2025] [Indexed: 01/21/2025] Open
Abstract
Premixed insulin combines two types of insulin in a single injection. This combination streamlines dosing for patients with type 1 or type 2 diabetes, thereby enhancing convenience. However, patients receiving premixed insulin commonly have less satisfactory blood glucose control. The fixed ratio of insulin in these formulations frequently fails to account for the nuanced demands of individualized glucose-lowering therapy. Moreover, local absorption of mixed insulin and potential systemic autoimmune responses may further compromise glycaemic control. The co-formulation of insulin degludec and insulin aspart introduces a new combination of the two insulin types within a single injection, offering a promising solution for mitigating the limitations inherent in premixed insulin.
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Affiliation(s)
- Yan Xia
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Yun Hu
- Department of Endocrinology, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi People’s Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Jian-Hua Ma
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210000, Jiangsu Province, China
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Zhu M, Chen Y, Wan L, Li Z, Pu J, Tang C. Pharmacokinetics and pharmacodynamics of insulin lispro 25 versus the original preparation (Humalog ®25) in Chinese healthy male volunteers. Front Pharmacol 2025; 16:1533548. [PMID: 40070573 PMCID: PMC11893401 DOI: 10.3389/fphar.2025.1533548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2024] [Accepted: 02/03/2025] [Indexed: 03/14/2025] Open
Abstract
Background: There are approximately 537 million adults with diabetes worldwide, and insulin still plays an important role in its treatment. However, the long-term use of insulin imposes a significant financial burden on patients. This study aims to explore the pharmacokinetic (PK)/ pharmacodynamic (PD) parameters of generic premixed insulin lispro 25 (25% insulin lispro and 75% protamine zinc lispro) and evaluate the bio-equivalence between generic and brand-name preparations to reduce medical costs while ensuring the effectiveness and safety of treatment. Research design and method: This is a single-center, randomized, open-label, two-period, crossover study. This study recruited 52 healthy volunteers and randomly divided them into two sequences to receive either the test (T) preparation or the reference (R) preparation in each period (Chinese Drug Trial Identifier: CTR20202288, URL: http://www.chinadrugtrials.org.cn). The C-peptide and plasma concentration of lispro 25 were analyzed using ELISA and high-performance liquid chromatography, respectively. A euglycemic clamp was used to measure the glucose infusion rate (GIR). The main PK parameters (AUC0-t and Cmax) and PD parameters (GIRmax and GIRAUC0-t) and the evaluation of bioequivalence were calculated using WinNonlin 8.3.1. Results: The quality of the clamp was approved by stable blood glucose and inhibited C-peptide levels. For PK parameters, the Cmax values of the T and R preparations were 1.40 ± 0.452 and 1.36 ± 0.418 ng·mL-1, respectively, and the AUC0-24h values were 497 ± 107 and 510 ± 86.2 ng h·mL-1, respectively. For PD parameters, GIRmax values were 4.47 ± 2.12 and 4.12 ± 1.81 mg kg·min-1, and AUCGIR0-24h values were 2,994 ± 1,232 and 2,994 ± 941 mg h·kg·min-1 for T and R, respectively. The 90% confidence intervals (CIs) for the geometric mean ratio (test/reference) of the main PK parameters (AUC0-t and Cmax) and PD parameters (GIRmax and GIRAUC0-t) in both cohorts were within the range of 80%-125%. Furthermore, there was no significant hypoglycemia and serious adverse events (SAEs) observed in this study. Conclusion: Bio-equivalence between insulin lispro (R) (Humalog®25) and insulin lispro (T) was demonstrated, with both showing good tolerance in healthy Chinese volunteers. The results provide evidence supporting the interchangeability of different drug formulations and offer more options for clinical drug use.
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Affiliation(s)
| | | | | | | | | | - Chengyong Tang
- Phase I Clinical Trial Center, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Chongqing, China
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Rivas-Montenegro A, Añez-Ramos R, Galdón-Sanz P, González-Albarrán O. Continuous Glucose Monitoring in Hospitalized Patients with Type 2 Diabetes: A Step Forward in Inpatient Glycemic Control. Endocr Pract 2025:S1530-891X(25)00046-1. [PMID: 39954783 DOI: 10.1016/j.eprac.2025.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 01/21/2025] [Accepted: 02/10/2025] [Indexed: 02/17/2025]
Abstract
OBJECTIVES To determine the effect and safety of Continuous Glucose Monitoring (CGM) use in glycemic control compared to standard approach in hospitalized patients with Type 2 Diabetes (T2D). METHODS This was a pilot randomized controlled clinical trial enrolled 37 hospitalized patients with T2D admitted in medical and surgical wards. All patients used CGM (Abbott FreeStyle2 or FreeStyle3) and concomitantly 6-point point of care glucose (POCG). In group A (n=19), daily CGM profiles, alarms, and trend arrows were considered for glycemic therapeutic decisions and in group B (n=18) were based on POCG. Primary outcomes included the difference in time in range (TIR) 70-180 mg/dL, hospital glycemia risk index (GRI), time below range (TBR) measured as the percentage below 70 mg/dL and below 54 mg/dL, and time above range (TAR) measured as the percentage above 180 mg/dL and above 250 mg/dL. RESULTS TIR was higher in group A: 78.26±10.83% vs. 67.39±19.13% p=0.04. TAR level 1 in group A: 14.37±8.33% vs. group B: 23.28±16.62% p=0.04. Asymptomatic hypoglycemic events were more detected by CGM-group (1.65±2.03 vs. 0.31±0.60 p=0.01). Overall MARD: 14.7%. DTS Error Grid: 69.5% zone A and 29.3% zone B. CONCLUSIONS The implementation of CGM in hospitals could represent a significant advancement in diabetes management, offering a more comprehensive and dynamic approach to monitoring glucose levels. Further research is needed to explore the long-term impacts of CGM on clinical outcomes and to optimize its integration into hospital protocols.
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Affiliation(s)
| | - Roberto Añez-Ramos
- Endocrinology and Nutrition Department, Gregorio Maranon Hospital. Madrid 28007, Spain
| | - Pastor Galdón-Sanz
- Endocrinology and Nutrition Department, Gregorio Maranon Hospital. Madrid 28007, Spain
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Marino EC, Momesso D, Toyoshima MTK, de Almeida MFO, Schaan BD, Negretto LAF, Santomauro Junior AC, Cukier P, Genestreti PRR, Feitosa ACR, da Silva Soares Pinto JE, Ribeiro RS, Lamounier RN, Lyra R, Bertoluci MC. Screening and management of hospital hyperglycemia in non-critical patients: a position statement from the Brazilian Diabetes Society (SBD). Diabetol Metab Syndr 2025; 17:54. [PMID: 39939862 PMCID: PMC11823188 DOI: 10.1186/s13098-025-01585-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Accepted: 01/10/2025] [Indexed: 02/14/2025] Open
Abstract
BACKGROUND Hospital Hyperglycemia (HH) is linked to poorer outcomes, including higher mortality rates, increased ICU admissions, and extended hospital stays, and occurs in both people living with diabetes or not. The prevalence of HH in non-critical patients ranges from 22 to 46%. This panel reviewed the evidence and made recommendations for the best care for hospitalized hyperglycemic patients, with or without diabetes mellitus. METHODS The methodology was published previously and was defined by the internal institutional steering committee. The SBD Acute and Hospital Complications Department drafted the manuscript, selecting key clinical questions for a narrative review using MEDLINE via PubMed. The best available evidence was reviewed, including randomized clinical trials (RCTs), meta-analyses, and high-quality observational studies related to Hospital Hyperglycemia. RESULTS AND CONCLUSIONS The department members and external experts developed 23 recommendations for the management of patients with HH, including screening, initial interventions, treatment adjustments, and care for potential complications. Based on the best available evidence, our article provides safe and effective management strategies for both public and private healthcare settings.
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Affiliation(s)
- Emerson Cestari Marino
- Curitiba Diabetes Center, Curitiba, Brazil.
- Endocrinology and Metabolism Service, Hospital Nossa Senhora das Graças, Curitiba, Brazil.
| | - Denise Momesso
- Endocrinology Service, Universidade Federal Do Estado Do Rio de Janeiro, Rio de Janeiro, Brazil
- Hospital Clínica São Vicente, Rio de Janeiro, Brazil
| | - Marcos Tadashi Kakitani Toyoshima
- Endocrine Oncology Unit, Instituto Do Câncer Do Estado de São Paulo Octavio Frias de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Beatriz D Schaan
- Faculdade de Medicina da Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Endocrinology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Priscilla Cukier
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Jorge Eduardo da Silva Soares Pinto
- Internal Medicine Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
- Nutrology and Diabetes Service, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rodrigo Nunes Lamounier
- Internal Medicine Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Endocrinology Service, Mater Dei Hospital, Belo Horizonte, Brazil
| | - Ruy Lyra
- Endocrinology and Metabolism Service, Federal University of Pernambuco, Recife, Brazil
| | - Marcello Casaccia Bertoluci
- Faculdade de Medicina da Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
- Endocrinology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Kanbour S, Zale AD, Shim JY, Abusamaan MS, Mathioudakis N. Association Between Daily Insulin Dose Adjustments and Glycemic Control in Noncritically Ill Hospitalized Hyperglycemic Patients: A Retrospective Cohort Study. Endocr Pract 2025:S1530-891X(25)00032-1. [PMID: 39884508 DOI: 10.1016/j.eprac.2025.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 01/21/2025] [Accepted: 01/23/2025] [Indexed: 02/01/2025]
Abstract
OBJECTIVE To evaluate the efficacy of daily insulin dose increases in managing inpatient hyperglycemia. METHODS Retrospective study of patients discharged from 2 urban academic medical centers and 3 large suburban community hospitals between 2015 and 2019 who received ≥10 units of basal insulin on any day. On hyperglycemic days (mean glucose ≥180 mg/dL), we categorized the relative insulin dose increases into 4 categories based on percentage changes from the previous day. We further subclassified these categories according to the average blood glucose (BG), total daily dose (TDD), and weight-based dosing quartiles. The primary goal was achieving an average BG of ≤160 mg/dL without subsequent hypoglycemia (≤70 mg/dL) on the following day. RESULTS From 25 186 hospital admissions, we collected data on 240 556 hospital days and 63 033 hyperglycemic index days. The median age was 64, with 53.4% being male and 52.1% White. The median BG level was 222.7 mg/dL. Type 2 diabetes was coded in 54.7%, while 36.3% lacked a diabetes code but received basal insulin. Insulin dose adjustments showed a strong correlation with glycemic control; specifically, a 44% to 100% increase in TDD was significantly more likely to achieve the primary outcome, compared to a TDD increase of 10% to 22%. This trend remained consistent across varied BG ranges and dosing categories. CONCLUSION More intensive insulin adjustments may be required for inpatient hyperglycemia compared to the typical 10% to 20% recommendation. Prospective studies are needed to validate and build upon these retrospective findings.
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Affiliation(s)
- Sarah Kanbour
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrew D Zale
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jalene Y Shim
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohammed S Abusamaan
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nestoras Mathioudakis
- Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD.
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ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Ekhlaspour L, Galindo RJ, Garg R, Khunti K, Lal R, Lingvay I, Matfin G, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Stanton RC, Bannuru RR. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2025. Diabetes Care 2025; 48:S321-S334. [PMID: 39651972 PMCID: PMC11635037 DOI: 10.2337/dc25-s016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Alexanian SM, Cheney MC, Spartano NL, Bello-Ramos JC, Reddy N, Malik A, Murati J, Wolpert HA, Steenkamp DW. Comparing Postprandial Glycemic Control Using Fiasp vs Insulin Aspart in Hospitalized Patients With Type 2 Diabetes. Endocr Pract 2024:S1530-891X(24)00846-2. [PMID: 39643003 DOI: 10.1016/j.eprac.2024.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 11/19/2024] [Accepted: 11/26/2024] [Indexed: 12/09/2024]
Abstract
OBJECTIVE Hyperglycemia in hospitalized patients is associated with increased morbidity and mortality. Basal-bolus insulin therapy is the treatment of choice for most patients. The efficacy of an ultrarapid vs rapid-acting insulin in hospitalized patients with diabetes has not been evaluated. We assessed noninferiority in efficacy and safety of Fiasp vs aspart (Novolog) as part of a basal-bolus insulin regimen in noncritically ill patients with type 2 diabetes in a safety-net hospital. METHODS This prospective, open-label, randomized trial included 137 patients with diabetes admitted to a non-intensive care unit setting. Subjects were treated with glargine at bedtime and either Fiasp or Novolog for prandial and correction insulin. Subjects were enrolled for a minimum of 4 or maximum of 6 meal boluses. Capillary blood glucose was used for insulin adjustment and a blinded Dexcom G6 Pro captured data for study analysis. The primary endpoint was time spent in sensor glucose range 100-180 mg/dL in the 4-hour postprandial period (assessed among 106 participants with ≥ 4 meals with a 4-hour postprandial period). Time spent in hypoglycemic ranges (<70, <54, <40 mg/dL) was assessed for safety. RESULTS Four-hour postprandial time in range 100-180 mg/dL was 45% in the Fiasp group vs 36% in the Novolog group (P = .012; meeting prespecified noninferiority criteria). Other glycemic metrics were similar between groups with no difference in time spent in hypoglycemic ranges. CONCLUSION Fiasp provides noninferior postprandial glucose control in hospitalized patients with type 2 diabetes when compared to Novolog with no increase in rates of hypoglycemia.
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Affiliation(s)
- Sara M Alexanian
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Michael C Cheney
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Nicole L Spartano
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Jenny C Bello-Ramos
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Niyoti Reddy
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Aamir Malik
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Jonila Murati
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Howard A Wolpert
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Devin W Steenkamp
- Section of Endocrinology, Diabetes, Nutrition and Weight Management, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts.
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Gianchandani R, Wei M, Demidowich A. Management of Hyperglycemia in Hospitalized Patients. Ann Intern Med 2024; 177:ITC177-ITC192. [PMID: 39652876 DOI: 10.7326/annals-24-02754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2024] Open
Abstract
People with diabetes account for 25% of hospitalizations, or 8 million admissions annually. Poor glycemic control in the hospital is associated with increased morbidity, mortality, length of stay, and readmissions. Key considerations of inpatient diabetes management include initiation of appropriate insulin or medication regimens and frequent dose adjustments based on patient-specific factors. Inpatient diabetes management teams and new technologies are increasingly prevalent and can assist in achieving glycemic targets in the hospital. At discharge, standardized checklists should be used to ensure successful transitions of care.
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Affiliation(s)
- Roma Gianchandani
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California (R.G., M.W.)
| | - Margaret Wei
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California (R.G., M.W.)
| | - Andrew Demidowich
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (A.D.)
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Thabit H, Schofield J. Technology in the management of diabetes in hospitalised adults. Diabetologia 2024; 67:2114-2128. [PMID: 38953925 PMCID: PMC11447115 DOI: 10.1007/s00125-024-06206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/14/2024] [Indexed: 07/04/2024]
Abstract
Suboptimal glycaemic management in hospitals has been associated with adverse clinical outcomes and increased financial costs to healthcare systems. Despite the availability of guidelines for inpatient glycaemic management, implementation remains challenging because of the increasing workload of clinical staff and rising prevalence of diabetes. The development of novel and innovative technologies that support the clinical workflow and address the unmet need for effective and safe inpatient diabetes care delivery is still needed. There is robust evidence that the use of diabetes technology such as continuous glucose monitoring and closed-loop insulin delivery can improve glycaemic management in outpatient settings; however, relatively little is known of its potential benefits and application in inpatient diabetes management. Emerging data from clinical studies show that diabetes technologies such as integrated clinical decision support systems can potentially mediate safer and more efficient inpatient diabetes care, while continuous glucose sensors and closed-loop systems show early promise in improving inpatient glycaemic management. This review aims to provide an overview of current evidence related to diabetes technology use in non-critical care adult inpatient settings. We highlight existing barriers that may hinder or delay implementation, as well as strategies and opportunities to facilitate the clinical readiness of inpatient diabetes technology in the future.
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Affiliation(s)
- Hood Thabit
- Diabetes, Endocrinology and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Jonathan Schofield
- Diabetes, Endocrinology and Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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11
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Ahmad MM, Hassan HA, Saadawy SF, Ahmad EA, Elsawy NAM, Morsy MM. Antox targeting AGE/RAGE cascades to restore submandibular gland viability in rat model of type 1 diabetes. Sci Rep 2024; 14:18160. [PMID: 39103403 PMCID: PMC11300852 DOI: 10.1038/s41598-024-68268-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
Diabetes mellitus (DM) is a chronic disorder of glucose metabolism that threatens several organs, including the submandibular (SMG) salivary glands. Antox (ANX) is a strong multivitamin with significant antioxidant benefits. The goal of this study was to demonstrate the beneficial roles of ANX supplementation in combination with insulin in alleviating diabetic SMG changes. For four weeks, 30 rats were divided into equal five groups (n = 6): (1) control group; (2) diabetic group (DM), with DM induced by streptozotocin (STZ) injection (50 mg/kg i.p.); (3) DM + ANX group: ANX was administrated (10 mg/kg/day/once daily/orally); (4) DM + insulin group: insulin was administrated 1U once/day/s.c.; and (5) DM + insulin + ANX group: co-administrated insulin. The addition of ANX to insulin in diabetic rats alleviated hyposalivation and histopathological alterations associated with diabetic rats. Remarkably, combined ANX and insulin exerted significant antioxidant effects, suppressing inflammatory and apoptotic pathways associated with increased salivary advanced glycation end-product (AGE) production and receptor for advanced glycation end-product expression (RAGE) activation in diabetic SMG tissues. Combined ANX and insulin administration in diabetic rats was more effective in alleviating SMG changes (functions and structures) than administration of insulin alone, exerting suppressive effects on AGE production and frustrating RAGE downstream pathways.
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Affiliation(s)
- Marwa M Ahmad
- Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Heba A Hassan
- Clinical Pharmacology Department, Faculty of Medicine, Zagazig University, Zagazig, 45519, Egypt
- Department of Pharmacology, Faculty of Medicine, Mutah University, Al-Karak, 61710, Jordan
| | - Sara F Saadawy
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Enssaf Ahmad Ahmad
- Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Manal Mohammad Morsy
- Department of Human Anatomy and Embryology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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12
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Walt JR, Loughran J, Fourlanos S, Barmanray RD, Zhu J, Varadarajan S, Kyi M. Glycaemic outcomes in hospital with IDegAsp versus BIAsp30 premixed insulins. Intern Med J 2024; 54:1329-1336. [PMID: 38578058 DOI: 10.1111/imj.16391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND AIMS IDegAsp (Ryzodeg 70/30), a unique premixed formulation of long-acting insulin degludec and rapid-acting insulin aspart, is increasing in use. Management of IDegAsp during hospitalisation is challenging because of degludec's ultra-long duration of action. We investigated inpatient glycaemia in patients treated with IDegAsp compared to biphasic insulin aspart (BIAsp30; Novomix30). METHODS We performed a retrospective observational study at two hospitals assessing inpatients with type 2 diabetes treated with IDegAsp or BIAsp30 prior to and during hospital admission. Standard inpatient glycaemic outcomes were analysed based on capillary blood glucose (BG) measurements. RESULTS We assessed 88 individuals treated with IDegAsp and 88 HbA1c-matched individuals treated with BIAsp30. Patient characteristics, including insulin dose at admission, were well matched, but the IDegAsp group had less frequent twice-daily insulin dosing than the BIAsp30 group (49% vs 87%, P < 0.001). Patient-days with BG <4 mmol/L were not different (10.6% vs 9.9%, P = 0.7); however, the IDegAsp group had a higher patient-day mean BG (10.4 (SD 3.4) vs 10.0 (3.4) mmol/L, P < 0.001), and more patient-days with mean BG >10 mmol/L (48% vs 38%, P < 0.001) compared to the BIAsp30 group. Glucose was higher in the IDegAsp group in the evening (4 PM to midnight) (11.6 (SD 4.0) vs 10.9 (4.6) mmol/L, P = 0.004), but not different at other times during the day. CONCLUSIONS Inpatients treated with IDegAsp compared to BIAsp30 had similar hypoglycaemia incidence, but higher hyperglycaemia incidence, potentially related to less frequent twice-daily dosing. With the increasing use of IDegAsp in the community, development of hospital management guidelines for this insulin formulation is needed.
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Affiliation(s)
- Joshua R Walt
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Royal Melbourne Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julie Loughran
- Endocrinology Unit, Northern Hospital, Epping, Victoria, Australia
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine at Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, Victoria, Australia
| | - Rahul D Barmanray
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine at Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, Victoria, Australia
| | - Jasmine Zhu
- Endocrinology Unit, Northern Hospital, Epping, Victoria, Australia
| | | | - Mervyn Kyi
- Department of Diabetes and Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Endocrinology Unit, Northern Hospital, Epping, Victoria, Australia
- Department of Medicine at Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, Victoria, Australia
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13
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Kanjee Z, Brown FM, Taxin ZH, Smetana GW. How Would You Treat This Inpatient With Type 2 Diabetes Mellitus? Grand Rounds Discussion From Beth Israel Deaconess Medical Center. Ann Intern Med 2024; 177:1106-1117. [PMID: 39133925 DOI: 10.7326/annals-24-01100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024] Open
Abstract
Management of hospitalized patients with type 2 diabetes mellitus (T2DM) presents unique challenges. Two recently released guidelines, one from the American Diabetes Association and the other from the Endocrine Society, provide useful recommendations and evidence review to inform the care of medical inpatients with T2DM. These guidelines mostly agree, although there are slight differences in their recommendations. In these rounds, 2 expert diabetologists discuss their approach to inpatient management of T2DM, specifically regarding inpatient glycemic goals on the medical ward, the use of noninsulin antihyperglycemic medications, and patient safety strategies for patients receiving long-acting insulin. They conclude with recommendations for Mr. D, a real patient with T2DM admitted with a recurrent foot infection.
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Affiliation(s)
- Zahir Kanjee
- Harvard Medical School, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.K.)
| | - Florence M Brown
- Harvard Medical School, Joslin and BIDMC Diabetes in Pregnancy Program, Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Boston, Massachusetts (F.M.B.)
| | - Zachary H Taxin
- Harvard Medical School, Inpatient Diabetes Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Z.H.T.)
| | - Gerald W Smetana
- Harvard Medical School, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (G.W.S.)
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Emad-Eldin M, Balata GF, Elshorbagy EA, Hamed MS, Attia MS. Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges. World J Diabetes 2024; 15:828-852. [PMID: 38766443 PMCID: PMC11099362 DOI: 10.4239/wjd.v15.i5.828] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/01/2024] [Accepted: 03/20/2024] [Indexed: 05/10/2024] Open
Abstract
Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient's perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.
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Affiliation(s)
- Mahmoud Emad-Eldin
- Department of Pharmacy Practice, Faculty of Pharmacy, Zagazig University, Zagazig HFQM+872, Al-Sharqia Governorate, Egypt
| | - Gehan F Balata
- Department of Pharmacy Practice, Faculty of Pharmacy, Heliopolis University, Cairo 44519, Egypt
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Eman A Elshorbagy
- Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mona S Hamed
- Department of Community at Faculty of Medicine, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
| | - Mohamed S Attia
- Department of Pharmaceutics, Faculty of Pharmacy, Zagazig University, Zagazig 44519, Al-Sharqia Governorate, Egypt
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15
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Ketaroonrut N, Kiertiburanakul S, Sriphrapradang C. Optimal initial insulin dosage for managing steroid-induced hyperglycemia in hospitalized COVID-19 patients: A retrospective single-center study. SAGE Open Med 2024; 12:20503121241238148. [PMID: 38516643 PMCID: PMC10956164 DOI: 10.1177/20503121241238148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Objectives To determine the optimal initial insulin dosage for controlling hyperglycemia in COVID-19 patients receiving steroids, an area with limited data. Methods We retrospectively analyzed 156 COVID-19 patients with steroid-induced hyperglycemia treated with insulin. Patients were categorized by their total daily dose of subcutaneous insulin therapy when starting dexamethasone ⩾6 mg/day or equivalent dose of glucocorticoid: Group A (⩽0.29 units/kg), Group B (0.3-0.49 units/kg), Group C (0.5-0.69 units/kg), and Group B (⩾0.7 units/kg). Treatment failure was defined as mean blood glucose level > 280 mg/dL for two consecutive days after initiating insulin or any blood glucose ⩾ 400 mg/dL. Results The mean age was 64 ± 14 years, with 50% male, and a mean body mass index of 26.9 ± 6.9 kg/m2. Most had preexisting type 2 diabetes (62%). Mean admission blood glucose and HbA1c were 233 ± 112 mg/dL and 7.8 ± 2.3%, respectively. Group A had the lowest HbA1c (6.7 ± 1.2%), while group D had the highest (9.8 ± 2.5%). Median daily dexamethasone dosage or equivalent was 36 (IQR 16.72) mg, with no significant differences in among groups. Group A had the lowest treatment failure rate. There were no significant differences in treatment failure rate between Groups B, C, and D. Additionally, there were no statistically significant differences in mean BG across the groups: Group A 232 ± 42 mg/dL, Group B 247 ± 57 mg/dL, Group C 247 ± 61 mg/dL, and Group D 227 ± 67 mg/dL (p = 0.2). Group D had a significantly higher rate of level 1 hypoglycemia (p = 0.008), while no differences in clinically significant hypoglycemia (level 2 or 3) were observed between groups. Conclusions Among patients requiring TDD ⩾ 0.3 units/kg/day, there was no significant difference in treatment failure rate between Groups B, C, and D. Group D had the highest rate of level 1 hypoglycemia. This initial insulin dosage for hospitalized COVID-19 patients on high-dose steroid therapy should be personalized.
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Affiliation(s)
- Nuttavadee Ketaroonrut
- Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasisopin Kiertiburanakul
- Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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16
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Thongsuk Y, Hwang NC. Perioperative Glycemic Management in Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2024; 38:248-267. [PMID: 37743132 DOI: 10.1053/j.jvca.2023.08.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Diabetes and hyperglycemic events in cardiac surgical patients are associated with postoperative morbidity and mortality. The causes of dysglycemia, the abnormal fluctuations in blood glucose concentrations, in the perioperative period include surgical stress, surgical techniques, medications administered perioperatively, and patient factors. Both hyperglycemia and hypoglycemia lead to poor outcomes after cardiac surgery. While trying to control blood glucose concentration tightly for better postoperative outcomes, hypoglycemia is the main adverse event. Currently, there is no definite consensus on the optimum perioperative blood glucose concentration to be maintained in cardiac surgical patients. This review provides an overview of perioperative glucose homeostasis, the pathophysiology of dysglycemia, factors that affect glycemic control in cardiac surgery, and current practices for glycemic control in cardiac surgery.
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Affiliation(s)
- Yada Thongsuk
- Department of Anesthesiology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
| | - Nian Chih Hwang
- Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore; Department of Anaesthesiology, Singapore General Hospital, Singapore.
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17
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Galindo RJ, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S295-S306. [PMID: 38078585 PMCID: PMC10725815 DOI: 10.2337/dc24-s016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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18
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Zhang X, Yan D, Du T, Zhao Y, Zhang J, Zhang T, Lin M, Li Y, Li W. Efficacy and safety of basal-bolus insulin at 1:1.5 ratio compared to 1:1 ratio using a weight-based initiation and titration (WIT2) algorithm in hospitalized patients with type 2 Diabetes: a multicenter, randomized, clinical study. Diabetol Metab Syndr 2023; 15:243. [PMID: 38008775 PMCID: PMC10680246 DOI: 10.1186/s13098-023-01193-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/16/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Most studies initiated basal-bolus insulin in a ratio of 1:1 and titrated based on glucose. This study aimed to investigate the effectiveness and safety of a weight-based and ratio of 1:1.5 basal-bolus insulin using an algorithm for both initiation and titration in hospitalized patients with type 2 diabetes (T2D). METHODS Hospitalized patients with T2D were randomly assigned to two groups in equal numbers to receive 1:1.5 and 1:1 ratios of basal-bolus insulin using a weight-based algorithm for both initiation and titration. The primary outcome was the time taken to reach the fasting blood glucose (FBG) target and 2-h postprandial blood glucose (2hBG) targets after three meals. The secondary outcome included insulin dosage to achieve glycemic control and the incidence of hypoglycemia during hospitalization. RESULTS 250 patients were screened between October 2021 and June 2022, 220 were randomly grouped, and 182 completed the trial (89 in the 1:1.5 and 93 in the 1:1 groups). The time taken to reach FBG targets was comparable between the two groups (3.4 ± 1.7 vs. 3.0 ± 1.3 days, p = 0.137) within about 3 days. The 2hBG after three meals was shorter in the 1:1.5 group than in the 1:1group (2.9 ± 1.5 vs. 3.4 ± 1.4 days, p = 0.015 for breakfast, 3.0 ± 1.6 vs. 3.6 ± 1.4 days, p = 0.005 for lunch, and 3.1 ± 2.1 vs. 4.0 ± 1.5 days, p = 0.002 for dinner). No significant difference in insulin dosages was found between the two groups at the end of the study. The incidence of hypoglycemia was similar in both groups. CONCLUSIONS We demonstrated that fixed dose-ratio basal-bolus insulin at 1:1.5 calculated using a weight-based initiation and titration algorithm was simple, as effective, and safe as ratio at 1:1 in managing T2D in hospitalized patients. Trial Registration ChiCTR 2,100,050,963. Date of registration: September 8, 2021.
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Affiliation(s)
- Xiaodan Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dewen Yan
- Department of Endocrinology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Tao Du
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yunjuan Zhao
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiangong Zhang
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tong Zhang
- Department of Endocrinology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Mingrun Lin
- Department of Endocrinology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanli Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | - Wangen Li
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Lee BW, Ahn KJ, Cho HC, Lee EY, Min K, Dahaoui A, Jeong JS, Lim HJ, Jang HC. Safety and Clinical Outcomes of Insulin Degludec in Korean Patients with Diabetes in Real-World Practices: A Prospective, Observational Study. Diabetes Ther 2023; 14:1659-1672. [PMID: 37468685 PMCID: PMC10499774 DOI: 10.1007/s13300-023-01448-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION To investigate the safety and effectiveness of insulin degludec (IDeg) in a real-world population of Korean patients with diabetes requiring insulin therapy. METHODS This was a multicenter, prospective, single-arm, open-label, non-interventional study. Patients aged ≥ 12 months and treated with previous glucose-lowering medications were eligible to switch to IDeg. The primary endpoint was the incidence of adverse events (AEs), and the secondary endpoints were changes in glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), postprandial glucose (PPG), and target HbA1c < 7.0%. RESULTS In total, 3225 and 2450 patients were included in the safety analysis set (SAS) and effectiveness analysis set (EAS), respectively. The mean baseline HbA1c and duration of diabetes were 9.4% and 13.0 years, respectively. Adverse events were reported in 740 patients (22.9%); the majority were mild and resolved. Significant improvements were observed in HbA1c, FPG, and PPG at week 26 (all p < 0.0001). The target of HbA1c < 7% was achieved in 22.2% of patients at week 26. CONCLUSION In real-world clinical practice, 26 weeks of IDeg treatment resulted in significant reductions in glycemic parameters with a low incidence of AEs in Korean patients with diabetes. No new safety signals were observed. CLINICAL TRIALS REGISTRY AND REGISTRATION NUMBER This trial is registered under ClinicalTrials.gov (NCT02779413) and the universal trial number is [U1111-1176-2287].
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Affiliation(s)
- Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ho Chan Cho
- Department of Clinical Endocrinology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Eun Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - KyungWan Min
- Department of Endocrinology and Metabolism, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Amine Dahaoui
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Jin Sook Jeong
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Hyo Jin Lim
- Novo Nordisk Pharma Korea Limited, Seoul, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
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Simões de Carvalho F, Brito Marques F, Lima Ferreira J, Lopes AE, Príncipe RM. COMBINSI (COMBat to INSufficient Insulin therapy) - A Portuguese project in type 2 diabetes. Diabetes Metab Syndr 2023; 17:102776. [PMID: 37207407 DOI: 10.1016/j.dsx.2023.102776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/04/2023] [Accepted: 04/28/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Inadequate glycemic control in type 2 diabetes (T2D) increases the risk of diabetes-related complications. Insulin initiation is often delayed for several years. This study aims to estimate the adequacy of insulin therapy prescription to people living with T2D in a primary care setting. MATERIAL AND METHODS This was a cross-sectional study based on adults with T2D in a Portuguese local health unit between January 2019 and January 2020. Subjects under insulin therapy were compared with non-insulin-treated subjects with Hemoglobin A1c (HbA1c) ≥9% regarding clinical and demographic characteristics. The proportion of insulin-treated subjects in both of these groups was defined as insulin therapy index. RESULTS Our study included 13,869 adults living with T2D, among whom 11.5% were treated with insulin therapy and 4.1% had HbA1c ≥ 9% and were not under insulin therapy. Insulin therapy index was 73.9%. When comparing with non-insulin-treated subjects with HbA1c ≥ 9%, insulin-treated subjects were significantly older (75.8 vs 66.2 years p < 0.001), had lower HbA1c (8.3 vs 10.3% p < 0.001), lower estimated glomerular filtration rate (66.4 vs 74.0 ml/min/1.73 m2p < 0.001), lower LDL-cholesterol (87.1 vs 105.8 mg/dl), and higher rates of atherosclerotic cardiovascular disease (32.7 vs 16.7% p < 0.001). CONCLUSION Insulin therapy is underprescribed in T2D, with over 1-in-4 people living with T2D not being prescribed insulin despite deficient glycemic control. These findings highlight the need for insulin therapy when glycemic control is inadequate under other interventions.
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Affiliation(s)
| | | | - Joana Lima Ferreira
- Endocrinology Department, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Ana Elisa Lopes
- Endocrinology Department, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Rosa Maria Príncipe
- Endocrinology Department, Matosinhos Local Health Unit, Matosinhos, Portugal
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Kuchay MS, Mathew A, Mishra M, Surendran P, Kaur P, Wasir JS, Gill HK, Jain R, Gagneja S, Kohli C, Kumari P, Singh MK, Mishra SK. Efficacy and safety of degludec U100 versus glargine U300 for the early postoperative management of patients with type 2 diabetes mellitus undergoing coronary artery bypass graft surgery: A non-inferiority randomized trial. Diabet Med 2023; 40:e15002. [PMID: 36354383 DOI: 10.1111/dme.15002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/30/2022] [Indexed: 11/12/2022]
Abstract
AIMS To compare the efficacy and safety of degludec U100 versus glargine U300 for the early postoperative management of patients with type 2 diabetes mellitus (T2D) undergoing coronary artery bypass graft (CABG) surgery. METHODS A total of 239 patients were randomly assigned (1:1) to receive a basal-bolus regimen in the early postoperative period using degludec U100 (n = 122) or glargine U300 (n = 117) as basal and glulisine before meals. The primary outcome was mean differences between groups in their daily BG concentrations. The major safety outcome was the occurrence of hypoglycemia. RESULTS There were no differences in mean daily BG concentrations (157 vs. 162 mg/dl), mean percentage of readings within target BG of 70-180 mg/dl (74% vs. 73%), daily basal insulin dose (19 vs. 21 units/day), length of stay (median [IQR]: 9 vs. 9 days), or hospital complications (21.3% vs. 21.4%) between treatment groups. There were no differences in the proportion of patients with BG <70 mg/dl (15.6% vs. 23.1%) or <54 mg/dl (1.6% vs. 4.3%) between degludec-100 and glargine-300 groups. CONCLUSIONS Treatment with degludec U100 is as effective and safe as glargine U300 for the early postoperative hospital management of patients with T2D undergoing CABG.
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Affiliation(s)
- Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Anu Mathew
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Mitali Mishra
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Parvathi Surendran
- Department of Clinical Research and Studies, Medanta-The Medicity Hospital, Gurugram, India
| | - Parjeet Kaur
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Jasjeet Singh Wasir
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Harmandeep Kaur Gill
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Rujul Jain
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Sakshi Gagneja
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Chhavi Kohli
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Poonam Kumari
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
| | - Manish Kumar Singh
- Department of Clinical Research and Studies, Medanta-The Medicity Hospital, Gurugram, India
| | - Sunil Kumar Mishra
- Division of Endocrinology and Diabetes, Medanta-The Medicity Hospital, Gurugram, India
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S267-S278. [PMID: 36507644 PMCID: PMC9810470 DOI: 10.2337/dc23-s016] [Citation(s) in RCA: 104] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, Chandrasekaran S, DeFronzo RA, Einhorn D, Galindo RJ, Gardner TW, Garg R, Garvey WT, Hirsch IB, Hurley DL, Izuora K, Kosiborod M, Olson D, Patel SB, Pop-Busui R, Sadhu AR, Samson SL, Stec C, Tamborlane WV, Tuttle KR, Twining C, Vella A, Vellanki P, Weber SL. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract 2022; 28:923-1049. [PMID: 35963508 PMCID: PMC10200071 DOI: 10.1016/j.eprac.2022.08.002] [Citation(s) in RCA: 221] [Impact Index Per Article: 73.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2022] [Accepted: 08/02/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this clinical practice guideline is to provide updated and new evidence-based recommendations for the comprehensive care of persons with diabetes mellitus to clinicians, diabetes-care teams, other health care professionals and stakeholders, and individuals with diabetes and their caregivers. METHODS The American Association of Clinical Endocrinology selected a task force of medical experts and staff who updated and assessed clinical questions and recommendations from the prior 2015 version of this guideline and conducted literature searches for relevant scientific papers published from January 1, 2015, through May 15, 2022. Selected studies from results of literature searches composed the evidence base to update 2015 recommendations as well as to develop new recommendations based on review of clinical evidence, current practice, expertise, and consensus, according to established American Association of Clinical Endocrinology protocol for guideline development. RESULTS This guideline includes 170 updated and new evidence-based clinical practice recommendations for the comprehensive care of persons with diabetes. Recommendations are divided into four sections: (1) screening, diagnosis, glycemic targets, and glycemic monitoring; (2) comorbidities and complications, including obesity and management with lifestyle, nutrition, and bariatric surgery, hypertension, dyslipidemia, retinopathy, neuropathy, diabetic kidney disease, and cardiovascular disease; (3) management of prediabetes, type 2 diabetes with antihyperglycemic pharmacotherapy and glycemic targets, type 1 diabetes with insulin therapy, hypoglycemia, hospitalized persons, and women with diabetes in pregnancy; (4) education and new topics regarding diabetes and infertility, nutritional supplements, secondary diabetes, social determinants of health, and virtual care, as well as updated recommendations on cancer risk, nonpharmacologic components of pediatric care plans, depression, education and team approach, occupational risk, role of sleep medicine, and vaccinations in persons with diabetes. CONCLUSIONS This updated clinical practice guideline provides evidence-based recommendations to assist with person-centered, team-based clinical decision-making to improve the care of persons with diabetes mellitus.
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Affiliation(s)
| | | | - S Sethu Reddy
- Central Michigan University, Mount Pleasant, Michigan
| | | | | | | | | | | | - Daniel Einhorn
- Scripps Whittier Diabetes Institute, La Jolla, California
| | | | | | - Rajesh Garg
- Lundquist Institute/Harbor-UCLA Medical Center, Torrance, California
| | | | | | | | | | | | - Darin Olson
- Colorado Mountain Medical, LLC, Avon, Colorado
| | | | | | - Archana R Sadhu
- Houston Methodist; Weill Cornell Medicine; Texas A&M College of Medicine; Houston, Texas
| | | | - Carla Stec
- American Association of Clinical Endocrinology, Jacksonville, Florida
| | | | - Katherine R Tuttle
- University of Washington and Providence Health Care, Seattle and Spokane, Washington
| | | | | | | | - Sandra L Weber
- University of South Carolina School of Medicine-Greenville, Prisma Health System, Greenville, South Carolina
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Sendekie AK, Netere AK, Belachew EA. Hypoglycemic events and glycemic control effects between NPH and premixed insulin in patients with type 2 diabetes mellitus: A real-world experience at a comprehensive specialized hospital in Ethiopia. PLoS One 2022; 17:e0275032. [PMID: 36149907 PMCID: PMC9506660 DOI: 10.1371/journal.pone.0275032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/09/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Though initiation of insulin results in a significant change in glycemic levels, treating patients without significant hypoglycemic events remains difficult in diabetes patients initiated with different insulin-based regimens. This study assessed the association of hypoglycemic incidence and glycemic control between NPH and premixed insulin regimens in patients with type 2 diabetes mellitus (T2DM). METHODS This was a retrospective observational study in patients with T2DM who were treated with insulin-based therapy from 2015 to 2020 at the University of Gondar Comprehensive Specialized hospital. Average fasting blood glucose (FBG) between NPH and premixed insulin regimens was compared using an independent t-test. The Association of NPH and premixed insulin regimens with hypoglycemic incidences and glycemic control was examined by a logistic regression model. P < 0.05 was statistically significant. RESULTS From 405 participants, more than half (55.3%) were males with a mean age of 59.2(±9.1) years. Baseline mean HbA1C and FBG levels were 12.73(±1.1) % and 347.7(±48.5) mg/dl, respectively. Within a one-year follow-up period of insulin initiation, the rate of hypoglycemia was 13.1%. The incidence of hypoglycemia was significantly higher in patients initiated with premixed insulin compared with NPH insulin regimens (P < 0.001). After one year of insulin initiation, HbA1C decreased from 12.7 to 7.6 and from 12.8 to 7.3% and FBG levels decreased from 347.5 to 160.7 and from 348.2 to 147.3 mg/dl following initiation of NPH and premixed insulin, respectively. Patients treated with premixed-based insulin were found more likely to achieve target FBG compared with patients treated with NPH insulin regimens after one year of initiation (P = 0.02). CONCLUSION Premixed insulin-based regimen has found to have a higher hypoglycemic incidence, but a better level of glycemic control compared to NPH insulin-based therapy. Therefore, patients initiated with premixed insulin need to be highly vigilant and motivated to recognize the symptoms of hypoglycemia.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Adeladlew Kassie Netere
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Sendekie AK, Belachew EA, Dagnew EM, Netere AK. Rate of glycaemic control and associated factors in patients with type 2 diabetes mellitus treated with insulin-based therapy at selected hospitals in Northwest Ethiopia: a multicentre cross-sectional study. BMJ Open 2022; 12:e065250. [PMID: 36691186 PMCID: PMC9454077 DOI: 10.1136/bmjopen-2022-065250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/16/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES This study was aimed to determine the level of glycaemic control and associated factors in patients with type 2 diabetes mellitus (T2DM) treated with insulin-based therapy. DESIGNS Institutional-based multicentre cross-sectional study design was employed to conduct this study. SETTINGS The diabetes follow-up clinics of selected hospitals in Northwest Ethiopia. PARTICIPANTS Adult patients with T2DM treated with insulin-based therapy at the selected hospitals who met the eligibility criteria were the study participants. MAIN OUTCOME MEASURES Good glycaemic control; when fasting blood glucose (FBG) level ranged from 70 to 130 mg/dL, and FBG <70 and >130 mg/dL was considered poor glycaemic control. A logistic regression model was used to identify determinants of poor glycaemic control. A p<0.05 at 95% CI was statistically significant. RESULTS Of 403 study participants, 54.8% were males with a mean age of 55.03±10.8 years. Though patients with T2DM were treated with insulin-based therapy, most of the participants (72.5%) could not achieve the target FBG. The overall mean FBG was 177.1±54.3, and far from the target glucose level. Patients who could not practise self-monitoring of blood glucose were found more likely to have poor glycaemic control compared with those who practised self-monitoring (p<0.001). Whereas patients who had a normal body mass index (p=0.011) and who were treated with premixed insulin-based therapy (p=0.04) were found less likely to have poor glycaemic control compared with patients with obesity and who received NPH insulin based-regimens, respectively. CONCLUSION This study demonstrated that a significant proportion of the study samples could not achieve glycaemic targets and the average blood glucose was far higher than the recommended glycaemic target level. Insulin initiation and titration, considering the determinants of glycaemic control, could be recommended to achieve target glycaemic levels.
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Affiliation(s)
- Ashenafi Kibret Sendekie
- Clinical Pharmacy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Clinical Pharmacy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Ephrem Mebratu Dagnew
- Clinical Pharmacy, Debre Markos University College of Health Science, Debre Markos, Amhara, Ethiopia
| | - Adeladlew Kassie Netere
- Clinical Pharmacy, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Shah P, Kalra S, Yadav Y, Deka N, Lathia T, Jacob JJ, Kota SK, Bhattacharya S, Gadve SS, Subramanium KAV, George J, Iyer V, Chandratreya S, Aggrawal PK, Singh SK, Joshi A, Selvan C, Priya G, Dhingra A, Das S. Management of Glucocorticoid-Induced Hyperglycemia. Diabetes Metab Syndr Obes 2022; 15:1577-1588. [PMID: 35637859 PMCID: PMC9142341 DOI: 10.2147/dmso.s330253] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/09/2022] [Indexed: 01/25/2023] Open
Abstract
Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs used for various systemic and localized conditions. The use of glucocorticoids needs to be weighed against their adverse effect of aggravating hyperglycemia in persons with diabetes mellitus, unmask undiagnosed diabetes mellitus, or precipitate glucocorticoid-induced diabetes mellitus appearance. Hyperglycemia is associated with poor clinical outcomes, including infection, disability after hospital discharge, prolonged hospital stay, and death. Furthermore, clear guidelines for managing glucocorticoid-induced hyperglycemia are lacking. Therefore, this consensus document aims to develop guidance on the management of glucocorticoid-induced hyperglycemia. Twenty expert endocrinologists, in a virtual meeting, discussed the evidence and practical experience of real-life management of glucocorticoid-induced hyperglycemia. The expert group concluded that we should be proactive in terms of diagnosis, management, and post-steroid care. Since every patient has different severity of underlying disease, clinical stratification would help understand patient profiles and determine the treatment course. Patients at home with pre-existing diabetes who are already on oral or injectable therapy can continue the same as long as they are clinically stable and eating adequately. However, depending on the degree of hyperglycemia, modification of doses may be required. Initiating basal bolus with correction regimen is recommended for patients in non-intensive care unit settings. For patients in intensive care unit, variable rate intravenous insulin infusion could be temporarily used, but under supervision of diabetes inpatient team, and patients can be transitioned to subcutaneous insulin once stable baseline assessment and continual evaluation are crucial for day-to-day decisions concerning insulin doses. Glycemic variability should be carefully monitored, and interventions to treat patients should also aim at achieving and maintaining euglycemia. Rational use of glucose-lowering drugs is recommended and treatment regimen should ensure maximum safety for both patient and provider. Glucovigilance is required as the steroids taper during transition, and insulin dosage should be reduced subsequently. Increased clinical and economic burden resulting from corticosteroid-related adverse events highlights the need for effective management. Therefore, these recommendations would help successfully manage GC-induced hyperglycemia and judiciously allocate resources.
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Affiliation(s)
- Parag Shah
- Department of Endocrinology, Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital & B.R.I.D.E, Karnal, Haryana, India
| | - Yogesh Yadav
- Department of Endocrinology, MAX Super Specialty Hospital, Dehradun, Uttarakhand, India
| | - Nilakshi Deka
- Department of Endocrinology, Apollo Hospital & Dispur Polyclinic and Nursing Home, Guwahati, West Bengal, India
| | - Tejal Lathia
- Department of Endocrinology, Apollo Hospital, Mumbai, Maharashtra, India
| | | | - Sunil Kumar Kota
- Department of Endocrinology, Diabetes and Endocrine Clinic, Berhampur, Orissa, India
| | - Saptrishi Bhattacharya
- Department of Endocrinology, OeHealth Diabates & Endocrinology Centre, Delhi, Delhi, India
| | - Sharvil S Gadve
- Department of Endocrinology, Excel Endocrine Centre, Kolhapur, Maharashtra, India
| | - K A V Subramanium
- Department of Endocrinology, Visakha Diabates & Endocrine Centre, Vishakhapatnam, Andhra Pradesh, India
| | - Joe George
- Department of Endocrinology, Endodiab Clinic, Calicut, Kerala, India
| | - Vageesh Iyer
- Department of Endocrinology, St.John’s Medical College & Hospital, Bangalore, Karnataka, India
| | - Sujit Chandratreya
- Department of Endocrinology, Endocare Clinic, Nashik, Maharashtra, India
| | - Pankaj Kumar Aggrawal
- Department of Endocrinology, Hormone Care & Research Centre, Ghaziabad, Uttar Pradesh, India
| | | | - Ameya Joshi
- Department of Endocrinology, Endocrine and Diabetes Clinic, Mumbai, Maharashtra, India
| | - Chitra Selvan
- Department of Endocrinology, Ramaiah Memorial Hospital, Bangalore, Karnataka, India
| | - Gagan Priya
- Department of Endocrinology, IVY Hospital, Chandigarh, Punjab, India
| | - Atul Dhingra
- Department of Endocrinology, Bansal Hospital, Sri Ganganagar, Rajasthan, India
| | - Sambit Das
- Department of Endocrinology, Endeavour Clinic, Bhubaneshwar, Orissa, India
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Basal-bolus insulin therapy for the treatment of non-critically ill patients with type 2 diabetes in Vietnam: effectiveness and factors associated with inpatient glycemic control. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Purpose
This study assessed the effectiveness of basal-bolus insulin therapy (BBIT) in non-critically ill patients with type 2 diabetes mellitus (DM) and the factors associated with optimal inpatient glycemic control (IGC) with BBIT.
Methods
This prospective study included 103 patients who were admitted to the University Medical Center and were treated with BBIT. Clinical characteristics, glucose, and glycated hemoglobin (HbA1c) levels at admission, renal function tests, basal-bolus insulin dosing, and other treatments were recorded. The optimal IGC was defined and classified for the analysis.
Results
The mean age of the patients was 67.2 ± 12.0 years. The blood glucose and HbA1c levels at admission were 319.2 ± 184.8 mg/dL and 10.7 ± 2.6%, respectively. Optimal IGC was defined as patients with ≥60% of in-hospital blood glucose values within the target range (3.9–10 mmol/L). Of the 103 patients, 66 patients (64%) achieved optimal IGC and only 5 patients (4.9%) had at least one hypoglycemic episode. The number of patients consuming snacks was higher in the poor than in the optimal IGC group whereas an estimated glomerular filtration rate (eGFR) <45-mL/min/1.73 m2 was predominant in the optimal IGC group. Multivariate analysis revealed that snack consumption and glucocorticoid (GC) use were factors associated with poor IGC, while eGFR <45 mL/min/1.73 m2 was a favorable factor for optimal IGC.
Conclusion
BBIT is safe and effective for the treatment of IGC in non-critically ill patients. Moreover, eGFR <45 mL/min/1.73 m2 at admission, snack consumption, and GC therapy were independent factors associated with IGC outcomes.
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Moon SJ, Choe HJ, Kwak SH, Jung HS, Park KS, Cho YM. Comparison of Prevailing Insulin Regimens at Different Time Periods in Hospitalized Patients: A Real-World Experience from a Tertiary Hospital. Diabetes Metab J 2022; 46:439-450. [PMID: 34666425 PMCID: PMC9171166 DOI: 10.4093/dmj.2021.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Prevailing insulin regimens for glycemic control in hospitalized patients have changed over time. We aimed to determine whether the current basal-bolus insulin (BBI) regimen is superior to the previous insulin regimen, mainly comprising split-mixed insulin therapy. METHODS This was a single tertiary center, retrospective observational study that included non-critically ill patients with type 2 diabetes mellitus who were treated with split-mixed insulin regimens from 2004 to 2007 (period 1) and with BBI from 2008 to 2018 (period 2). Patients from each period were analyzed after propensity score matching. The mean difference in glucose levels and the achievement of fasting and preprandial glycemic targets by day 6 of admission were assessed. The total daily insulin dose, incidence of hypoglycemia, and length of hospital stay were also evaluated. RESULTS Among 244 patients from each period, both fasting glucose (estimated mean±standard error, 147.4±3.1 mg/dL vs. 129.4±3.2 mg/dL, P<0.001, day 6) and preprandial glucose (177.7±2.8 mg/dL vs. 152.8±2.8 mg/dL, P<0.001, day 6) were lower in period 2 than in period 1. By day 6 of hospital admission, 42.6% and 67.2% of patients achieved a preprandial glycemic target of <140 mg/dL in periods 1 and 2, respectively (relative risk, 2.00; 95% confidence interval, 1.54 to 2.59), without an increased incidence of hypoglycemia. Length of stay was shorter in period 2 (10.23±0.26 days vs. 8.70±0.26 days, P<0.001). CONCLUSION BBI improved glycemic control in a more efficacious manner than a split-mixed insulin regimen without increasing the risk of hypoglycemia in a hospital setting.
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Affiliation(s)
- Sun Joon Moon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hun Jee Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soo Heon Kwak
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hye Seung Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyong Soo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Gracia-Ramos A, Cruz-Domínguez M, Madrigal-Santillán E. Terapia basada en incretinas para control glucémico de los pacientes hospitalizados con diabetes tipo 2: una revisión sistemática. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Idris I, Annamalai N, Aung T, Binnian I, Gibb FW, Malik MIA, Ramtoola S. Hypoglycaemia in type 2 diabetes treated with pre-mixed insulin. Diabet Med 2022; 39:e14684. [PMID: 34464470 DOI: 10.1111/dme.14684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Iskandar Idris
- School of Medicine, University of Nottingham & University Hospitals of Derby and Burton Foundation Trust, Derby, UK
| | | | | | | | - Fraser W Gibb
- Edinburgh Centre for Endocrinology & Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
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Zabeen B, Ahmed B, Islam N, Tayyeb S, Nahar J, Azad K. Comparison of efficacy of detemir and degludec insulin in the management of children and adolescents with type 1 diabetes. JOURNAL OF DIABETOLOGY 2022. [DOI: 10.4103/jod.jod_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Galindo RJ, Pasquel FJ, Vellanki P, Alicic R, Lam DW, Fayfman M, Migdal AL, Davis GM, Cardona S, Urrutia MA, Perez-Guzman C, Zamudio-Coronado KW, Peng L, Tuttle KR, Umpierrez GE. Degludec hospital trial: A randomized controlled trial comparing insulin degludec U100 and glargine U100 for the inpatient management of patients with type 2 diabetes. Diabetes Obes Metab 2022; 24:42-49. [PMID: 34490700 PMCID: PMC8665002 DOI: 10.1111/dom.14544] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 01/03/2023]
Abstract
AIMS Limited data exist about the use of insulin degludec in the hospital. This multicentre, non-inferiority, open-label, prospective randomized trial compared the safety and efficacy of insulin degludec-U100 and glargine-U100 for the management of hospitalized patients with type 2 diabetes. METHODS In total, 180 general medical and surgical patients with an admission blood glucose (BG) between 7.8 and 22.2 mmol/L, treated with oral agents or insulin before hospitalization were randomly allocated (1:1) to a basal-bolus regimen using degludec (n = 92) or glargine (n = 88), as basal and aspart before meals. Insulin dose was adjusted daily to a target BG between 3.9 and 10.0 mmol/L. The primary endpoint was the difference in mean hospital daily BG between groups. RESULTS Overall, the randomization BG was 12.2 ± 2.9 mmol/L and glycated haemoglobin 84 mmol/mol (9.8% ± 2.0%). There were no differences in mean daily BG (10.0 ± 2.1 vs. 10.0 ± 2.5 mmol/L, p = .9), proportion of BG in target range (54·5% ± 29% vs. 55·3% ± 28%, p = .85), basal insulin (29.6 ± 13 vs. 30.4 ± 18 units/day, p = .85), length of stay [median (IQR): 6.7 (4.7-10.5) vs. 7.5 (4.7-11.6) days, p = .61], hospital complications (23% vs. 23%, p = .95) between treatment groups. There were no differences in the proportion of patients with BG <3.9 mmol/L (17% vs. 19%, p = .75) or <3.0 mmol/L (3.7% vs. 1.3%, p = .62) between degludec and glargine. CONCLUSION Hospital treatment with degludec-U100 or glargine-U100 is equally safe and effective for the management of hyperglycaemia in general medical and surgical patients with type 2 diabetes.
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Affiliation(s)
- Rodolfo J Galindo
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Francisco J Pasquel
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Priyathama Vellanki
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Radica Alicic
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Providence Health Care, Spokane, Washington, USA
| | - David W Lam
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maya Fayfman
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alexandra L Migdal
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Georgia M Davis
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Saumeth Cardona
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Maria A Urrutia
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Citlalli Perez-Guzman
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Limin Peng
- Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Katherine R Tuttle
- Providence Health Care, Spokane, Washington, USA
- Division of Nephrology and Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Qiao J, Tan Z, Xu X, Zhou Y, Wang W, Luo J, Fan J, Pan Q, Guo L. Medications and medical costs for diabetes patients with or without chronic respiratory disease in Beijing, China: A retrospective study. Front Endocrinol (Lausanne) 2022; 13:980982. [PMID: 36093107 PMCID: PMC9458880 DOI: 10.3389/fendo.2022.980982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS The cost of drug regimens prescribed to Chinese patients has not been evaluated. This study aims to evaluate the medical costs and hypoglycemic agents for diabetes mellitus patients with or without chronic respiratory disease in Beijing, and to investigate the changes in the costs and number of antidiabetic medications used for diabetes patients with chronic respiratory disease from 2016 to 2018. METHODS This observational, retrospective study included diabetes patients with outpatient medication records from Beijing Medical Insurance between 2016 and 2018. The medications, including hypoglycemic and nonhypoglycemic drugs, insulin dosage, comorbidities, diabetes-related complications, treatment strategies, and annual medical costs, were recorded. RESULTS This study included 2,853,036 diabetes patients from 2016 to 2018. About 18.95%-20.53% of patients with chronic respiratory disease were predominantly distributed among those aged 45-84 years (88.7%-89.1%). Diabetes patients with chronic respiratory disease used more medications (4.48 ± 2.41 vs. 3.76 ± 2.33) and had higher total annual drug costs (¥12,286 ± 10,385 vs. ¥9700 ± 9202) to treat more comorbidities (2.52 ± 1.53 vs. 2.05 ± 1.85) than those without chronic respiratory disease (p <.0001, respectively). From 2016 to 2018, diabetes patients with chronic respiratory disease had a 4.2% increase in medication, a 1.9% decrease in comorbidities, and a 5.4% decrease in total annual drug costs. CONCLUSIONS In summary, diabetes patients with chronic respiratory disease had more comorbidities, required more hypoglycemic drugs, and had higher medical costs. During 2016-2018, diabetes patients with chronic respiratory disease used more medications and spent less money on medical care.
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Affiliation(s)
- Jingtao Qiao
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zheng Tan
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaomao Xu
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhou
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingyi Luo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingwen Fan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Qi Pan,
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- *Correspondence: Lixin Guo, ; Qi Pan,
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Gracia-Ramos AE, Carretero-Gómez J, Mendez CE, Carrasco-Sánchez FJ. Evidence-based therapeutics for hyperglycemia in hospitalized noncritically ill patients. Curr Med Res Opin 2022; 38:43-53. [PMID: 34694181 DOI: 10.1080/03007995.2021.1997288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hyperglycemia in hospitalized patients, either with or without diabetes, is a common, serious, and costly healthcare problem. Evidence accumulated over 20 years has associated hyperglycemia with a significant increase in morbidity and mortality, both in surgical and medical patients. Based on this documented link between hyperglycemia and poor outcomes, clinical guidelines from professional organizations recommend the treatment of hospital hyperglycemia with a therapeutic goal of maintaining blood glucose (BG) levels less than 180 mg/dL. Insulin therapy remains a mainstay of glycemic management in the inpatient setting. The use of non-insulin antidiabetic drugs in the hospital setting is limited because little data are available regarding their safety and efficacy. However, information about the use of incretin-based therapy in inpatients has increased in the past 15 years. This review aims to summarize the different treatment strategies for hyperglycemia in hospitalized noncritical patients that are supported by observational studies or clinical trials with insulin and non-insulin drugs. In addition, we propose a protocol to help with the management of this important clinical problem.
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Affiliation(s)
- Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medicinal Center "La Raza," Instituto Mexicano del Seguro Social, Mexico City, Mexico
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Mexico City, Mexico
| | | | - Carlos E Mendez
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Diabetes and Endocrinology, Milwaukee VA Medical Center, Milwaukee, WI, USA
| | - Francisco Javier Carrasco-Sánchez
- Department of Internal Medicine, Diabetes and Cardiovascular Risk Factor Unit, University Hospital Juan Ramón Jimenez, Huelva, Spain
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Gracia-Ramos AE, Cruz-Domínguez MP, Madrigal-Santillán EO. Incretin-based therapy for glycemic control of hospitalized patients with type 2 diabetes: a systematic review. Rev Clin Esp 2021; 222:180-189. [PMID: 34872879 DOI: 10.1016/j.rceng.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
Incretin-based therapy leads to glycemic control in a glucose-dependent manner with a low risk of hypoglycemia, making it appealing for use in the hospital. The aim of this systematic review was to assess the benefits of incretin-based therapy in patients with type 2 diabetes hospitalized outside of the intensive care unit. We searched for studies published up to August 2021 in the PubMed and Scopus databases. Clinical trials comparing incretin-based therapy (alone or in combination with insulin) versus an insulin regimen were selected. The results of the included studies showed that incretin-based therapy showed mean blood glucose values, a percentage of records within the therapeutic target, and a percentage of treatment failure similar to insulin management, particularly in patients with mild to moderate hyperglycemia. Furthermore, incretin-based treatment was associated with a lower total insulin dose and a lower incidence of hypoglycemia. In conclusion, incretin-based therapy achieved glycemic control similar to insulin treatment in patients with type 2 diabetes hospitalized outside the intensive care unit and has the advantages of reducing the insulin requirement and a lower risk of hypoglycemia.
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Affiliation(s)
- A E Gracia-Ramos
- Departamento de Medicina Interna, Hospital General, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico; Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico.
| | - M P Cruz-Domínguez
- División de Investigación en Salud, Hospital de Especialidades, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, Ciudad de México, Mexico
| | - E O Madrigal-Santillán
- Laboratorio de Medicina de Conservación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico
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Abstract
At the time of its first clinical application 100 years ago, insulin was presented as the cure for people with diabetes mellitus. That transpired to be an overstatement, yet insulin has proven to be the lifesaver for people with type 1 diabetes mellitus and an essential therapy for many with type 2 diabetes mellitus or other forms of diabetes mellitus. Since its discovery, insulin (a molecule of only 51 amino acids) has been the subject of pharmaceutical research and development that has paved the way for other protein-based therapies. From purified animal-extracted insulin and human insulin produced by genetically modified organisms to a spectrum of insulin analogues, pharmaceutical laboratories have strived to tailor the preparations to the needs of patients. Nonetheless, overall glycaemic control often remains poor as exogenous insulin is still not able to mimic the physiological insulin profile. Circumventing subcutaneous administration and the design of analogues with profiles that mimic that of physiological insulin are ongoing areas of research. Novel concepts, such as once-weekly insulins or glucose-dependent and oral insulins, are on the horizon but their real-world effectiveness still needs to be proven. Until a true cure for type 1 diabetes mellitus is found and the therapeutic arsenal for other forms of diabetes mellitus is expanded, insulin will remain central in the treatment of many people living with diabetes mellitus.
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Affiliation(s)
- Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium.
| | - Pieter-Jan Martens
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Roman Vangoitsenhoven
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
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Moon S, Chung HS, Kim YJ, Yu JM, Jeong WJ, Park J, Oh CM. Efficacy and Safety of Insulin Degludec/Insulin Aspart Compared with a Conventional Premixed Insulin or Basal Insulin: A Meta-Analysis. Metabolites 2021; 11:metabo11090639. [PMID: 34564455 PMCID: PMC8470485 DOI: 10.3390/metabo11090639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022] Open
Abstract
Insulin degludec/insulin aspart (IDegAsp) is a novel co-formulation of 70% insulin degludec and 30% insulin aspart. The present meta-analysis was conducted to assess the efficacy and safety of IDegAsp compared with a conventional premixed insulin or basal insulin. We extracted data from citation databases, including PubMed, EMBASE, and the Cochrane Library, since inception to 2021. We calculated the mean differences for hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), self-measured mean glucose, and postprandial glucose (PPG) and odds ratios for confirmed hypoglycemia events. Compared with twice-daily conventional premixed insulin, twice-daily IDegAsp showed a similar effect on changes in HbA1c, but it significantly reduced FPG and self-measured mean glucose levels. Furthermore, compared to once-daily basal insulin, once-daily IDegAsp had a similar effect on changes in HbA1c, but it significantly reduced self-measured mean glucose and PPG levels. The risk of overall confirmed hypoglycemia was similar between treatments; however, the risk of nocturnal hypoglycemia events was significantly lower with IDegAsp than with conventional premixed insulin and basal insulin. Thus, IDegAsp was more effective than conventional premixed insulin and basal insulin at reducing blood glucose with fewer nocturnal hypoglycemia events.
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Affiliation(s)
- Shinje Moon
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Hye-Soo Chung
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Yoon-Jung Kim
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Jae-Myung Yu
- Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon 24252, Korea
| | - Woo-Ju Jeong
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
| | - Jiwon Park
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
| | - Chang-Myung Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju 61005, Korea
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Brož J, Janíčková Žďárská D, Urbanová J, Piťhová P, Doničová V, Pálová S, Pelechová B, Smržová A, Kvapil M. Insulin Management of Patients with Inadequately Controlled Type 2 Diabetes Admitted to Hospital: Titration Patterns and Frequency of Hypoglycemia as Results of a Prospective Observational Study (Hospital Study). Diabetes Ther 2021; 12:1799-1808. [PMID: 34028699 PMCID: PMC8266977 DOI: 10.1007/s13300-021-01080-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/12/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Despite the continuously growing number of therapeutic options for type 2 diabetes mellitus (T2DM) including insulins, a large percentage of patients fail to achieve HbA1c targets. Several real-world studies focused on patients with T2DM receiving insulin treatment in outpatient settings were conducted, but information about real-world in-hospital insulin management is lacking. The aim of this study was to describe the management of insulin therapy with a focus on basal-bolus and premixed insulin regimens in patients with T2DM under routine in-hospital medical practice in the Czech Republic. METHODS This non-interventional prospective study was conducted from June 2014 to December 2017 in 22 centers in the Czech Republic under routine clinical practice conditions. Adult patients admitted to hospital with metabolically uncontrolled T2DM [HbA1c ≥ 60 mmol/mol; > 7.6% Diabetes Control and Complications Trial (DCCT)] and there treated with basal-bolus and premixed insulin regimens were documented during hospitalization. RESULTS Overall, 369 patients with T2DM (54.7% male, mean age 64.44 ± 13.84 years, BMI 31.10 ± 6.00 kg/m2, duration of diabetes 8.11 ± 9.93 years, HbA1c 95.90 ± 24.38 mmol/mol, length of stay was 7.94 ± 4.53 days) were included. The percentage of glucose values under 10 mmol/l at time of randomization (the group with basal-bolus insulin regimen vs. the premix insulin regimen group) was 24.2% vs. 33.5% (p = 0.053), at time of first insulin dose adjustment it was 43.1% vs. 50.0% (p = 0.330), and 1 day before hospital discharge it was 61.7% vs. 61.4% (p = 0.107). A hypoglycemic event occurred in a total of 15 patients in the basal-bolus regimen group, and no hypoglycemic event occurred in the premixed insulin regimen group. CONCLUSION In-hospital insulin management regarding basal-bolus and premixed insulin regimens is safe and in concordance with current international recommendations.
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Affiliation(s)
- Jan Brož
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 00, Prague, Czech Republic.
| | - Denisa Janíčková Žďárská
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 00, Prague, Czech Republic
| | - Jana Urbanová
- Department of Internal Medicine, Third Faculty of Medicine and Faculty Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
| | - Pavlína Piťhová
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 00, Prague, Czech Republic
| | - Viera Doničová
- Private Department of Diabetology, Internal Medicine and Metabolism, Kosice, Slovakia
| | - Sabina Pálová
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 00, Prague, Czech Republic
| | - Barbora Pelechová
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 00, Prague, Czech Republic
| | - Anna Smržová
- Institute of Biostatistics and Analyses, Ltd., Brno, Czech Republic
| | - Milan Kvapil
- Department of Internal Medicine, Second Faculty of Medicine, Charles University, V Úvalu 84, 150 00, Prague, Czech Republic
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Otieno FC, Mikhail T, Acharya K, Muga J, Ngugi N, Njenga E. Suboptimal glycemic control and prevalence of diabetes-related complications in Kenyan population with diabetes: cohort analysis of the seventh wave of the International Diabetes Management Practices Study (IDMPS). ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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A randomized trial to investigate the efficacy and safety of insulin glargine in hyperglycemic acute stroke patients receiving intensive care. Sci Rep 2021; 11:11523. [PMID: 34075142 PMCID: PMC8169927 DOI: 10.1038/s41598-021-91036-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
This pilot, randomized, open-label controlled study compared the basal–bolus regimens of insulin glargine (IG) and neutral protamine Hagedorn (NPH) insulin in stroke patients with hyperglycemia receiving intensive care. The study recruited acute stroke patients requiring intensive care within 72 h (h) of onset and had blood glucose > 200 mg/dL. 50 patients received IG (n = 26) or NPH (n = 24) with added short-acting prandial regular insulin over a 72-h period. The primary end point was the percentage of glucose within 80–180 mg/dL assessed through continuous glucose monitoring. The baseline characteristics were comparable, except the IG had higher glucose pre-randomization than the NPH (290.69 ± 82.31 vs. 246.04 ± 41.76 mg/dL, P = 0.021). The percentage of time with glucose between 80 and 180 mg/dL was 45.88 ± 27.04% in the IG and 53.56 ± 22.89% in the NPH (P = 0.341) and the percentage of glucose reduction was 31.47 ± 17.52% in the IG and 27.28 ± 14.56% in the NPH (P = 0.374). The percentage of time with glucose < 60 mg/dL was 0.14 ± 0.49% in the IG and 0.47 ± 1.74% in the NPH. Poststroke outcomes were not significantly different. In conclusion, IG is safe and equally effective as an NPH-based basal-bolus regimen for acute stroke patients with hyperglycemia receiving intensive care. Trial registration ClinicalTrials.gov, NCT02607943. Registered 18/11/2015, https://clinicaltrials.gov/ct2/show/NCT02607943.
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Tootee A, Larijani B. Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update. J Diabetes Metab Disord 2021; 20:1003-1009. [PMID: 33996651 PMCID: PMC8108432 DOI: 10.1007/s40200-021-00804-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Institute, Beneath Dr. Shariati Hospital, 3rd floor, Gomnam highway, Tehran, 1411713137 Iran
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Tootee A, Larijan B. Ramadan fasting and diabetes, latest evidence and technological advancements: 2021 update. J Diabetes Metab Disord 2021; 20:1085-1091. [PMID: 33968836 PMCID: PMC8088403 DOI: 10.1007/s40200-021-00806-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijan
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Jude EB, Trescoli C, Emral R, Ali A, Lubwama R, Palmer K, Shaunik A, Nanda N, Raskin P, Gomez‐Peralta F. Effectiveness of premixed insulin to achieve glycaemic control in type 2 diabetes: A retrospective UK cohort study. Diabetes Obes Metab 2021; 23:929-937. [PMID: 33319424 PMCID: PMC8048616 DOI: 10.1111/dom.14298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/26/2020] [Accepted: 12/03/2020] [Indexed: 12/11/2022]
Abstract
AIM To investigate the effectiveness of premixed insulin for achieving glycaemic outcomes in clinical practice in the UK. MATERIALS AND METHODS Electronic medical record data from The Health Improvement Network database were captured for adults with type 2 diabetes (T2D) uncontrolled (HbA1c ≥9%) on two or more oral antihyperglycaemic drugs (OADs) initiating premixed insulin. Effectiveness of premixed insulin was assessed by the probability and incidence of achieving glycaemic outcomes (target HbA1c <7.5% [<58 mmol/mol] and a ≥1% or ≥2% HbA1c reduction) over 24 months. RESULTS Data from 974 participants (mean age 62 years; 56% male; 52% obese or extremely obese; mean HbA1c 11.3% [100 mmol/mol]; hypertension 64%, dyslipidaemia 23% and nephropathy 21%) were analysed. The probability of achieving HbA1c <7.5% was highest during months 3-6 (18.2%), while the cumulative probability of achieving this target plateaued between months 15-24 (15.7%-16.0%). Incidence of achieving all glycaemic outcomes plateaued after 12 months and differed by baseline HbA1c, but not OAD use. Factors affecting some glycaemic outcomes included a body mass index >40 kg/m2 and co-morbidities including nephropathy and stroke. CONCLUSIONS In people with uncontrolled T2D (HbA1c ≥9%), glycaemic outcome achievement on premixed insulin was low at 6 months with little additional clinical benefit beyond 12 months, suggesting a high unmet need for early, timely treatment changes with more effective, simpler therapies.
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Affiliation(s)
- Edward B. Jude
- Tameside and Glossop Integrated Care NHS Foundation TrustAshton‐under‐LyneUK
| | | | - Rifat Emral
- Department of Endocrinology and Metabolic Diseases, Faculty of MedicineAnkara UniversityAnkaraTurkey
| | - Amar Ali
- Oakenhurst Medical PracticeBlackburnUK
| | | | | | | | | | - Philip Raskin
- Department of MedicineUniversity of Texas Southwestern Medical CenterDallasTexas
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A Japanese Study Assessing Glycemic Control with Use of IDegAsp Co-formulation in Patients with Type 2 Diabetes in Clinical Practice: The JAGUAR Study. Adv Ther 2021; 38:1638-1649. [PMID: 33560496 PMCID: PMC7932946 DOI: 10.1007/s12325-021-01623-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/12/2021] [Indexed: 12/18/2022]
Abstract
Introduction The aim of this study was to evaluate the glycemic control and safety of insulin degludec/insulin aspart (IDegAsp) co-formulation in Japanese patients with type 2 diabetes (T2D) in a real-world clinical setting, including elderly patients (aged > 75 years). Methods Patients (≥ 18 years) diagnosed with T2D, previously treated with insulin were included from the Japanese Medical Data Vision database. Baseline data were taken at the index date, defined as the first IDegAsp prescription claim. Change in glycated hemoglobin (HbA1c) at 12 months was estimated using a mixed model repeated measures analysis. The proportion of patients achieving target HbA1c < 8.0% without experiencing hypoglycemia (identified by International Classification of Disease codes) was calculated at 12 months (365 ± 90 days) after baseline. Results Overall, 10,798 patients were included, 3940 were aged > 75 years, and 913 had baseline HbA1c values available. Switching to IDegAsp was associated with significantly improved HbA1c values at 12 months (− 1.23% [− 1.43, − 1.02]95%CI, p < 0.001) versus baseline. Moreover, relative to baseline, a significantly greater proportion of patients achieved HbA1c < 8.0% without hypoglycemia at 12 months, relative rate (RR) 1.30 [1.15, 1.45]95%CI, p < 0.001. Results were similar for patients aged ≤ 75 years and aged > 75 years; 66% and 64% of patients, respectively, achieved HbA1c < 8.0% without hypoglycemia at 12 months. Conclusion Switching from insulin to IDegAsp co-formulation was associated with significantly improved glycemic control and a reduction in hypoglycemia rate during 12 months of follow-up in Japanese patients with T2D, including those aged > 75 years. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01623-y.
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Pasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE. Management of diabetes and hyperglycaemia in the hospital. Lancet Diabetes Endocrinol 2021; 9:174-188. [PMID: 33515493 PMCID: PMC10423081 DOI: 10.1016/s2213-8587(20)30381-8] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.
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Affiliation(s)
- Francisco J Pasquel
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - M Cecilia Lansang
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Guillermo E Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Lansang MC, Zhou K, Korytkowski MT. Inpatient Hyperglycemia and Transitions of Care: A Systematic Review. Endocr Pract 2021; 27:370-377. [PMID: 33529732 DOI: 10.1016/j.eprac.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/15/2021] [Accepted: 01/20/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The transition of diabetes care from home to hospital, within the hospital, and upon discharge is fraught with gaps that can adversely affect patient safety and length of stay. We aimed to highlight the variability in care during these transitions and point out areas where research is needed. METHODS A PubMed search was performed with a combination of search terms that pertained to diabetes, hyperglycemia, hospitalization, locations in the hospital, discharge to home or a nursing facility, and diabetes medications. Studies with at least 50 patients that were written in the English language were included. RESULTS With the exception of transitioning from intravenous insulin infusion to subcutaneous insulin and perhaps admission to the regular floors, few studies pointedly focused on transitions of care, leading us to extrapolate recommendations based on data from disparate areas of care in the hospital. There is evidence at every stage of care, starting from the entry into the hospital and ending with discharge home or to a facility, that patients benefit from having protocols in place guiding overall care. CONCLUSION Pockets of care exist in hospitals where methods of effective diabetes management have been studied and implemented. However, there is no sustained continuum of care. Protocols and care teams that follow patients from one physical location to the other may result in improved clinical outcomes during and following a hospital stay.
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Affiliation(s)
- M Cecilia Lansang
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic, Cleveland, Ohio.
| | - Keren Zhou
- Department of Endocrinology, Diabetes & Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Mary T Korytkowski
- Department of Endocrinology & Metabolism, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Orozco-Beltrán D, Guillen-Mollá A, Cebrián-Cuenca AM, Navarro-Pérez J, Gil-Guillén VF, Quesada JA, Pomares-Gómez FJ, Lopez-Pineda A, Carratalá-Munuera C. Hospital admissions trends for severe hypoglycemia in diabetes patients in Spain, 2005 to 2015. Diabetes Res Clin Pract 2021; 171:108565. [PMID: 33242511 DOI: 10.1016/j.diabres.2020.108565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 02/03/2023]
Abstract
AIMS To analyze hospital admissions trends, inpatient mortality, and mean length of hospital stay due to hypoglycemia in patients with diabetes in Spain from 2005 to 2015. METHODS National Institute of Statistics provided information on hospital discharge and mortality. Hospital admissions due to severe hypoglycemia were identified using ICD-9 codes. Age-adjusted admission and mortality rates were stratified by sex and year. Joinpoint regression models were used to estimate trends. RESULTS Admissions rates per 100,000 population were higher for men than women in 2005 (30.2, 95%CI:29.3, 31.0 versus 21.5, 95%CI:20.9, 22.1) and 2015 (23.7, 95%CI:23.0, 24.4 versus 13.2, 95%CI:12.7, 13.6). Mortality per 100,000 population was also higher for men in both years (2005: 9.4, 95%CI:7.8, 11.0 versus 8.6, 95%CI:7.4, 9.8; 2015: 6.4, 95%CI:5.3, 7.6 versus 4.1, 95%CI:3.3, 4.8). Mortality dropped 5.2 percentage points annually (95%CI:-8.4, -1.9) in men and 7.0 percentage points annually (95%CI:-8.7, -5.2) in women from 2005 to 2015. Mean length of hospital stay changed only for women: 7.8 days (95%CI:7.5, 8.0) to 6.7 days (95%CI:6.4, 6.9). CONCLUSIONS Hospital admissions and inpatient mortality due to hypoglycemia in diabetes patients decreased from 2005 to 2015. This trend was more pronounced in women. Mean length of hospital stay decreased in women.
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Affiliation(s)
- Domingo Orozco-Beltrán
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Alberto Guillen-Mollá
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | | | - Jorge Navarro-Pérez
- Biomedical Research Institute INCLIVA, University of Valencia Clinical Hospital, Valencia, Spain; CIBER, Epidemiology and Public Health (CIBERESP), Health Institute Carlos III, Madrid, Spain
| | - Vicente F Gil-Guillén
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Jose A Quesada
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain.
| | | | - Adriana Lopez-Pineda
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
| | - Concepción Carratalá-Munuera
- Chair of Family Medicine. Clinical Medicine Department, Miguel Hernandez University, San Juan de Alicante, Spain
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Abstract
Diabetes is one of the most common comorbidities in hospitalized patients with coronavirus disease 2019 (COVID-19). Inpatient hyperglycemia during this pandemic has been associated with worse outcomes, so it is mandatory to implement effective glycemic control treatment approaches for inpatients with COVID-19. The shortage of personal protective equipment, the need to prevent staff exposure, or the fact that many of the healthcare professionals might be relatively unfamiliar with the management of hyperglycemia may lead to worse glycemic control and, consequently, a worse prognosis. In order to reduce these barriers, we intend to adapt established recommendations to manage hyperglycemia during this pandemic in critical and noncritical care settings.
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Affiliation(s)
- Virginia Bellido
- Department of Endocrinology and Nutrition, Cruces University Hospital, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Vizcaya, Spain
- University of the Basque Country (UPV/EHU), Vizcaya, Spain
| | - Antonio Pérez
- Department of Endocrinology and Nutrition, Santa Creu I Sant Pau Hospital, Barcelona, Spain.
- Sant Pau Institute of Biomedical Research, Barcelona, Spain.
- Autonomous University of Barcelona, Barcelona, Spain.
- CIBER de Diabetes Y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
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