Open-loop device Microjet MC 2 improves unstable diabetes, lowers the daily insulin requirement and reduces the excursions of plasma free insulin levels: comparison with a traditional intensive treatment

1983 ◽  
Vol 6 (3) ◽  
pp. 189-194
Author(s):  
Piero Micossi ◽  
U. Raggi ◽  
F. Dosio ◽  
M. Scavini ◽  
A. Bertin ◽  
...  
Keyword(s):  
Insulin Requirement ◽  
Open Loop ◽  
Intensive Treatment ◽  
Unstable Diabetes ◽  
Insulin Levels ◽  
Daily Insulin ◽  
Free Insulin ◽  
Plasma Free Insulin ◽  
Daily Insulin Requirement

Purified insulins

1977 ◽  
Vol 15 (5) ◽  
pp. 18-20
Keyword(s):  
Diabetic Complications ◽  
Insulin Requirement ◽  
Insulin Antibodies ◽  
Daily Insulin ◽  
Antibody Complex ◽  
Antigen Antibody ◽  
Immunogenic Properties ◽  
Daily Insulin Requirement

Purified porcine insulins were developed to reduce the immunogenic properties of conventional insulin. About 95% of diabetics who use standard beef insulin develop insulin antibodies within the first 12 weeks of treatment.1 These antibodies may increase the daily insulin requirement and slow the hypoglycaemic action because active insulin may be only gradually released from the antigen-antibody complex. Suggestions that the antibodies also increase the incidence of long-term diabetic complications2–4 are not widely accepted.

scholarly journals Therapeutic efficacy of umbilical cord-derived stem cells for diabetes mellitus: a meta-analysis study

2020 ◽  
Vol 11 (1) ◽  
Author(s):  
Dina H. Kassem ◽  
Mohamed M. Kamal
Keyword(s):  
Stem Cells ◽  
Umbilical Cord ◽  
Therapeutic Efficacy ◽  
Meta Analysis ◽  
Insulin Requirement ◽  
Β Cell ◽  
C Peptide ◽  
Analysis Study ◽  
Daily Insulin ◽  
Daily Insulin Requirement

Abstract Background Stem cell therapy provides great hope for patients with diabetes mellitus (DM). DM is a seriously alarming metabolic disease characterized by hyperglycemia and β cell dysfunction. Efficient novel therapeutic modalities to treat DM are indeed warranted. Stem cells (SC) derived from the umbilical cord specifically provide several advantages and unique characteristics being a readily available non-invasive source, with an additional credit for their banking potential. This meta-analysis study aims to provide a focused assessment for therapeutic efficacy of umbilical cord (UC)-derived SC-transplantation, namely Wharton’s jelly mesenchymal stem cells (WJ-MSCs) and umbilical cord blood (UCB) for DM. Methods The clinical efficacy was evaluated based on glycemic control status (reflected on HbA1c%) and β cell function (reflected on C-peptide levels), as well as the daily insulin requirement in diabetic patients after receiving UC-derived SC-transplantation compared to baseline values. Moreover, we assessed these outcome measures in patients who received such intervention compared to those who did not receive it in randomized/non-randomized controlled clinical trials. We employed a random-effects model and standardized mean difference for this meta-analysis. Results Eleven eligible clinical studies were included; WJ-MSCs (6 studies; 172 patients including 71 controls) and UCB (5 studies; 74 patients including 15 controls). WJ-MSCs significantly improved HbA1c% (pooled-estimate − 1.085; 95%CI (− 1.513, − 0.657); p < 0.001) and C-peptide levels (pooled-estimate 1.008; 95%CI (0.475, 1.541); p < 0.001), as well as the daily insulin-requirement (pooled-estimate − 2.027; 95%CI (− 3.32, − 0.733); p = 0.002). On the contrary, UCB was found to be uniformly ineffective; HbA1c% (pooled-estimate − 0.091, 95%CI (− 0.454, 0.271); p = 0.622), significantly deteriorated C-peptide levels (pooled-estimate − 0.789; 95%CI (− 1.252, − 0.325); p < 0.001) and daily insulin-requirement (pooled-estimate 0.916; 95%CI (0.247, 1.585); p = 0.007). All these observations remained consistent when we carried out sub-group meta-analysis for T1DM and T2DM and also when we compared patients who received WJ-MSCs or UCB to controls. Conclusions The results of our meta-analysis provide a clear evidence for the superior efficacy of WJ-MSCs over UCB in DM. This sheds lights on the importance to consider banking of WJ-MSCs together with the well-established routine UCB-banking, especially for those with family history of DM. Additionally, further clinical studies are required to investigate therapeutic efficacy of selected/enriched UCB-derived cell populations with immunomodulatory/regenerative potential in DM.

Sotagliflozin in Combination with Optimized Insulin Therapy Reduced HbA1c Levels with a Decreased Daily Insulin Requirement after 52 Weeks in Adults with T1D

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 5-LB
Author(s):  
JEREMY PETTUS ◽  
STUART A. WEINZIMER ◽  
RORY J. MCCRIMMON ◽  
FRANCISCO JAVIER AMPUDIA BLASCO ◽  
JOHN A. STEWART ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Insulin Requirement ◽  
Daily Insulin ◽  
Hba1c Levels ◽  
Daily Insulin Requirement

scholarly journals Can the AHCL System Be Used in T1D Patients with Borderline TDDI? A Case Report

Sensors ◽  
2021 ◽  
Vol 21 (21) ◽  
pp. 7195
Author(s):  
Anna Tekielak ◽  
Sebastian Seget ◽  
Ewa Rusak ◽  
Przemysława Jarosz-Chobot
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Insulin Dose ◽  
Insulin Requirement ◽  
Total Daily Dose ◽  
Daily Insulin ◽  
Automatic Mode ◽  
Remission Phase ◽  
Daily Insulin Requirement

(1) Background: Intensive insulin therapy using continuous subcutaneous insulin infusion (CSII) with continuous real-time glucose monitoring (rt CGM) is the best option for patients with T1D. The recent introduction of a technology called Advanced Hybrid Closed Loop (AHCL) represents a new era in the treatment of type 1 diabetes, the next step towards better care, as well as improving the effectiveness and safety of therapy. The aim is to present the case of a T1D patient with a borderline total daily dose of insulin being treated with the Medtronic AHCL system in automatic mode. (2) Materials and Methods: A 9-year-old boy, from October 2020, with type 1 diabetes in remission was connected to the Minimed™ 780G (AHCL) system in accordance with the manufacturer’s recommendations (daily insulin dose > 8 units, age > 7). Records of the patient’s history were collected from visits to The Department of Children’s Diabetology, as well as from the Medtronic CareLink™ software and the DPV SWEET program from October 2020 to April 2021. (3) Results: The patient’s total daily insulin requirement decreased in the first 6 weeks after the AHCL was connected, which may reflect the remission phase (tight glycemic control with a healthy lifestyle). The lowest daily insulin requirement of 5.7 units was also recorded. In a three-month follow-up of the patient treated with AHCL, it was found that for almost 38% of the days the insulin dose was less than 8 IU. (4) Conclusions: The AHCL system allows safe and effective insulin therapy in automatic mode, as well as in patients with a lower daily insulin requirement. The AHCL system should be considered a good therapeutic option for patients from the onset of T1D, as well in the remission phase.

scholarly journals Influence of Age on Partial Clinical Remission among Children with Newly Diagnosed Type 1 Diabetes

2020 ◽  
Vol 17 (13) ◽  
pp. 4801
Author(s):  
Stefano Passanisi ◽  
Giuseppina Salzano ◽  
Albino Gasbarro ◽  
Valentina Urzì Brancati ◽  
Matilde Mondio ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Clinical Remission ◽  
Ph Value ◽  
Insulin Requirement ◽  
Newly Diagnosed ◽  
Daily Insulin ◽  
Endogenous Insulin ◽  
Remission Phase ◽  
Daily Insulin Requirement

Partial clinical remission (PCR) is a transitory period characterized by the residual endogenous insulin secretion following type 1 diabetes (T1D) diagnosis and introducing the insulin therapy. Scientific interest in PCR has been recently increasing, as this phase could be crucial to preserve functional beta cells after T1D onset, also taking advantage of new therapeutic opportunities. The aim of this study was to assess the frequency, duration and associated factors of PCR in children newly diagnosed with T1D. Our cohort study included 167 pediatric patients aged 13.8 ± 4.1 years. The association of clinical and laboratory factors with the occurrence and duration of PCR was evaluated via logistic regression and multivariable generalized linear model, respectively. PCR occurred in 63.5% of the examined patients. Patients who achieved the remission phase were significantly older, and they had lower daily insulin requirement compared with non-remitters. PCR was positively associated to body mass index (OR = 1.11; p = 0.032), pH value (OR 49.02; p = 0.003) and c-peptide levels (OR 12.8; p = 0.002). The average duration of PCR was 13.4 months, and older age at diagnosis was the only predictor factor. Two years after diagnosis remitter patients had lower HbA1c and daily insulin requirement.

Metabolic response of normal man and insulin-infused diabetics to postprandial exercise

1982 ◽  
Vol 242 (5) ◽  
pp. E309-E316 ◽  
Author(s):  
J. D. Nelson ◽  
P. Poussier ◽  
E. B. Marliss ◽  
A. M. Albisser ◽  
B. Zinman
Keyword(s):  
Insulin Infusion ◽  
Closed Loop ◽  
Endocrine Pancreas ◽  
Metabolic Response ◽  
Insulin Requirement ◽  
Open Loop ◽  
Artificial Endocrine Pancreas ◽  
Intravenous Insulin ◽  
Fasting Glycemia ◽  
Identical Manner

Physical exercise is often performed during absorption of meals. We have characterized the metabolic response to 45 min of moderate exercise (approximately 55% of estimated maximal oxygen uptake) beginning 30 min after breakfast in seven healthy controls. Nine insulin-dependent diabetes were studied in an identical manner, with glycemia controlled by a closed-loop "artificial endocrine pancreas" controlled by a closed-loop "artificial endocrine pancreas" (AEP). Responses were compared to those during breakfast without exercise. In the controls, onset of exercise rapidly reversed the rise in both glycemia and insulin (IRI) that occurred with breakfast alone, both returning to fasting levels (glycemia, 80 +/- 3 mg/dl; IRI, 0.38 +/- 0.10 ng/ml). After exercise, small and transient increments occurred (glycemia, 33 +/- 6 mg/dl; IRI, 0.81 +/- 0.15 ng/ml). In the diabetics, prior overnight intravenous insulin normalized fasting glycemia (98 +/- 4 mg/dl), and its postbreakfast excursion was identical to that of controls, as were those of most measured substrates. Similarly, with exercise, glycemia returned rapidly to fasting levels, accompanied by an appropriate decrease in insulin infusion rates. "Free" IRI levels mirrored changes in infusion rates by the AEP, with a decrease in insulin requirement of 30% during exercise as compared to breakfast alone (P less than 0.05). Thus, in both diabetics treated with the AEP and in normals, the responses to postprandial exercise required rapid modulation of insulin delivery. To demonstrate the effect of postprandial exercise on preprogrammed open-loop insulin replacement, four diabetic subjects were studied during breakfast with and without exercise while receiving a fixed open-loop insulin infusion pattern (6.1 +/- 0.7 U over 140 +/- 8 min). The glycemic response to breakfast alone was entirely normalized. However, symptomatic hypoglycemia occurred in all subjects when exercise was initiated 30 min after breakfast. The diabetic responses to closed-loop insulin infusion provide important data in defining the appropriate preprogrammed open-loop insulin infusion pattern for postprandial exercise.

scholarly journals Dietary Intervention with Oatmeal in Patients with uncontrolled Type 2 Diabetes Mellitus – A Crossover Study

2018 ◽  
Vol 127 (09) ◽  
pp. 623-629 ◽  
Author(s):  
Graciela Delgado ◽  
Marcus E. Kleber ◽  
Bernhard K Krämer ◽  
Michael Morcos ◽  
Per M. Humpert ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Crossover Study ◽  
Dietary Intervention ◽  
Control Period ◽  
Insulin Requirement ◽  
Control Treatment ◽  
Daily Insulin

Abstract Background In a pilot study, we evaluated the efficacy of two days of oatmeal on insulin resistance and glucose metabolism and found a marked decrease of insulin requirements. The most important shortcoming of that study was that the interventions were not isocaloric (diabetes adapted diet: 1500 kcal/d vs. oatmeal 1100 kcal/d). To address these drawbacks we designed the OatMeal And Insulin Resistance (OMA-IR) study. Methods The study was a randomized, open label crossover dietary intervention study with consecutive inclusion of 15 patients with uncontrolled type 2 diabetes. The intervention comprised two days of oatmeal on days 3 and 4 of a 5 days hospital stay. During the control period, patients received a diabetes mellitus adapted diet only. The primary endpoint was the daily insulin requirement and glycemic control. Results Upon oatmeal treatment, the required insulin dose could be significantly reduced on the third and fourth day as compared to the second day of inpatient stay (82.0±30.3 and 69.9±29.9IU versus 112±36.2IU;P<0.001). During control treatment, insulin requirement did not change. There were no significant differences in the changes of mean blood glucose or fasting glucose between both treatments. HbA1c was lower four weeks after the oatmeal intervention. Conclusion In this crossover study, two days of oatmeal intervention allowed a highly significant reduction of required daily insulin doses while maintaining adequate metabolic control as compared to a diabetes adapted diet only. The beneficial effects of the intervention might last for several weeks as shown by the lower HbA1c four weeks after the intervention.

Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Emine Ayça Cimbek ◽  
Aydın Bozkır ◽  
Deniz Usta ◽  
Nazım Ercüment Beyhun ◽  
Ayşenur Ökten ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Partial Remission ◽  
Hemoglobin A1c ◽  
Insulin Dose ◽  
Age At Onset ◽  
Insulin Requirement ◽  
C Peptide ◽  
Factors Associated ◽  
Daily Insulin

Abstract Objectives Most patients with type 1 diabetes (T1D) experience a transient phase of partial remission (PR). This study aimed to identify the demographic and clinical factors associated with PR. Methods This was a longitudinal retrospective cohort study of 133 children and adolescents with T1D. PR was defined by the gold standard insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of ≤9. Results Remission was observed in 77 (57.9%) patients. At diagnosis, remitters had significantly higher pH (7.3 ± 0.12 vs. 7.23 ± 0.15, p=0.003), higher C-peptide levels (0.45 ± 0.31 ng/mL vs. 0.3 ± 0.22, p=0.003), and they were significantly older (9.3 ± 3.6 years vs. 7.3 ± 4.2, p=0.008) compared with non-remitters. PR developed more frequently in patients without diabetic ketoacidosis (DKA) (p=0.026) and with disease onset after age 5 (p=0.001). Patients using multiple daily insulin regimen were more likely to experience PR than those treated with a twice daily regimen (63.9 vs. 32%, p=0.004). Only age at onset was an independent predictor of PR (OR: 1.12, 95% CI: 1-1.25; p=0.044). Remitters had lower HbA1c levels and daily insulin requirement from diagnosis until one year after diagnosis (p<0.001). PR recurred in 7 (9%) patients. The daily insulin requirement at three months was lower in remitters with PR recurrence compared to those without (0.23 ± 0.14 vs. 0.4 ± 0.17 U/kg/day, p=0.014). Conclusions Addressing factors associated with the occurrence of PR could provide a better comprehension of metabolic control in T1D. The lack of DKA and higher C-peptide levels may influence PR, but the main factor associated with PR presence was older age at onset. PR may recur in a small proportion of patients.

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