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.

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.

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.

scholarly journals MON-703 Injection Technique over Insulin Dose - Nuances in Diabetes Therapy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Neha Mehrotra ◽  
Daniel Kotok ◽  
Carla J DeJesus ◽  
Mary T Korytkowski ◽  
Sann Yu Mon
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Direct Observation ◽  
Insulin Dose ◽  
Insulin Injection ◽  
Insulin Requirement ◽  
Injection Technique ◽  
Periodic Review ◽  
Major Barrier ◽  
Daily Insulin

Abstract Introduction Optimal insulin injection technique is crucial for therapeutic success in patients with diabetes who require insulin therapy for glycemic control. One of the causes for failure to reach glycemic goals can be attributed to improper injection technique. Problems related to poor injection technique may arise at a later stage and hence, may lead to a major barrier to intended glycemic control. We present a patient with worsening glycemic control and significant insulin requirement due to ineffective injection technique. Our case highlights the importance of direct observation of the patient injecting insulin, even for those who have been on insulin therapy for years. Case Presentation A 55-year-old woman with T2DM and Class III obesity was referred for endocrine consultation with HbA1c &gt;12% for 9 months despite adhering to 4.7 unit/kg/day basal bolus daily Insulin, Metformin 1000 mg twice daily and liraglutide 1.8 mg daily. Secondary causes of insulin resistance were ruled out. Initial review of injection technique on an insulin-injection pad failed to identify the error. However, a leakage was observed when patient was asked to demonstrate injection technique on herself, using the BD AutoShield Duo needle, which she was using at that time. Patient was advised to switch to BD nano needles and given proper training. Following this adjustment, her HbA1c improved to 6.9% within 3 months with a decrease in daily insulin requirement to 1 unit/kg/day. Discussion In optimizing glycemic control, proper insulin injection technique is as essential as the appropriate type and dose of insulin; however, this is often overlooked. Studies assessing proper insulin injection technique by direct observation are limited. Problems experienced by patients are rarely brought up and often neglected during the follow-up visits. Supervision of injection technique periodically can help identify injection errors. The BD AutoShield Duo offers the distinct advantages of concealing the needle which benefits those who have an aversion to needles and reduces the risks of accidental needlesticks. The force required to deliver a successful injection of insulin using this needle is greater in comparison to traditional needles. Such force and lack of direct visualization may potentially lead to failure of insulin delivery. Such challenges may be more obvious in patients with obesity. Our case highlights the importance of periodic review of insulin injection technique, particularly when glycemic control is suboptimal, and emphasizes the correct choice of insulin pen needle. References 1.King, Laila. “Subcutaneous insulin injection technique.” Nursing Standard, vol. 17, no. 34, 2003, p. 45+. Academic OneFile, https://link.galegroup.com/apps/doc/A130629162/AONE?u=googlescholar&sid=AONE&xid=5f28fd49. Accessed 18 Nov. 2018.

scholarly journals Topical problems of diabetes treatment during pregnancy

2009 ◽  
Vol 12 (4) ◽  
pp. 32-36
Author(s):  
Irina Yur'evna Demidova ◽  
Natalya Yur'evna Arbatskaya ◽  
Elena Petrovna Mel'nikova
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Pregnant Women ◽  
Intensive Insulin Therapy ◽  
Insulin Requirement ◽  
Subcutaneous Insulin ◽  
Diabetes Treatment ◽  
Self Monitoring ◽  
Stable Control

The main causes behind decompensation of diabetes mellitus (DM) in pregnant women are consid-ered, such as metabolic and hormonal disturbancesinfluencing insulin requirement in different periods of pregnancy and variability of glycemia related to pharmacokinetic and pharmacodynamicproperties of insu-lin preparations. Recommended target levels of glycemia in pregnant women with DM are cited. The fre-quencyof self-monitoring blood glucose and principles of intensive insulin therapy are discussed. Advan-tages of continuous subcutaneous insulin infusionand its role in the maintenance of stable control of car-bohydrate metabolism during pregnancy are discussed.

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.

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