scholarly journals Lower Glucose Variability and Hypoglycemia Measured by Continuous Glucose Monitoring With Novel Long-Acting Insulin LY2605541 Versus Insulin Glargine

Diabetes Care ◽  
2013 ◽  
Vol 37 (3) ◽  
pp. 659-665 ◽  
Author(s):  
Richard M. Bergenstal ◽  
Julio Rosenstock ◽  
Edward J. Bastyr ◽  
Melvin J. Prince ◽  
Yongming Qu ◽  
...  
Keyword(s):  
Insulin Glargine ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Glucose Variability ◽  
Acting Insulin ◽  
Lower Glucose ◽  
Long Acting

scholarly journals Titration of Long-Acting Insulin Using Continuous Glucose Monitoring and Smart Insulin Pens in Type 1 Diabetes: A Model-Based Carbohydrate-Free Approach

2022 ◽  
Vol 12 ◽  
Author(s):  
Anas El Fathi ◽  
Chiara Fabris ◽  
Marc D. Breton
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Acting Insulin ◽  
Insulin Pens ◽  
Long Acting ◽  
Titration Algorithm

ObjectiveMultiple daily injections (MDI) therapy is the most common treatment for type 1 diabetes (T1D), consisting of long-acting insulin to cover fasting conditions and rapid-acting insulin to cover meals. Titration of long-acting insulin is needed to achieve satisfactory glycemia but is challenging due to inter-and intra-individual metabolic variability. In this work, a novel titration algorithm for long-acting insulin leveraging continuous glucose monitoring (CGM) and smart insulin pens (SIP) data is proposed.MethodsThe algorithm is based on a glucoregulatory model that describes insulin and meal effects on blood glucose fluctuations. The model is individualized on patient’s data and used to extract the theoretical glucose curve in fasting conditions; the individualization step does not require any carbohydrate records. A cost function is employed to search for the optimal long-acting insulin dose to achieve the desired glycemic target in the fasting state. The algorithm was tested in two virtual studies performed within a validated T1D simulation platform, deploying different levels of metabolic variability (nominal and variance). The performance of the method was compared to that achieved with two published titration algorithms based on self-measured blood glucose (SMBG) records. The sensitivity of the algorithm to carbohydrate records was also analyzed.ResultsThe proposed method outperformed SMBG-based methods in terms of reduction of exposure to hypoglycemia, especially during the night period (0 am–6 am). In the variance scenario, during the night, an improvement in the time in the target glycemic range (70–180 mg/dL) from 69.0% to 86.4% and a decrease in the time in hypoglycemia (<70 mg/dL) from 10.7% to 2.6% was observed. Robustness analysis showed that the method performance is non-sensitive to carbohydrate records.ConclusionThe use of CGM and SIP in people with T1D using MDI therapy has the potential to inform smart insulin titration algorithms that improve glycemic control. Clinical studies in real-world settings are warranted to further test the proposed titration algorithm.SignificanceThis algorithm is a step towards a decision support system that improves glycemic control and potentially the quality of life, in a population of individuals with T1D who cannot benefit from the artificial pancreas system.

scholarly journals Insulin glargine: pharmacokinetic and pharmacodynamic basis of clinical effect

2014 ◽  
Vol 17 (4) ◽  
pp. 99-107
Author(s):  
Vadim Valer'evich Klimontov ◽  
Natalya Evgen'evna Myakina
Keyword(s):  
Insulin Glargine ◽  
Human Insulin ◽  
Plasma Concentrations ◽  
Glucose Variability ◽  
Proliferative Effect ◽  
Insulin Requirements ◽  
Lower Glucose ◽  
Metabolic Activities ◽  
Long Acting

Glargine became the first long-acting insulin analogue. Glargine was designed to meet basal insulin requirements throughout the day with a single injection. Pharmacokinetics of insulin glargine is characterized by biotransformation into metabolites M1 and M2 that transforms the B chain of glargine so it is similar to the B chain of human insulin. Plasma concentrations of active M1 and M2 metabolites have no pronounced peaks during the day, resulting in lower glucose variability and hypoglycaemia risk when compared with NPH insulin. The metabolic activities of M1 and M2 metabolites are similar to the effect of glargine, whereas the mitogenic effects of these metabolites do not exceed the effect of human insulin. Insulin glargine shows a higher affinity for the insulin-like growth factor-1 (IGF-1) receptor when compared with human insulin. Glargine has no proliferative effect in vivo owing to its rapid conversion into metabolites. Pharmacokinetic and pharmacodynamic variability of glargine is comparable to other insulins. These characteristics are important for the clinical efficacy and safety of glargine.

scholarly journals Continuous glucose monitoring use and glucose variability in pre-school children with type 1 diabetes

2019 ◽  
Vol 147 ◽  
pp. 76-80 ◽  
Author(s):  
Klemen Dovc ◽  
Kevin Cargnelutti ◽  
Anze Sturm ◽  
Julij Selb ◽  
Natasa Bratina ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Continuous Glucose Monitoring ◽  
School Children ◽  
Glucose Monitoring ◽  
Glucose Variability

scholarly journals Time-action profile of the long-acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo

Diabetes Care ◽  
2000 ◽  
Vol 23 (5) ◽  
pp. 644-649 ◽  
Author(s):  
L. Heinemann ◽  
R. Linkeschova ◽  
K. Rave ◽  
B. Hompesch ◽  
M. Sedlak ◽  
...  
Keyword(s):  
Insulin Glargine ◽  
Insulin Analog ◽  
Nph Insulin ◽  
Acting Insulin ◽  
Analog Insulin ◽  
Long Acting ◽  
Action Profile
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