Comparison on Efficacy and Safety of Three Inpatient Insulin Regimens for Management of Non-Critical Patients with Type 2 Diabetes

Background: Hyperglycemia in hospitalized patients is associated with poor clinical outcomes. Scheduled Subcutaneous Insulin therapy has been recommended for better glycemic control. Aims: To compare efficacy and safety of traditional sliding scale insulin (SSI) versus modified 70/30 insulin versus basal plus supplemental scale (SS) insulin regimens for glycemic control of inpatients with diabetes. Methods: In a prospective trial, 62 patients with diabetes were randomized to receive either hospital SSI (N = 22), or twice daily 70/30 insulin plus supplemental lunchtime insulin for BG ≥ 150 mg/dL (N = 21) or once every night glargine plus prandial glulisine for BG ≥ 150 mg/dL (N = 19). 70/30 insulin and glargine were started respectively at 0.4 and 0.2 U/kg/day for BG ≤ 200 mg/dL or 0.5 and 0.3 U/kg/day for BG above 200 mg/dL. Results: Starting at BG level of 204 ± 68, 200 ± 50 and 241 ± 94 mg/dL in SSI, 70/30 insulin and glargine/glulisine groups respectively, (F(2,35.47) = 1.467, p = 0.244, Welch test), mean daily BG after first day of hospitalization was statistically significant (F(2,35.58) = 7.043, p = 0.003, Welch test) lower in 70/30 insulin group (171 ± 38 mg/dL) compared to (218 ± 71 mg/dL) in SSI group (p = 0.026) and (225 ± 65 mg/dL) in glargine/glulisine group (p = 0.01). Conclusions: With poorly educated nursing staff, basal plus SS insulin failed to provide adequate glycemic control. However, tailored 70/30 insulin regimen resulted in statistically significant glycemic control compared to traditional SSI.

UGT1A1*28 Polymorphism in Advanced Colorectal Cancer: The Story Is Not Yet Ended

Background: UGT1A1*28 polymorphism is associated with neutropenia and diarrhea in previous reports, while this study tried to investigate correlation with other toxicities like vomiting. Patients and Methods: This is a prospective case control study including all eligible cases of advanced colorectal cancer. The genotypes of UGT1A1*28 was assessed in the peripheral blood and/or in tissues by PCR. Patients were divided into two groups, Group 1: patients with no mutation, Group 2: patients with homo or hetero mutation. All patients received standard IFL regimen. Primary objectives were: 1) comparison between the 2 groups as regard vomiting, 2) assessment of the incidence of UGT1A1*28 polymorphism. Secondary objectives were: comparison between the 2 groups as regard: neutropenia, diarrhea, treatment delay, progressive diseases (PD), progression free survival (PFS) and overall survival (OS). Results: 46 cases of advanced colorectal cancer present to National Cancer Institute, Cairo University, aged between 19 and 71 years with a median age of 45 years were included and followed up during the period from September 2010 to January 2013 with a median follow-up of 9 months. UGT1A1*28 polymorphism was present in 20 patients (43%), of whom 15% are homozygous. Grade (II-IV) vomiting was found in 8.3% of Group 1 versus 52.5% of Group 2 (P = 0.01). Grade (II-IV) neutropenia was found in 20.8% of Group 1 versus 64.7% of Group 2 (P = 0.03). Grade (II-IV) diarrhea was found in 37.5% of patients of Group 1 and 27.5% of patients with Group 2. (P = 0.75). Treatment delay occurred in 29.16% of Group 1 versus 72.4% of Group 2 (P = 0.02). 25% of Group 1 showed PD versus 25% of Group 2 (P = 0.8). 1-year PFS was 19% in Group 1 versus 23% in Group 2 (P = 0.8) while there was a trend towards better OS in Group 1 (47% versus 35%) (P = 0.07). Conclusions: UGT1A1*28 polymorphism is present frequently (43%) in a Caucasian population and is associated with more vomiting, neutropenia and treatment delay.