The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduc...The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduction of (basal) insulin-analogues could possibly improve PRO, particularly “quality of life”. Direct comparative studies between once daily insulin glargine and once to twice or twice daily insulin detemir have previously shown differences in insulin dosage, dosing frequency and weight gain. Whether this leads to a difference in quality of life in patients who are transferred from insulin detemir to insulin glargine remains to be determined. To establish the effect of insulin glargine on quality of life and patient satisfaction in patients with DM2 who are in poor metabolic control with a (human) basal insulin, a large prospective, observational study in Dutch daily practice was performed. The results of the patient population switched from NPH-insulin to insulin glargine have been published previously. In this article the results of the group of patients treated with insulin detemir before the observation period are described. The results of this observational study show that changing basal insulin therapy to insulin glargine in patients with DM2 who are in poor glycemic control with insulin detemir leads to a clinically significant improvement of glycemic control as well as emotional wellbeing, despite a small increase in weight. Whether other factors such as decreased dosing frequency play a role remains to be determined by future studies.展开更多
Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impa...Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impact of this transition in subjects with Type 1 DM is recently reported. Objective: To examine the impact of this transition on various parameters of diabetes management in Type 2 DM. Subjects and Methods: A retrospective review of the records of subjects with Type 2 DM was conducted until 8/2007 in whom the transition had occurred. Only those subjects with adequate glycemic control while receiving insulin glargine [GI] and completing at least 3 months of therapy with insulin detemir [DI] are included in this report. Ten subjects with Type 2 DM, duration 7 ± 2 years with age, 55 ± 3 years who were switched from GI to DI (Group 1) fulfilled the criteria for inclusion. Subjects were switched from GI in Q AM to DI Q HS in the same daily dose. Glycemic control (HbA1c), body weight, daily insulin dose (Units) and severe hypoglycemic events during the last 2 weeks of the period, pre switch and again at the end of 3 months post switch were assessed. Records of 8 subjects matched for age, duration of DM, glycemic control while receiving GI for additional 3 months (Group 2) during the same period were examined for comparison. All subjects were followed in the outpatient clinic at intervals of 3 months. Results Glycemic control remained stable on continuing GI AM;HbA1c;7.1 ± 0.3 to 7.1 ± 0.3%, while it worsened on switching to DI Q HS;HbA1c, 7.1 ± 0.3 to 8.1 ± 0.5 [P < 0.01]. A mild weight loss was noted in subjects on transition. No severe hypoglycemic events were reported in any subject in either group. Conclusion Abrupt transition from insulin glargine to insulin detemir in subjects with Type 2 DM is likely to result in lapse of glycemic control which may cause decreased quality of life. Furthermore, use of insulin detemir may result in increased costs due to need of the higher daily dose as well as additional equipment required for probable twice daily administration to achieve adequate glycemic control. Therefore, insulin glargine and detemir appear to be far from being bioequivalent.展开更多
Objective:To evaluate the meta-analysis of evaluate the clinical efficacy and safety of insulin deside in improving pregnancy with diabetes,and to conduct a Meta-analysis study on the treatment of pregnancy with diabe...Objective:To evaluate the meta-analysis of evaluate the clinical efficacy and safety of insulin deside in improving pregnancy with diabetes,and to conduct a Meta-analysis study on the treatment of pregnancy with diabetes.Methods:Before this study,we comprehensively and systematically searched the major literature websites at home and abroad.From the establishment of the database to January 9,2022,we searched the Chinese and English literature on the randomized controlled trial(RCT)of insulin detemir in the treatment of pregnancy complicated with diabetes.We screened them in strict accordance with the acceptance criteria.The bias risk assessment tool in Cochrane system evaluator manual 5.1.0 was used to evaluate the quality of the selected literature,and the Review Manager 5.4 software was used for meta-analysis.Results:Finally,24 RCTs target literatures were obtained,with a cumulative sample size of 2,362 cases.The results of meta-analysis showed that the reduction range of fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin in patients with insulin detemir combined with routine treatment was greater than that in the control group(P<0.05);compared with conventional treatment,the incidence of premature delivery,macrosomia and cesarean section of the diabetes group were lower than those of the control group(P<0.05).Among them,preterm birth(RR=0.44,95%CI[0.28,0.68],P=0.0002),macrosomia(RR=0.35,95%CI[0.21,0.59],P<0.0001),cesarean section(RR=0.82,95%CI[0.72,0.94],P=0.005),fasting blood glucose(SMD=-1.21,95%CI[-1.54,-0.88],P<0.00001),2 h postprandial blood glucose(SMD=-1.63,95%CI[-1.91,-1.35],P<0.00001),glycosylated hemoglobin(SMD=-2.41,95%CI[-3.12,-1.70],P<0.00001).Conclusion:Routine treatment can improve the clinical effect of pregnancy with diabetes.However,there are low limits on the reference level of this study,so this conclusion has some limitations.展开更多
目的:探讨参芪降糖胶囊联合地特胰岛素治疗初发2型糖尿病伴肥胖症的效果。方法:选取2020年6月—2022年6月在中国人民解放军第九六〇医院接受治疗的100例初发2型糖尿病伴肥胖症患者为研究对象,根据随机分层法分为对照组(n=50)与研究组(n=...目的:探讨参芪降糖胶囊联合地特胰岛素治疗初发2型糖尿病伴肥胖症的效果。方法:选取2020年6月—2022年6月在中国人民解放军第九六〇医院接受治疗的100例初发2型糖尿病伴肥胖症患者为研究对象,根据随机分层法分为对照组(n=50)与研究组(n=50)。对照组采用地特胰岛素治疗,研究组在对照组的基础上联合参芪降糖胶囊治疗。比较两组用药前后的血糖水平、胰岛功能指标水平、血脂水平及体重指数(BMI)、血糖达标时间。结果:用药后两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平明显比用药前低,研究组低于对照组,差异有统计学意义(P<0.05)。用药后两组胰岛素抵抗指数(HOMA-IR)水平均比用药前低,且研究组较对照组更低,两组胰岛素β细胞功能(HOMA-β)、空腹胰岛素(FINS)水平比用药前高,且研究组较对照组更高,差异有统计学意义(P<0.05)。两组用药后甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)水平均较用药前降低,研究组比对照组低,两组高密度脂蛋白胆固醇(HDL-C)水平较用药前上升,研究组比对照组高,差异有统计学意义(P<0.05)。两组用药后BMI均下降,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组血糖达标时间比对照组短,差异有统计学意义(P<0.05)。结论:针对初发2型糖尿病伴肥胖症患者采用参芪降糖胶囊联合地特胰岛素进行治疗,不仅能够有效稳定患者血糖与血脂水平,还能降低体重,改善胰岛功能。展开更多
文摘The success of a specific treatment is traditionally judged according to parameters such as HbA1c. However, other, patient-reported outcomes (PRO) of (insulin) therapy, become increasingly more important. The introduction of (basal) insulin-analogues could possibly improve PRO, particularly “quality of life”. Direct comparative studies between once daily insulin glargine and once to twice or twice daily insulin detemir have previously shown differences in insulin dosage, dosing frequency and weight gain. Whether this leads to a difference in quality of life in patients who are transferred from insulin detemir to insulin glargine remains to be determined. To establish the effect of insulin glargine on quality of life and patient satisfaction in patients with DM2 who are in poor metabolic control with a (human) basal insulin, a large prospective, observational study in Dutch daily practice was performed. The results of the patient population switched from NPH-insulin to insulin glargine have been published previously. In this article the results of the group of patients treated with insulin detemir before the observation period are described. The results of this observational study show that changing basal insulin therapy to insulin glargine in patients with DM2 who are in poor glycemic control with insulin detemir leads to a clinically significant improvement of glycemic control as well as emotional wellbeing, despite a small increase in weight. Whether other factors such as decreased dosing frequency play a role remains to be determined by future studies.
文摘Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impact of this transition in subjects with Type 1 DM is recently reported. Objective: To examine the impact of this transition on various parameters of diabetes management in Type 2 DM. Subjects and Methods: A retrospective review of the records of subjects with Type 2 DM was conducted until 8/2007 in whom the transition had occurred. Only those subjects with adequate glycemic control while receiving insulin glargine [GI] and completing at least 3 months of therapy with insulin detemir [DI] are included in this report. Ten subjects with Type 2 DM, duration 7 ± 2 years with age, 55 ± 3 years who were switched from GI to DI (Group 1) fulfilled the criteria for inclusion. Subjects were switched from GI in Q AM to DI Q HS in the same daily dose. Glycemic control (HbA1c), body weight, daily insulin dose (Units) and severe hypoglycemic events during the last 2 weeks of the period, pre switch and again at the end of 3 months post switch were assessed. Records of 8 subjects matched for age, duration of DM, glycemic control while receiving GI for additional 3 months (Group 2) during the same period were examined for comparison. All subjects were followed in the outpatient clinic at intervals of 3 months. Results Glycemic control remained stable on continuing GI AM;HbA1c;7.1 ± 0.3 to 7.1 ± 0.3%, while it worsened on switching to DI Q HS;HbA1c, 7.1 ± 0.3 to 8.1 ± 0.5 [P < 0.01]. A mild weight loss was noted in subjects on transition. No severe hypoglycemic events were reported in any subject in either group. Conclusion Abrupt transition from insulin glargine to insulin detemir in subjects with Type 2 DM is likely to result in lapse of glycemic control which may cause decreased quality of life. Furthermore, use of insulin detemir may result in increased costs due to need of the higher daily dose as well as additional equipment required for probable twice daily administration to achieve adequate glycemic control. Therefore, insulin glargine and detemir appear to be far from being bioequivalent.
文摘Objective:To evaluate the meta-analysis of evaluate the clinical efficacy and safety of insulin deside in improving pregnancy with diabetes,and to conduct a Meta-analysis study on the treatment of pregnancy with diabetes.Methods:Before this study,we comprehensively and systematically searched the major literature websites at home and abroad.From the establishment of the database to January 9,2022,we searched the Chinese and English literature on the randomized controlled trial(RCT)of insulin detemir in the treatment of pregnancy complicated with diabetes.We screened them in strict accordance with the acceptance criteria.The bias risk assessment tool in Cochrane system evaluator manual 5.1.0 was used to evaluate the quality of the selected literature,and the Review Manager 5.4 software was used for meta-analysis.Results:Finally,24 RCTs target literatures were obtained,with a cumulative sample size of 2,362 cases.The results of meta-analysis showed that the reduction range of fasting blood glucose,2 h postprandial blood glucose and glycosylated hemoglobin in patients with insulin detemir combined with routine treatment was greater than that in the control group(P<0.05);compared with conventional treatment,the incidence of premature delivery,macrosomia and cesarean section of the diabetes group were lower than those of the control group(P<0.05).Among them,preterm birth(RR=0.44,95%CI[0.28,0.68],P=0.0002),macrosomia(RR=0.35,95%CI[0.21,0.59],P<0.0001),cesarean section(RR=0.82,95%CI[0.72,0.94],P=0.005),fasting blood glucose(SMD=-1.21,95%CI[-1.54,-0.88],P<0.00001),2 h postprandial blood glucose(SMD=-1.63,95%CI[-1.91,-1.35],P<0.00001),glycosylated hemoglobin(SMD=-2.41,95%CI[-3.12,-1.70],P<0.00001).Conclusion:Routine treatment can improve the clinical effect of pregnancy with diabetes.However,there are low limits on the reference level of this study,so this conclusion has some limitations.
文摘目的:探讨参芪降糖胶囊联合地特胰岛素治疗初发2型糖尿病伴肥胖症的效果。方法:选取2020年6月—2022年6月在中国人民解放军第九六〇医院接受治疗的100例初发2型糖尿病伴肥胖症患者为研究对象,根据随机分层法分为对照组(n=50)与研究组(n=50)。对照组采用地特胰岛素治疗,研究组在对照组的基础上联合参芪降糖胶囊治疗。比较两组用药前后的血糖水平、胰岛功能指标水平、血脂水平及体重指数(BMI)、血糖达标时间。结果:用药后两组空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbA1c)水平明显比用药前低,研究组低于对照组,差异有统计学意义(P<0.05)。用药后两组胰岛素抵抗指数(HOMA-IR)水平均比用药前低,且研究组较对照组更低,两组胰岛素β细胞功能(HOMA-β)、空腹胰岛素(FINS)水平比用药前高,且研究组较对照组更高,差异有统计学意义(P<0.05)。两组用药后甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)水平均较用药前降低,研究组比对照组低,两组高密度脂蛋白胆固醇(HDL-C)水平较用药前上升,研究组比对照组高,差异有统计学意义(P<0.05)。两组用药后BMI均下降,且研究组低于对照组,差异有统计学意义(P<0.05)。研究组血糖达标时间比对照组短,差异有统计学意义(P<0.05)。结论:针对初发2型糖尿病伴肥胖症患者采用参芪降糖胶囊联合地特胰岛素进行治疗,不仅能够有效稳定患者血糖与血脂水平,还能降低体重,改善胰岛功能。
