Diabetes mellitus affects people worldwide,and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients.Previous reports have confirmed that hyperg...Diabetes mellitus affects people worldwide,and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients.Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit(ICU).In addition,severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy.The innovation of continuous glucose monitoring(CGM)may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia,which may decrease the potential complications in patients in the ICU.The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels;thus,there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients.Recently,the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control,which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients.In this mini-review paper,we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.展开更多
Background: Several studies have shown that twice-daily injections of premixed insulin analogs (MIX) could achieve comparable HbA1c levels to basal-bolus (BB) therapy. However, HbA1c does not necessarily reflect short...Background: Several studies have shown that twice-daily injections of premixed insulin analogs (MIX) could achieve comparable HbA1c levels to basal-bolus (BB) therapy. However, HbA1c does not necessarily reflect short-term glycemic fluctuations that may contribute to the onset or progression of diabetic complications. Therefore, in this study, we compared MIX and BB therapies in terms of their effects on glycemic variability. Methods: We performed a crosssectional observational study of patients attending our outpatient clinics to compare the effects of two insulin regimens on glycemic variability. We recruited patients treated with MIX or BB with HbA1c < 8.4%. A total of 27 patients (11 treated with BB and 16 treated with MIX) were enrolled and wore a continuous glucose monitor (CGM) for 72 h, while continuing their usual lifestyle and insulin doses. Results: No significant differences in CGM-determined glycemic markers were observed between the two groups. However, the post-lunch duration of glucose levels > 180 mg/dL (t > 180) was significantly shorter with BB therapy (88 ± 76 min) than with MIX therapy (145 ± 54 min;p < 0.05). After classification according to HbA1c levels, markers of glycemic variability were better in patients treated with BB than in those treated with MIX in better control group. Conclusion: These results suggest that BB therapy achieves better glucose profiles than MIX therapy in patients with type 2 diabetes, particularly after lunch.展开更多
BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus,particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also hel...BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus,particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also helps to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.Children are suitable candidates for pump therapy as they need a more freestyle and proper metabolic control to ensure adequate growth and development.Therefore, children and their caregivers should have proper education and training and understand the proper use of insulin pumps to achieve successful pump therapy. The pump therapy continuously improves to enhance its performance and increase its simulation of the human pancreas. Nonetheless, there is yet a long way to reach the desired goal.AIM To review discusses the history of pump development, its indications, types, proper use, special conditions that may enface the children and their families while using the pump, its general care,and its advantages and disadvantages.METHODS We conducted comprehensive literature searches of electronic databases until June 30, 2022,related to pump therapy in children and published in the English language.RESULTS We included 118 articles concerned with insulin pumps, 61 were reviews, systemic reviews, and meta-analyses, 47 were primary research studies with strong design, and ten were guidelines.CONCLUSION The insulin pump provides fewer needles and can provide very tiny insulin doses, a convenient and more flexible way to modify the needed insulin physiologically, like the human pancreas, and can offer adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.展开更多
Treatment of type 1 diabetes mellitus has always posed a challenge to balance hyperglycemia control with hypoglycemia episodes. The quest for newer therapies is continuing and this review attempts to outline the recen...Treatment of type 1 diabetes mellitus has always posed a challenge to balance hyperglycemia control with hypoglycemia episodes. The quest for newer therapies is continuing and this review attempts to outline the recent developments. The insulin molecule itself has got moulded into different analogues by minor changes in its structure to ensure well controlled delivery, stable half-lives and lesser side effects. Insulin delivery systems have also consistently undergone advances from subcutaneous injections to continuous infusion to trials of inhalational delivery. Continuous glucose monitoring systems are also becoming more accurate and user friendly. Smartphones have also made their entry into therapy of diabetes by integrating blood glucose levels and food intake with calculated adequate insulin required. Artificial pancreas has enabled to a certain extent to close the loop between blood glucose level and insulin delivery with devices armed with meal and exercise announcements, dual hormone delivery and pramlintide infusion. Islet, pancreas-kidney and stem cells transplants are also being attempted though complete success is still a far way off. Incorporating insulin gene and secretary apparatus is another ambitious leap to achieve insulin independence though the search for the ideal vector and target cell is still continuing. Finally to stand up to the statement, prevention is better than cure, immunological methods are being investigated to be used as vaccine to prevent the onset of diabetes mellitus.展开更多
文摘Diabetes mellitus affects people worldwide,and management of its acute complications or treatment-related adverse events is particularly important in critically ill patients.Previous reports have confirmed that hyperglycemia can increase the risk of mortality in patients cared in the intensive care unit(ICU).In addition,severe and multiple hypoglycemia increases the risk of mortality when using insulin or intensive antidiabetic therapy.The innovation of continuous glucose monitoring(CGM)may help to alert medical caregivers with regard to the development of hyperglycemia and hypoglycemia,which may decrease the potential complications in patients in the ICU.The major limitation of CGM is the measurement of interstitial glucose levels rather than real-time blood glucose levels;thus,there will be a delay in the treatment of hyperglycemia and hypoglycemia in patients.Recently,the European Union approved a state-of-art artificial intelligence directed loop system coordinated by CGM and a continuous insulin pump for diabetes control,which may provide a practical way to prevent acute adverse glycemic events related to antidiabetic therapy in critically ill patients.In this mini-review paper,we describe the application of CGM to patients in the ICU and summarize the pros and cons of CGM.
文摘Background: Several studies have shown that twice-daily injections of premixed insulin analogs (MIX) could achieve comparable HbA1c levels to basal-bolus (BB) therapy. However, HbA1c does not necessarily reflect short-term glycemic fluctuations that may contribute to the onset or progression of diabetic complications. Therefore, in this study, we compared MIX and BB therapies in terms of their effects on glycemic variability. Methods: We performed a crosssectional observational study of patients attending our outpatient clinics to compare the effects of two insulin regimens on glycemic variability. We recruited patients treated with MIX or BB with HbA1c < 8.4%. A total of 27 patients (11 treated with BB and 16 treated with MIX) were enrolled and wore a continuous glucose monitor (CGM) for 72 h, while continuing their usual lifestyle and insulin doses. Results: No significant differences in CGM-determined glycemic markers were observed between the two groups. However, the post-lunch duration of glucose levels > 180 mg/dL (t > 180) was significantly shorter with BB therapy (88 ± 76 min) than with MIX therapy (145 ± 54 min;p < 0.05). After classification according to HbA1c levels, markers of glycemic variability were better in patients treated with BB than in those treated with MIX in better control group. Conclusion: These results suggest that BB therapy achieves better glucose profiles than MIX therapy in patients with type 2 diabetes, particularly after lunch.
文摘BACKGROUND Insulin pump therapy is a real breakthrough in managing diabetes Mellitus,particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also helps to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.Children are suitable candidates for pump therapy as they need a more freestyle and proper metabolic control to ensure adequate growth and development.Therefore, children and their caregivers should have proper education and training and understand the proper use of insulin pumps to achieve successful pump therapy. The pump therapy continuously improves to enhance its performance and increase its simulation of the human pancreas. Nonetheless, there is yet a long way to reach the desired goal.AIM To review discusses the history of pump development, its indications, types, proper use, special conditions that may enface the children and their families while using the pump, its general care,and its advantages and disadvantages.METHODS We conducted comprehensive literature searches of electronic databases until June 30, 2022,related to pump therapy in children and published in the English language.RESULTS We included 118 articles concerned with insulin pumps, 61 were reviews, systemic reviews, and meta-analyses, 47 were primary research studies with strong design, and ten were guidelines.CONCLUSION The insulin pump provides fewer needles and can provide very tiny insulin doses, a convenient and more flexible way to modify the needed insulin physiologically, like the human pancreas, and can offer adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.
文摘Treatment of type 1 diabetes mellitus has always posed a challenge to balance hyperglycemia control with hypoglycemia episodes. The quest for newer therapies is continuing and this review attempts to outline the recent developments. The insulin molecule itself has got moulded into different analogues by minor changes in its structure to ensure well controlled delivery, stable half-lives and lesser side effects. Insulin delivery systems have also consistently undergone advances from subcutaneous injections to continuous infusion to trials of inhalational delivery. Continuous glucose monitoring systems are also becoming more accurate and user friendly. Smartphones have also made their entry into therapy of diabetes by integrating blood glucose levels and food intake with calculated adequate insulin required. Artificial pancreas has enabled to a certain extent to close the loop between blood glucose level and insulin delivery with devices armed with meal and exercise announcements, dual hormone delivery and pramlintide infusion. Islet, pancreas-kidney and stem cells transplants are also being attempted though complete success is still a far way off. Incorporating insulin gene and secretary apparatus is another ambitious leap to achieve insulin independence though the search for the ideal vector and target cell is still continuing. Finally to stand up to the statement, prevention is better than cure, immunological methods are being investigated to be used as vaccine to prevent the onset of diabetes mellitus.
