Effects of different low-dose of insulin glargine on antioxidation of organs in burned rats with delayed resuscitation / 中华危重病急救医学

Objective:To study the antioxidant protective effects of different low-dose of insulin glargine on organs of burned rats with delayed resuscitation.Methods:Forty male Sprague-Dawley (SD) rats were randomly divided into sham group, delayed resuscitation control group, and insulin glargine 0.5, 1.0, and 2.0 U groups, with 8 rats in each group. The rats were immersed in hot water (95.0±0.5) ℃ for 15 s to establish the third-degree scald model with 30% total body surface area. The rats in the sham group were immersed in a 37 ℃ water bath for 15 s. Insulin glargine (0.5, 1.0, 2.0 U·kg -1·d -1) was injected subcutaneously in corresponding insulin glargine group 2 hours after injury, and the same amount of normal saline was injected intraperitoneally in the delayed resuscitation control group. Intraperitoneal injection of normal saline 40 mL/kg simulated delayed resuscitation 6 hours after injury in all groups. Abdominal aortic blood samples, heart and kidney tissue were collected immediately after simulating burn in the sham group, and 24 hours after burn in other four groups. The blood glucose, myocardial enzymes [lactate dehydrogenase (LDH), creatine kinase (CK), α-hydroxybutyrate dehydrogenase (α-HBDH), and aspartate aminotransferase (AST)] and renal function indexes [blood urea nitrogen (BUN) and serum creatinine (SCr)] were measured by spectrophotometry, and the isoenzyme MB of creatine kinase (CK-MB) level was determined by immunosuppression method to evaluate the effects of different low-dose insulin glargine intervention on blood glucose, cardiac and renal functions in scalded rats with delayed resuscitation. The oxidative and antioxidant indices [xanthine oxidase (XOD), myeloperoxidase (MPO), copper-zinc superoxide dismutase (CuZn-SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and total antioxidant capacity (T-AOC)] from the heart and kidney tissues of rats were detected by spectrophotometry to analyze the antioxidant effects of different low-dose insulin glargine interventions. Results:Compared with the sham group, the blood glucose of the rats in the delayed resuscitation control group was significantly increased, the heart and kidney functions were significantly reduced, the oxidation capacity was enhanced, and the antioxidant indicators were significantly reduced. After the intervention of insulin glargine, with the increase of insulin glargine dose, the blood glucose, myocardial enzyme and renal function indicators of rats showed a gradual downward trend, the oxidation indicators continued to decrease, and the antioxidant indicators showed a gradual upward trend. When the dose was 2.0 U·kg -1·d -1, the blood glucose, LDH, CK, CK-MB, α-HBDH, AST, BUN, SCr, XOD and MPO were significantly lower than those in the delayed resuscitation control group [blood glucose (mmol/L): 5.91±0.25 vs. 11.76±0.36, LDH (U/L): 3 332.12±51.61 vs. 5 008.94±490.12, CK (kU/L): 0.49±0.03 vs. 0.85±0.04, CK-MB (U/L): 125.40±12.19 vs. 267.52±11.63, α-HBDH (U/L): 122.99±5.37 vs. 240.85±13.99, AST (U/L): 11.95±1.81 vs. 17.87±1.57, BUN (mmol/L): 4.72±0.15 vs. 7.16±0.34, SCr (μmol/L): 87.11±6.51 vs. 137.50±11.36, XOD (U/g): 166.29±3.27 vs. 204.90±4.82 in heart tissue, 63.51±1.46 vs. 79.69±1.75 in kidney tissue, MPO (U/g): 1.05±0.02 vs. 1.55±0.06 in heart tissue, 1.04±0.04 vs. 1.87±0.01 in kidney tissue, all P < 0.05], and CuZn-SOD, CAT, GSH-Px and T-AOC were significantly higher than those in the delayed resuscitation control group [CuZn-SOD (kU/g): 82.95±2.69 vs. 56.52±2.26 in heart tissue, 94.50±2.73 vs. 62.02±1.66 in kidney tissue, CAT (U/g): 36.07±2.01 vs. 15.15±2.22 in heart tissue, 184.49±4.53 vs. 156.02±3.96 in kidney tissue, GSH-Px (kU/g): 231.93±8.03 vs. 179.48±3.15 in heart tissue, 239.63±7.30 vs. 172.20±2.09 in kidney tissue, T-AOC (kU/g): 4.85±0.23 vs. 2.71±0.11 in heart tissue, 5.51±0.08 vs. 3.50±0.07 in kidney tissue, all P < 0.05]. Conclusion:Different low-dose of insulin glargine (≤2.0 U·kg -1·d -1) could exert antioxidant protection on the heart and kidney of rats with delayed resuscitation after burns, with a dose-dependent manner.

Effects of glargine insulin on glycemic control in patients with diabetes mellitus type II undergoing off-pump coronary artery bypass graft

Background: The prevalence of diabetes mellitus in patients requiring coronary artery bypass grafting (CABG) is noticeably high (20%–30%). These patients have inferior perioperative outcome, reduced long-term survival, and high risk of recurrent episodes of angina. To improve perioperative outcome surgical unit defined satisfactory glycemic control is desired during this period. Hence, the aim of our study is to compare the efficacy of glargine insulin combination with continuous human insulin infusion for perioperative glycemic control in patients with diabetes undergoing CABG. Materials and Methods: Fifty Patients, who were posted for off-pump CABG with diabetes mellitus type II, were randomized in two group, Group I normal saline + human insulin infusion during the perioperative period, Group II (glargine group): Glargine + human insulin infusion during perioperative period. Results: During surgery and in the postoperative period, random blood sugar and human insulin requirement are significantly higher in control group than glargine group. Other infection, step-up antibiotics, intensive care unit (ICU) stay, and hospital stay were significantly higher in control groups in postoperative period. Conclusion: Our study results suggest that glargine effectively manages blood glucose level with significantly greater control over postoperative morbidity.

Experiencia con insulina degludec en pacientes diabéticos Tipo 1 del Hospital San Juan de Dios Santiago / Experience with degludec insulin in Type 1 diabetic patients at the San Juan de Dios Hospital

OBJECTIVE: To study the efficacy and safety of degludec insulin in Type 1 diabetic patients. PATIENTS AND METHOD: In a prospective study, 230 type 1 diabetics patients, average aged 34 years age and 14 years of diagnosis of diabetes and treated with two doses of insulin glargine U-100, were changed to degludec. Patients had glycosylated hemoglobins (HbA1c) greater than 10 percent. Results were recorded at 3 and 6 months with parameters clinical, biochemical, insulin requirements per kilogram of weight (U/kg/wt) and hypoglycemia. Capillary glycemia was evaluated three times a day and the dose of insulin degludec every two weeks. The statistical analysis used was average and rank, standard deviation, normal Swilk test, categorical Chi2 and continuous ANOVA or Kwallis, and p < 0.05. A psychological survey was conducted to evaluate satisfaction with the new treatment. RESULTS: Fasting blood glucose decreased from 253 (range 243-270) at 180 mg/dl (172-240) at 3 months and at 156 (137-180) at 6 months after the change insulin (p < 0.05). HbA1c, initially 10.6 percent (10.4-12.2) decreased to 8.7 percent (9.3-10.1) and 8.3 percent (8.7-9.7) at 3 and 6 months, respectively (p < 0.05). There was a decrease in basal insulin requirements from 0.7 to 0.4 U/kg/60 percent reduction in hypoglycaemia; both mild and moderate and severe. Isolated nocturnal hypoglycaemias were recorded in only 4 patients in this group. CONCLUSION: Six months of treatment with degludec insulin reduces fasting blood glucose, glycosylated hemoglobin and hypoglycemia, both mild and moderate severe and nocturnal, which makes this new ultra-long acting basal insulin a safe and effective tool for the management of type 1 diabetics patients

Efficacy observation of liraglutide combined with glargine insulin in treatment of newly diagnosed type 2 diabetes mellitus / 重庆医学

Objective To investigate the effect of liraglutide combined with glargine insulin in treating the patients with newly diagnosed type 2 diabetes mellitus (T2DM).Methods Sixty-one cases of newly diagnosed T2DM in the endocrinology department of Affiliated Chaozhou Central Hospital of Southern Medical University,from August 2014 to December 2015 were selected and divided into two groups according to the random number table.The observation group (29 cases) was treated with liraglutide combined with glargine insulin and the control group (32 cases) was given the intensive insulin therapy.The curative effects before and after treatment were analyzed and compared between the two groups.Results The fast plasma glucose(FPG),postprandial 2 h blood glucose(PPG),glycosylated hemoglobin(HbA1c),fasting C peptide(FCP),postprandial 2 h C peptide(PCP),insulin resistance index(HOMA-IR),blood lipid indicators and body mass index after 12-week treatment were decreased in the treatment and follow up periods,while pancreatic β cell function index (HOMA-β) and HDL-C were increased,indicating that the two kinds of treatment method all were effective.The effect onset in the observation group was faster,the above indexes after 4-week treatment were significantly improved compared with before treatment.The above indexes after 4-,12-week treatment in the observation group were significantly superior to those in the control group,the difference was statistically significant(P<0.05).Conclusion Liraglutide combined with glargine insulin has better effect in the aspects of reducing blood glucose,regulating blood lipid,decreasing the body mass and islet function recovery than the intensive insulin treatment and is worthy of clinical promotion and application.

Comportamiento de hemoglobina glicosilada y frecuencia de hipoglicemias en diabéticos tipo 2 tratados con insulina glargina o NPH / Glycosylated hemoglobin behavior and frequency of hypoglycemia in type 2 diabetics treated with insulin glargine or NPH

Objetivo: Evaluar comportamiento de hemoglobina glicosilada (HbA1c) y frecuencia de hipoglicemias sintomáticas con esquema basal con insulina NPH comparado con insulina glargina en diabéticos tipo 2 (DM2), atendidos en un programa de riesgo cardiovascular. Materiales y métodos: Estudio observacional de cohorte retrospectivo. Se revisaron 613 historias clínicas de pacientes con DM2 manejados con esquema basal con insulina NPH o glargina, de los cuales 76 cumplieron los criterios de inclusión. Se revisó historia clínica al momento de inclusión (consulta No. 1), a los seis (consulta No. 2) y a los doce meses (consulta No. 3). Resultados: Se analizaron 13 pacientes del grupo glargina y 63 del grupo NPH (edad 64,9 [± 10,9 años], 54 porciento mujeres). En la consulta No. 1 el promedio de HbA1c fue 7.8 porciento en grupo con NPH y 7.5 porciento en grupo glargina. Al final del seguimiento los niveles de HbA1c fueron 7.5 porciento en grupo NPH y 7.9 porciento en grupo glargina (p= 0.4). Los eventos de hipoglucemia fueron 3 en la primera consulta y 4 en la tercera, todos recibían NPH. En la segunda consulta se presentaron 5 eventos en pacientes con NPH y 1 caso con glargina (p=0.9). Las variables más fuertemente asociadas con niveles bajos de HbA1c fueron enfermedad renal crónica y sexo femenino. Conclusiones: Los pacientes con DM2 de este estudio no presentaron diferencia estadísticamente significativa en valores de HbA1c de acuerdo al tipo de insulina recibida.Se observó menor frecuencia de hipoglucemias en pacientes que utilizaban insulina glargina sin encontrarse diferencia estadísticamente significativa.

To evaluate performance of glycosylated hemoglobin (HbA1c) and frequencyof symptomatic hypoglycemia scheme with basal insulin glargine compared toNPH insulin in type 2 diabetics (DM2), served in a program of cardiovascularrisk. Materials and methods: Observational retrospective cohort. 613 medicalrecords of patients with DM2 managed scheme with basal insulin NPHor glargine, of which 76 met the inclusion criteria were reviewed. medicalrecords were reviewed at the time of inclusion (see No. 1), six (see No. 2)and twelve months (see No. 3). Results: 13 patients in the glargine group and63 in the NPH group (age 64.9 [± 10.9 years], 54% female) were analyzed.The consultation No. 1 mean HbA1c was 7.8% with NPH group and 7.5% inglargine group. At follow-up HbA1c levels were 7.5% in NPH group and 7.9%in glargine group (p = 0.4). Hypoglycemic events were 3 in the first visit and 4in the third, all received NPH. In the second consultation five events occurredin patients with NPH and 1 case with glargine (p = 0.9). The variables moststrongly associated with low levels of HbA1c were chronic kidney disease andwomen. Conclusions: Patients with DM2 of this study showed no statisticallysignificant difference in HbA1c values according to the type of insulinreceived. Lower frequency of hypoglycemia in patients using insulin glargineno statistically significant difference was observed.

Study on clinical effect of glargine insulin combined with glimepiride in newly diagnosed T2DM patients / 中国基层医药

Objective To study the efficacy and safety of glargine insulin combined with glimepiride therapy in type 2 diabetes mellitus(T2DM).Methods According to the random number table,100 T2DM patients with unsatisfactory efficacy of oral hypoglycemic agents were randomly divided into treament group and control group, 50 cases in each group.Then,the treatment group was dealed with glargine insulin and glimepiride,the control group were treated with insulin glargine for our treatment protocol.12 weeks after treament,the fasting blood glucose(FPG), 2 hours blood glucose(2hPG),body mass index(BMI),glycosylated hemoglobin(HbA1c),islet β-cell function index(HOMA -β),insulin resistance index(Homa -IR),insulin dosage(INS),time requirds,weight gain and so on were observed.Meanwhile,The occurrence condition of hypoglycemia was also observed.Results In control groups, the post -treatment indexes of FPG,2hPG,HbAlc,HOMA -βand HOMA -IR[(5.7 ±0.8)mmol/L,(8.6 ± 2.5)mmol/L,(6.5 ±0.7)%,(40.35 ±3.12),(2.68 ±1.41 )]were much better than those in pre -treatment [(11.7 ±1.6)mmol/L,(15.1 ±6.1 )mmol/L,(9.2 ±1.1 )%,(19.01 ±2.79),(3.42 ±1.47)](t =23.717, 6.971,14.642,36.052,2.568,P <0.01 or 0.05 for both).In the treatment group,the post -treatment indexes of FPG,2hPG,HbAlc,HOMA -β,HOMA -IR[(5.6 ±0.7)mmol/L,(7.3 ±2.3)mmol/L,(6.3 ±1.0)%,(54.18 ± 3.23),(2.12 ±1.26 )]improved obviously than those in pre -treatment [(11.8 ±1.7 )mmol/L,(15.8 ± 5.2)mmol/L,(9.3 ±1.2)%,(18.71 ±3.12),(3.36 ±1.56)](t =23.846,10.570,13.580,55.849,4.372,P <0.01 for both).After treatment,the indexes of 2hPG,HOMA -β,HOMA -IR,insulin dose,time requirds and ampli-tude of weight gain[(7.3 ±2.3)mmol/L,(54.18 ±3.23),(2.12 ±1.26),(18.06 ±1.43)U /d,(10.1 ±2.4)d, (1.1 ±0.4kg)]etc in the treatment group were significantly ameliorated than those in the control group[(8.6 ± 2.5)mmol/L,(40.35 ±3.12),(2.68 ±1.41 ),(22.46 ±1.77)U /d,(13.2 ±2.6)d,(2.1 ±0.6)kg](t =23.717,6.971,14.642,36.052,2.568,P <0.01 or 0.05 for both).Hypoglycemia events of treatment group were 4 cases(8.0%)and the same in the control group were 13 cases(26.0%),there were statistical significance between the two groups(χ2 =5.535,P <0.05).Conclusion Treatment of glargine insulin combined with glimepiride can improve blood glucose level of T2DM patients,recover their islet β-cell function,relieve the IR,shorten the time requirds,as well as reduce the insulin dosage,range of weight gain and rate of hypoglycemia events.Hence,treatment protocol of glargine insulin combined with glimepiride is an effective clinical treatment for newly diagnosed T2DMpatients.

The effect of Glargine insulin combined with Metformin or/and Acarbose in treatment for the newly diagnosed type 2 diabetes / 中国基层医药

Objective To compare the clinical effects and safety of treating newly diagnosed type 2 diabetes patients by combining Glargine insulin with Metformin or/and Acarbose. Methods 84 patients with newly diagnosed type 2 diabetes ,who have a history of weight loss, body mass index( BMI )23 ～ 28kg/m2 and poorly controlled blood glucose in Metformin at least a month ,were randomly divided into three groups. Glargine insulin plus Mefformin were used in group A. Glargine insulin plus Acarbose(without mefformin)were used in group B, Glargine insulin, Acarbos and metformin were used in Group C. All three groups were given a 12-week follow-up. Results FBG,2hBG and HbA1c levels were lower in the patients after treatment( P ＜0. 05 ). HbA1c of patients was partly up to the standard in group A and group B,but HbA1c of patients was all up to the standard in group C. The effects in group C were better than those in group A and group B. It had the shortest time to achieve the target and the smallest dose of insulin in group C. BMI in group A and B did not change but decreased in group C(P＞0.05).The incidence of low blood sugar in all three groups was low and no significant difference observed among three groups (P＞0.05). And in all three groups no severe hypoglycemia occurred. Conclusion The method of combining Glargine insulin with Mefformin or/and Acarbose could effectively control blood sugar had little impact on body weight of the newly diagnosed type 2 diabetes patients, and moreover, the incidence of low blood sugar in the newly diagnosed type 2 diabetes patients was lower. It would be the ideal method to treat newly diagnosed type 2 diabetes patients considering the general safety and effectiveness and convenience.