Inercia clínica en el tratamiento con insulina en el primer nivel de atención / Clinical inertia in insulin treatment at the primary care level

Resumen Introducción: Poco se ha evaluado el rechazo de los médicos a prescribir insulina a sus pacientes; el retraso en intensificar el tratamiento impide una atención adecuada y de calidad. Objetivo: Identificar la percepción de los médicos acerca de las barreras para iniciar la insulina en los pacientes con diabetes. Método: Por Índice Smith y análisis multivariado, en 81 médicos familiares se evaluó la relevancia y agrupación de los conceptos relacionados con las barreras para la prescripción de insulina. Resultados: 35.8 % de los médicos mostró confianza en prescribir insulina; casi la mitad calificó la intensificación del tratamiento entre moderadamente y poco importante (39.5 y 6.2 %). Las barreras se relacionaron con el médico (39.5 %), el paciente (37 %), el tratamiento con insulina (11.1 %) y la institución (6.2 %); 6.2 % de los médicos no percibió ninguna barrera. Las barreras se agruparon en cinco factores, que explicaron 62.48 % de la varianza: cultura de los pacientes, falta de habilidades, miedo a los eventos adversos, inseguridad y falta de capacitación. Conclusión: La inercia clínica no resultó de una condición clínica compleja o comorbilidades del paciente, sino de la percepción del médico y de su confianza en sus habilidades clínicas y comunicativas.

Abstract Introduction: Refusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care. Objective: To identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes. Method: Using the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors. Results: Only 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training. Conclusion: Clinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor’s perception and confidence in his/her clinical and communication skills.

Hipoglucemia en pacientes con diabetes tipo 1 y tipo 2 en tratamiento con insulina. Resultados del estudio HAT en argentina / Hypoglycaemia in patients with type 1 and type 2 diabetes mellitus on insulin therapy. Results of the global HAT study in Argentina

Describimos los resultados del estudio internacional no intervencionista HAT en una muestra de Argentina que evaluó las hipoglucemias graves y no graves en 433 pacientes con diabetes mellitus tipo 1 (DMT1) y 823 con diabetes tipo 2 (DMT2) tratados con insulina, mediante un cuestionario de autoevaluación doble (retrospectivo y prospectivo). La incidencia anual de al menos un evento de hipoglucemia fue 46 episodios/paciente-año en DMT1 y 14.2 en DMT2 (retrospectivo) y 96.5 y 24.6 eventos/paciente/año en DMT1 y DMT2, respectivamente (prospectivo). La hipoglucemia influyó en la calidad de vida (en escala 0-10 de temor a hipoglucemia: 60% en DMT1 y 37.6% en DMT2 puntuó de 5 a 10), en el desempeño cotidiano, laboral o académico (2.1% con DMT1 y el 3.2% con DMT2 no asistieron a su labor por hipoglucemia) y en el mayor consumo de recursos (en DMT1: 66.1% aumentó el monitoreo glucémico, 60.5% la ingesta, 51% las consultas y 60.5% redujo la insulina y el 20.9% el ejercicio, con 3.5% de internación, y en DMT2 aumentó un 46.2% el monitoreo glucémico, 43.8% las consultas, 38.6% la ingesta, el 24.1% redujo y el 13.9% salteó la dosis de insulina, 14.3% suspendió el ejercicio). Se registró mayor número de episodios en el período prospectivo. Es necesario contar con un instrumento para evaluar las hipoglucemias en la práctica clínica y con estrategias para reducir su riesgo. También es importante indagar sobre los episodios y reforzar la educación de pacientes y familiares sobre ajustes de tratamiento ante episodios de hipoglucemia.

We describe the results of the HAT study in 433 Argentinean patients with type 1 diabetes (T1D) and 823 with type 2 diabetes (T2D). HAT was an international non-interventional study assessing severe and non-severe hypoglycaemia in patients with T1D and T2D under insulin treatment through a two-part self-assessment questionnaire (retrospective and prospective). The annual incidence of at least one hypoglycaemic episode was 46 episode/patient/year in T1D and 14.2 in T2D (retrospective), 96.5 and 24.6 episode/patient/year in T1D and T2D, respectively (prospective). Hypoglycaemia affected quality of life (on a scale of 0-10 for fear of hypoglycaemia: 60% in T1D and 37.6% in T2D scored 5 to 10), daily life, occupational or academic performance (2.1% with T1D and 3.2% with T2D did not attend to their work after hypoglycaemia), and induced an increased use of health resources (T1D: 66.1% increased glucose monitoring, 60.5% food intake, 51% consultations, 3.5% hospital admissions; 60.5% reduced insulin and 20.9% exercises; T2D increased 46.2% glucose monitoring, 43.8% consultations, 38.6% food intake, 24.1% reduced and 13.9% skipped the insulin dose and 14.3% suspended exercises). Greater numbers of episodes were recorded in the prospective period. An instrument to assess hypoglycaemia in clinical practice and strategies to reduce their risk are required. It is also important to ask about the episodes and reinforce the education of patients and close relatives on hypoglycaemia prevention and treatment.

Effect of intensive insulin treatment on healthcare-associated infection rate in acute stroke:A Meta-analysis / 中国感染控制杂志

Objective To evaluate effect of intensive insulin treatment(IIT)on healthcare-associated infection (HAI)rate in patients with acute stroke and stress hyperglycemia.Methods Databases,including PubMed,Em-base,Cochrane Library,WanFang,and China National Knowledge Infrastructure(CNKI)Data,were electronically searched,relevant journals and references of the included literatures were also searched manually,literatures were selected according to the uniform inclusion and exclusion criteria,incidence of HAI and mean blood glucose in patients who received IIT for acute stroke were assessed systematically.Results A total of 13 randomized controlled trials (RCT)involving 1 032 patients were included in this systematic review.Meta-analysis results showed that 10 studies involving 832 patients were finally enrolled for comparing HAI rate, HAI rates in IIT group and conventional insulin treatment group were 28.3% and 56.1 %,respectively(Z =4.50 ),difference between two groups was statistically significant (RR=0.53 [95 %CI :0.40 to 0.70],P <0.001 );A total of 328 patients in 5 studies were finally included in the comparison of blood glucose,difference in mean blood glucose between two groups was statistically significant(MD =-2.52 [95% CI :-4.30 to -0.74],P =0.006).Funnel plot of HAI rate revealed that there was publication bias.Conclusion IIT is used for the regulation of stress hyperglycemia in acute stroke,it can reduce the incidence of HAI and blood glucose in patients.

Frecuencia y factores asociados al tratamiento con insulina en diabéticos tipo 2 de la provincia Granma / Frequency and factors associated with insulin therapy in type 2 diabetics in Granma Province

Objetivo: determinar con qué frecuencia se indica la insulina a personas con diabetes mellitus tipo 2 de la provincia Granma y los factores asociados a la indicación de este tratamiento.Métodos: estudio descriptivo transversal con 520 pacientes diabéticos tipo 2 ingresados en el Centro de Atención al Diabético de Bayamo, Granma, entre septiembre de 2011 y junio de 2013. Los pacientes se dividieron en 2 grupos: con tratamiento insulínico y sin él.Resultados: 308 pacientes (59,2 por ciento), llevaban tratamiento con insulina. De ellos, 156 (30 por ciento) la utilizaban de forma permanente y 152 (29,2 por ciento) de manera transitoria. El porcentaje de pacientes con tratamiento insulínico se incrementó significativamente a medida que aumentaba el tiempo de evolución de la diabetes (p= 0,0000). Los casos con tratamiento insulínico tenían un índice de masa corporal significativamente menor que aquellos que no la utilizaban (p= 0,0000). La presencia de complicaciones microvasculares de la diabetes se asoció notoriamente al uso de insulina (p= 0,0000).Conclusiones: la mayoría de los diabéticos tipo 2 en nuestro medio necesita insulina para su control y su uso está estrechamente relacionado con el tiempo de evolución de la diabetes, el índice de masa corporal, los niveles de glucemia y la presencia de complicaciones vasculares de esta enfermedad....

Objective: to determine how often insulin for people with type 2 diabetes mellitus is indicated in Granma province, and to determine the associated factors with the indication for this treatment. Methods: a cross-sectional descriptive study of 520 type 2 diabetic patients admitted to the Diabetic Care Center of Bayamo, Granma, from September 2011 to June 2013. Patients were divided into two groups: those with insulin therapy with and those with no insulin therapy. Results: 308 patients (59.2 percent) had insulin treatment. 156 (30 percent) out of them used it continuously and 152 (29.2 percent) had it briefly. The percentage of patients with insulin treatment significantly increased, increasing the duration of diabetes (p= 0.0000) as well. Cases with insulin treatment had a significantly lower body mass rate than those who did not use it (p= 0.0000). The presence of microvascular complications of diabetes is notoriously associated with the use of insulin (p= 0.0000). Conclusions: the majority of type 2 diabetics in our country need insulin to control it and its use is closely related to the duration of diabetes, body mass index, blood glucose levels, and the presence of vascular complications of this disease...

Management of diabetes by a healthcare team in a cardiology unit: a randomized controlled trial

OBJECTIVE: To assess the effectiveness of healthcare team guidance in the implementation of a glycemic control protocol in the non-intensive care unit of a cardiology hospital. METHODS: This was a randomized clinical trial comparing 9 months of intensive guidance by a healthcare team on a protocol for diabetes care (Intervention Group, n = 95) with 9 months of standard care (Control Group, n = 87). Clinicaltrials.gov: NCT01154413. RESULTS: The mean age of the patients was 61.7±10 years, and the mean glycated hemoglobin level was 71±23 mmol/mol (8.7±2.1%). The mean capillary glycemia during hospitalization was similar between the groups (9.8±2.9 and 9.1±2.4 mmol/l for the Intervention Group and Control Group, respectively, p = 0.078). The number of hypoglycemic episodes (p = 0.77), hyperglycemic episodes (47 vs. 50 in the Intervention Group and Control Group, p = 0.35, respectively), and the length of stay in the hospital were similar between the groups (p = 0.64). The amount of regular insulin administered was 0 (0-10) IU in the Intervention Group and 28 (7-56) IU in the Control Group (p<0.001), and the amount of NPH insulin administered was similar between the groups (p = 0.16). CONCLUSIONS: While guidance on a glycemic control protocol given by a healthcare team resulted in a modification of the therapeutic strategy, no changes in glycemic control, frequency of episodes of hypoglycemia and hyperglycemia, or hospitalization duration were observed. .

Five cases of acute painful neuropathy induced by rapid glycaemic control with insulin and literature review / 中华内分泌代谢杂志

[Summary] The characteristics ot clinical data and relevant inspection (quantitative sensory and electrophysiological studies) in 5 patients hospitalized with acute painful neuropathy following rapid glycaemic control with insulin from 2010 to 2012 in our hospital were analyzed.The results showed that 5 patients were all males,aged 31-49 years,with lower body mass index,and diagnosed as latent autoimmune diabetes of adults (LADA) or type 2 diabetes.Glycaemic control was poor before application of insulin.When insulin was used,the hyperglycemia was rapidly corrected in a short time,with recurrent episodes of hypoglycemia during insulin treatment.The painful neuropathic symptoms appeared within 2-4 weeks after application of insulin,and were relieved partially or completely after 2-6 months.Neuropathic symptoms manifested as tingling and tenderness,with worsening during night and after insulin injection.The neuropathic symptoms were not significantly alleviated after application of neurotrophic drugs such as methycobal,protogen,and prostaglandin.These patients often suffered from severe anxiety.Nerve electromyogram examination showed slowed or normal motor conduction velocity of tibial and fibular nerves,and normal feeling threshold.

Effects of transient intensive insulin treatment on free fatty acid in newly diagnosed type 2 diabetic patients / 中国医师进修杂志

Objective To study the effect of transient intensive insulin treatment on the serum free fatty acid (FFA) in newly diagnosed type 2 diabetic patients.Methods Sixty-four newly diagnosed type 2 diabetic patients were treated with transient intensive insulin.The fasting plasma glucose (FPG),2 hours post-prandial glucose (2hPG),lipid,fastin insulin (FINS),and serum FFA was examined hefore and after treatment.Results The levels of FPG,2hPG,total cholesterol (TC),triglycerides (TG),low density lipoproteins cholesterol (LDL-C),FFA and HOMA-IR after treatment were (9.68 ± 2.02) mmol/L,(12.77 ± 1.35) mmol/L,(4.26 ± 1.07) mmol/L,(1.52 ± 0.58) mmol/L,(2.50 ±0.75) mmol/L,(435.84 ± 190.94) μmol/L,0.51 ± 0.62,and they decreased obviously compared with those before treatment [(14.66 ± 3.50) mmol/L,(17.43 ±4.89) mmol/L,(5.03 ±0.94) mmol/L,(2.05 ± 1.42) mmol/L,(2.91 ±0.78) mmol/L,(586.68 ±229.45)μmol/L,0.65 ± 0.89](P＜0.05).The level of HOMA-β increased obviously (2.70 ± 0.83 vs.1.74 ± 1.04)(P＜0.05).The increase of HOMA-β and the decrease of HOMA-IR was positively correlated with the decrease of FFA.Conclusion The transient intensive insulin treatment can evidently decrease the level of FFA that can improve beta-cell function and relieve insulin resistance in newly diagnosed type 2 diabetic patients.

The effects of intensive insulin treatment on islet β cell apoptosis associated protein bcl-2 and bax in type 2 diabetic rats / 中国基层医药

Objective To observe the effects of intensive insulin treatment on islet β cell apoptosis associated protein bcl-2 and bax in type 2 diabetic rats.Methods 36 Wistar rats were randomly divided into two groups : normal control group and high fat diet group.Rats in normal control group fed by basical feedstuff.Rats in high fat diet group fed by high fat and basical feedstuff.After 10 days,rats in high fat group were injected with STZ.After 3 days,rats in high fat group were randomly divided into two groups:diabetes control group and insulin treatment group.The course of treatment was 4 weeks.After 10 days by fat milk intragastfic administration, after 3 days of STZ injection and after 4 weeks treatment, each index was measured.After experiment, pancreatic tissue bel-2 and bax were detected through immunohistocbemical method.Results After 4 weeks intensive insulin treatment,the bcl-2 was significantly increased at(6.20 ± 2.05 )% in insulin treatment group than diabetes control group.The bax was significantly decreased at ( 2.68 ± 1.04 ) % in insulin treatment group than diabetes control group ( P < 0.05 ).Conclusion The method of insulin intensive treatment could increase islet βcell bcl-2 and decrease bax in type2 diabetic rots, Insulin intensive treatment could decrease islet β cell apoptosis.

Morbilidad materna en diabéticas mellitus gestacionales con tratamiento insulínico preventivo / Mother morbidity in diabetes mellitus pregnant under preventive insulin-treatment

OBJETIVO: reportar la morbilidad materna en diabéticas gestacionales con tratamiento insulínico preventivo por riesgo de hiperglucemia tardía. MÉTODOS: reportamos los resultados en 230 gestantes diagnosticadas de intolerancia a la glucosa durante el embarazo. El diagnóstico de la intolerancia se realizó utilizando los criterios propuestos por la Organización Mundial de la Salud (OMS) en el período 2004-08. La muestra se dividió de modo randomizado en 2 grupos de 115 gestantes. Al grupo experimental (grupo de intervención), se le aplicó dieta calculada más insulina regular humana Novo Nordisk a dosis de 0,3 UI/kg de peso corporal ideal, dividida en 3 dosis preprandiales según el método descrito por Valdés y Márquez. En el otro grupo solo se empleó dieta calculada nunca menos de 1 800 kcal/día (grupo control). Aquellas que no mantuvieron el control metabólico exigido por el servicio se le adicionó insulina de modo convencional. Empleamos para la comparación de proporciones el estadígrafo chi cuadrado y para las muestras independientes la t de Student.RESULTADOS: la morbilidad en la embarazada resultó de un 24,3 % en el grupo de intervención y de solo 21,7 % en el grupo control, así como el índice de cesáreas que fue del 53,9 % para ambos grupos.CONCLUSIÓN: el tratamiento insulínico preventivo en diabéticas gestacionales con factores de riesgo para hiperglucemia tardía, no logró disminuir la frecuencia de morbilidad materna, ni la disminución en el índice de cesárea esperado, probablemente por estar influidos ambos eventos por problemas multifactoriales y no solo en relación con hiperglucemia

OBJECTIVE: to report on maternal morbidity in pregnant diabetic women under preventive insulin-treatment by late hyperglycemia risk. METHODS: results from 230 pregnants diagnosed with glucose intolerance during pregnancy are reported. The intolerance diagnosis was made using the criteria proposed by HWO during 2004-2008. Sample was divided in a random way into two groups of 115 pregnants each. Experimental group (intervention group) received a calculated diet plus Novo Nordisk human regular insulin with dose of 0.3 IU/kg of ideal body weight, divided into three preprandial dose according the method described by ValdÚs and Mßrquez. In the other group we used the calculated diet never less than 1 800 kcal/day (control group). To those without the metabolic control demanded by Service we added insulin in a conventional way. Also, for comparisons of ratios, we used the Chi² test, and for the independent samples, we used the t Student test. RESULTS: pregnant morbidity was of 24.3 percent in intervention group and only of 21.7 percent in control group, as well as, the cesarean section rate was of 53.9 percent for both groups. CONCLUSION: preventive insulin treatment in pregnant diabetic women with late hyperglycemia risk fails to decrease neither the maternal morbidity frequency nor decrease in expected cesarean section rate, probably due to influence of multifactor problems and not only in relation to hyperglycemia

Morbilidad neonatal y peso al nacimiento en diabéticas gestacionales con tratamiento insulínico preventivo / Neonatal morbidity and birth weight in gestational diabetes patients under preventive insulin-treatment

OBJETIVO: reportar la morbilidad neonatal y el peso de los recién nacidos en diabéticas mellitus gestacionales (DMG), con tratamiento insulínico preventivo o no, portadoras de factores de riesgo para hiperglucemias tardías.MÉTODOS: estudiamos 230 embarazadas DMG en el período 2004-08, las cuales se dividieron en dos grupos, en uno se administró insulina regular humana Novo Nordisk a dosis de 0,3 Ud/kg de peso ideal, dividida en 3 dosis preprandiales según método de Valdés y Márquez más dieta calculada (grupo de intervención), y al otro (grupo control), solo se le administró dieta calculada, en ninguno de los dos grupos menos de 1 800 kcal/día. Utilizamos el test chi-cuadrado y la t de Student para el análisis de los resultados con valor de p<0,05. RESULTADOS: la morbilidad neonatal en lo referente a hiperbilirrubinemia e hipoglucemia neonatal se comportó con una frecuencia de 5,2 y 2,6 por ciento para el grupo de intervención y ello se elevó a 10,4 y 6,1 respectivamente en el grupo control. La frecuencia de exceso de peso corporal neonatal fue de 6,1 por ciento para el grupo de intervención y 25,2 por ciento para el de tratamiento solo con la dieta calculada, la frecuencia de recién nacidos con más de 4 200g fue del 3,5 por ciento en el grupo de insulina preventiva y ello se elevó significativamente a 11,3 por ciento en el grupo control con sólo la dieta calculada. CONCLUSIONES: el tratamiento insulínico preventivo en diabéticas gestacionales con factores de riesgo para hiperglucemia tardía, logró una reducción significativa tanto del exceso de peso corporal como de la macrosomía neonatal según nuestros resultados, muy probablemente por la anticipación lograda a la hiperglucemia tardía

OBJECTIVE: To report the neonatal morbidity and the newborn weight in diabetes mellitus pregnants (DMP) under preventive or not insulin-treatment, carriers of risk factors for late hyperglycemias. METHODS: A total of 230 DMPs were studied during 2004-2008, who were divided into two groups, in one we administered Nordisk Novo human regular insulin at 0.3 Ud/kg dose of ideal weight, divided into 3 preprandial doses according to ValdÚs and Mßrquez method plus a estimated diet (intervention group) and in the other group (control group) only a estimated diet was administered, in no two groups less than 1 800 kcal/day. Chi² test and t Student test were used for results analysis with a value of p < 0.05. RESULTS: The neonatal morbidity concerning the neonatal hyperbilirubinemia and hypoglycemia had a frequency of 5.2 and 2.6 percent for intervention group with a increase of 10,.4 and 6.1, respectively in control group. Frequency of neonatal body weight gain was of 6.1 percent for intervention group and of 25.2 percent for the treatment group only with a estimated diet, newborn frequency above 4.200 g was of 3.5 percent in preventive insulin group increasing significantly to 11.3 percent in control group with only the estimated diet. CONCLUSIONS: Preventive insulin treatment in diabetic pregnants with risk factors for a later hyperglycemia, achieve a significant reduction in body weight excess and in neonatal macrosomia according to our results, very probable by achieved anticipation to late hyperglycemia

Effects of Early Rehabilitation and Insulin Treatment on Acute Cerebral Infarction / 中国康复理论与实践

@#ObjectiveTo observe the effect of early rehabilitation and insulin treatment on acute cerebral infarction. Methods160 cases with acute cerebral infarction (without diabetes and the serum glucose were all above 6.7 mmol/L) were divided into treatment group and control group. Each case of both groups was treated with routine treatment, and those in the treatment group were treated with insulin instantly and early rehabilitation in the first day after onset when physical signs were stable and conditions didn't deteriorate. They were assessed with Neurological Impairment, Fugl-Meyer Assessment and Barthel Index 4 weeks after treatment. ResultsCompared with the control group, the neurological function improved obviously in the treated group (P＜0.05). ConclusionEarly rehabilitation and insulin treatment can improve neurological function and the activity of daily living.

Influence of psychological nursing on the therapeutic effect of patients with newly diagnosed type 2 diabetes / 中国实用护理杂志

Objective To discuss the influence of psychological nursing on the therapeutic effect of patients with newly diagnosed type 2 diabetes. Methods Patients (60 cases) who received psychological nursing were set as the nursing group. Patients (65 cases) who did not received psychological nursing were set as the control group. The number of patients who received early insulin treatment and whose fasting plasma glucose return to normal value on the 7th and 30th days after treatment was observed. Results The number of patients who received early insulin treatment and whose fasting plasma glucose return to normal value on the 7th and 30th days after treatment in the nursing group was higher than that of the control group (P<0.01). Conclusions Psychological nursing of patients with newly diagnosed type 2 diabetes could make patients obey doctors' advice and accept early insulin treatment to control plasma glucose and delete the toxicity of high concentration of plasma glucose as soon as possible.

Investigation of cognition and anxious state of type 2 diabetes mellitus accepted insulin-treatment / 重庆医科大学学报

Objective:To investigate the cognition and anxious state of the type 2 diabetes mellitus accepted insulin-treatment for the first time,and offer reference for clinical mental nursing and healthy education. Methods: Use SAS (self-rating anxiety scale) and questionnaire to investigate the cognition of 156 type 2 diabetes mellitus for insulin-treatment at the first time,collect SAS score of different groups from basic understanding for insulin, worry of insulin injection treatment,and influence of their social communication. the statistics and analysis is done by SPSSⅡ10.0. Results: Anxiety score of type 2 diabetes mellitus compared with internal normal norm,the difference has statistical significance. Anxiety score compared in different age,culture degree,and medical cost,the difference has also statistical significance. 51%patients think insulin-treatment means aggravation of pathogenetic condition. 63% patients worry and don’t want injection of insulin. 36% patients think injection of insulin influence their social communication. Conclusion: Type 2 diabetes mellitus who accept insulin-treatment for the first time, have anxiety symptom at different levels. Recognizing the psychological state of every diabetes mellitus for insulin-treatment, will provide some help to clinical management. To insulin-treatment, it is very necessary to strengthen psychological education and eliminate misunderstand of the patients. The patients can accept insulin-treatment protocols early and correctly.

Short-term intensive insulin treatment and sensitivity of sulfonylureas / 中国医师进修杂志

Objective To research the effects of short-term intensive insulin treatment on regaining the sensitivity of sulfonylureas in diabetes patients. Methods Thirty patients from outpatient and emergency department,including 12 male and 18 female,who took regular-dose sulfonylureas but was high blood glucose level,were selected to suspend the sulfonylureas treatment and were given the BIAsp30 to control the blood glucose level for three months,then they were stopped the BIAsp30 and took the same sulfonylureas used before.Results The average fasting blood glucose(FBG) was(9.4?7.5)mmol/L and the average postprandial 2 h blood glucose(PG2h)(or random blood glucose) was(14.2?7.2)mmol/L in 3 months before stopping the sulfonylureas.The average FBG was(5.7?0.7)mmol/L and PG2h was(7.2?1.4)mmol/L at the beginning of the insulin getting the blood glucose under control.The average FBG was(6.0?0.8)mmol/L and PG2h was (7.8?1.2)mmol/L during the insulin treatment.The average FBG was(6.1?0.6)mmol/L and PG2 h was(7.7?1.3)mmol/L at the end of the insulin treatment.The average FBG was(6.5?0.5)mmol/L and PG2h was(8.1?(0.8))mmol/L when continuing the sulfonylureas treatment in one months.It increased significantly to compare the blood glucose before the treatment of insulin to that after the treatment of insulin(P

The Effects of Intensive Insulin Therapy on the ? Cell of Islets of Pancreas in Incipient Type Diabetes Patients / 医学研究杂志

0.05);The levels of basal FINS showed a significant differences between group A and group B(P0.05).Conclusions Intensive insulin treatment to newly diagnosed type 2 diabetes patients can control blood glucose rapidly to a desired level,and can recover the function of B cell better than traditional oral hypoglycemic agents by dissolving the virulence of glucose rapidly.

Effect of short-term intensive insulin treatment on hyperglycemic toxicity / 中华内分泌代谢杂志

Forty-one type 2 diabetic patients with fasting plasma glucose≥15 mmol/L and postprandial plasma glucose≥16.8 mmol/L underwent short-term intensive insulin treatment (IIT). Glucose load tests were performed before and after treatment in these patients and proinsulin and C peptide were assayed by RIA. The results showed that IIT decreased the levels of fasting and postprandial proinsulin and improved the ? cell function.

Predictors of long-term remission induced by short-term intensive insulin treatment in type 2 diabetic patients / 中华内分泌代谢杂志

Objective To investigate the predictors of long-term remission of type 2 diabetes induced by short-term intensive insulin treatment.Methods Fifty-four cases of diabetes mellitus with the duration of illness less than 5 years received an intensive insulin treatment for 2 weeks.The standard meal test and intravenous glucose tolerance test were performed at the baseline and 24 h after treatment completion respectively.Long-term remission meant that the diabetic patients should maintain the target glyeaemic control without any hypoglyeaemie agent within one year.Results The remission rate was 57.4% (31/54) overall,and even reached to 80.6% (29/36) in patients with the duration of illness less than 6 months,whereas,the remission rate was only 11.1% (2/18) in those with the duration of illness more than 12 months.In another view,the remission rate was significantly higher in the patients with fasting plasma glucose (FPG) level of less than 7 mmol/L (78.8%,26/ 33) 24 h after intensive treatment than those with FPG level of more than 7 mmol/L (23.8%,5/21,P