Prevalence and predictors of diabetes-related distress in adults with type 1 diabetes.

Type 1 diabetes (T1DM) is a chronic disease requiring lifelong insulin therapy and rigorous self-management. As it negatively impacts the affected individuals' quality of life, it may eventually lead to diabetes-related distress. This study evaluated the prevalence and identified the predictors of diabetes-related distress in a representative sample of adults with T1DM treated at secondary and tertiary levels in Croatia. A multicenter, cross-sectional study was conducted in adults with T1DM in Croatia (N = 100). Data were collected between January 2018 and December 2018 from medical records and interviews during a single clinical visit, when participants completed a 20-item Problem Area in Diabetes (PAID) Questionnaire. The proportion of participants with a total PAID score ≥ 40 indicating high diabetes-related distress was calculated, and binary logistic regression was run to determine predictors. High diabetes-related distress was found in 36% of participants, with a mean PAID total score of 31.9 (21.1). The predictors of diabetes-related distress were higher HbA1c level (OR = 1.491, p = 0.037, CI = 1.025-2.169) and the presence of microvascular complications (OR = 4.611, p = 0.005; 95%CI 1.546-13.754). Worrying about the future and chronic complications and feeling guilty when off-track with diabetes management were identified as items that contribute the most to distress. Diabetes-related distress is a frequent condition in adults with T1DM in Croatia. Special attention should be given to patients with suboptimal glycemic control and microvascular complications. Given the high prevalence and impact of psychosocial problems in diabetes, psychological care should be integrated into routine care for adults with type 1 diabetes.

An observational, multicentre study on different insulin glargine U100 titration algorithms used in patients with type 2 diabetes in daily medical practice in Adriatic countries: The ADRESA study.

AIMS: To compare the effectiveness of different titration algorithms for insulin glargine U100 used in everyday practice to achieve glycaemic targets in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 526 patients (278 in Slovenia, 248 in Croatia) with T2DM (aged ≥ 18 years) and treated with insulin glargine prior to inclusion were enrolled. Patients self-titrated insulin glargine according to physicians' guidance. RESULTS: Among the 524 patients included in the final analysis, the titration algorithm from the LANMET study was used most commonly (n = 368, 70.5% patients), followed by the Treat-To-Target (TTT) algorithm (n = 117, 22.4%). At the end of the study (6 months), 179 (34.3%) patients reached HbA1c ≤ 7%. There was no significant difference in the proportion of patients who reached their target HbA1c between the different algorithms at 6 months (35.6% using LANMET, 30.7% with TTT, and 32.4% with other algorithms; p = 0.611). HbA1c levels were more significantly reduced in patients using the TTT algorithm compared to LANMET (-2.31%, vs. -1.57%; p < 0.05). The proportion of patients with reported symptomatic hypoglycaemia did not differ significantly between the algorithms. CONCLUSIONS: Continuous titration of insulin glargine U100 is a safe and efficient option for T2DM management, regardless of the titration algorithm applied.

Switching From Pre-mixed Insulin to Regimens with Insulin Glargine in Type 2 Diabetes: A Prospective, Observational Study of Data From Adriatic Countries.

INTRODUCTION: Long-acting insulin analogs such as insulin glargine may offer improved glycemic control in patients with type 2 diabetes (T2D) compared to conventional insulin therapies. The objective of this study was to determine whether switching to insulin glargine had beneficial effects on glycemic control, weight gain, and incidence of hypoglycemia in patients with suboptimally managed T2D. METHODS: This prospective observational study was performed on 1041 patients who were suboptimally controlled on pre-mixed insulin therapy and were switched to an insulin glargine regimen. Clinical markers of glycemic control including glycosylated hemoglobin (HbA1c) < 7% (< 53 mmol/mol) and fasting blood glucose (FBG) levels ranging from 3.9 to 7.2 mmol/L were used for the primary outcome measures. Follow-up assessment of primary outcomes, weight gain, incidence of hypoglycemia, and patient satisfaction with the therapy was performed after three and six months of treatment. RESULTS: Target therapeutic values of HbA1c were achieved in 9.3% and 30.2% of patients, whereas FBG target values were achieved in 25.9% and 52.3% of patients after the third and sixth month of therapy, respectively. Both the HbA1c and FBG targets were reached in 7% and 25.9% of patients at the third and sixth month of therapy, respectively. Switching to insulin glargine decreased the incidence of hypoglycemia from 49.5% to 5.2% after six months of therapy; this decrease was associated with weight loss and was well perceived by the patients. CONCLUSION: Insulin glargine-based regimens are beneficial and safe therapeutic alternatives for T2D patients inadequately controlled with pre-mixed insulin. FUNDING: Sanofi-Aventis Croatia d.o.o., Zagreb, Croatia.

Effectiveness of insulin glargine in type 2 diabetes mellitus patients failing glycaemic control with premixed insulin: Adriatic countries data meta-analysis.

AIMS: Type 2 diabetes mellitus (T2DM) is a progressive disease, often requiring exogenous insulin therapy and treatment intensification. Despite new therapies, most patients do not reach the recommended HbA1c targets, among them a significant proportion of patients on premixed insulins. The aim was to summarize published data in Adriatic countries on effectiveness of insulin glargine based therapy in type 2 diabetic patients suboptimally controlled on premix insulin. METHODS: A meta-analysis was carried out in major medical databases up to April 2014, focusing on Adriatic region. We searched observational studies with duration of at least 6 months, evaluating effectiveness and safety of insulin glargine (IGlar), in combination with OAD or bolus insulin in patients with T2 failing premixed insulin therapy. Outcomes included values of HbA1c, fasting blood glucose and two hours post-prandial glucose concentration as well as changes in body mass index after at least 6 months of study duration. RESULTS: Three prospective, observational, multicentric trials (698 patients in total) were included. The basal bolus regimen with glargine significantly reduced HbA1c (Mean Difference, MD=2.27, CI [1.76, 2.78]), fasting glucose (MD=5.15, CI [4.86, 5.44]) and 2-hours postprandial glucose concentration (MD=6.94, CI [6.53, 7.34]). No significant changes were found in BMI after switching from premixes to IGlar based treatment. CONCLUSION: Insulin glargine based therapy following premix failure is efficacious and safe option of type 2 diabetes treatment intensification.

Improved glycaemic control with insulin glargine as part of a basal-bolus regimen in T2DM patients inadequately controlled on premixed therapy.

OBJECTIVES: Monitoring efficacy of insulin glargine administered to patients with diabetes mellitus type 2 (DMT2) in combination with rapid-action insulin and analogues, where the hitherto fixed-mixture insulin therapy failed to achieve a satisfactory glycaemic control (HbA1c < 7%) following a six-month fixed-mixture insulin therapy. DESIGN: Open, observational, multicentric, non comparative, prospective product registry. RESULTS: 9-month prospective observational study recruited DMT2 patients previously uncontrolled on premixed insulin (HbA1c > 7%). Total of 278 subjects were documented in the study. At 9 months of follow-up 45,3% of patients reached a target HbA1c level <7% with a mean HbA1c change from 9.63 +/- 1.64% to 7.10 +/- 0.77% (p<0.01). Fasting plasma glucose values decreased from 12.7 +/- 4.3 mmol/L to 6.6 +/- 1.4 mmol/L (p<0,01). 93 patients (33,4%) experienced hypoglycemia events (3(1) hypoglycemic episode). Insulin glargine mean starting dose was 32,4 +/- 11,5 U. This dose was increased progressively over the study visits to a final mean dose of 42,0 +/- 11,9 U (p<0.01). The mean final daily dose of rapid-acting insulin was 24.8 +/- 13.7 U and was almost unchanged during the study. Patients who did not adhere to treatment were 4.9 times more likely to fail to achieve target HbA1c level (RR [95%CI] = 4.9 [1.7-12.11, p<0.01). CONCLUSION: Results from the study suggest that basal-bolus regimen consisting of insulin glargine significantly improves glycaemic control without increasing hypoglycemia risk in DMT2 population with inadequate glycaemic control on previous premixed therapy.