Subject(s)
Diabetes Mellitus, Type 2/etiology , Obesity/complications , Prediabetic State/etiology , Social Environment , Diabetes Mellitus, Type 2/prevention & control , Dietary Sucrose/administration & dosage , Energy Intake , Humans , Life Style , Motor Activity , Obesity/epidemiology , Risk , Socioeconomic Factors , United States/epidemiologyABSTRACT
T2DM is a multifaceted disease that requires careful selection of treatment, which must be frequently modified over the continuum of care to attain successful long-term management. A checklist of factors to be considered can be helpful in individualizing treatment for optimal effectiveness based on each patient's needs, concerns, and capabilities.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/therapeutic use , Safety Management , Blood Glucose/drug effects , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/diagnosis , Dose-Response Relationship, Drug , Drug Administration Schedule , Drug Monitoring , Family Practice/standards , Female , Humans , Hypoglycemic Agents/classification , Risk Factors , Severity of Illness Index , Total Quality ManagementABSTRACT
OBJECTIVE: To review insulin detemir for clinical use to better manage patients with type 1 and type 2 diabetes. METHODS: A MEDLINE search, in English, from June 30, 2006 to December 1, 2008, using the terms "insulin analogs," "insulin detemir" and "long-acting insulin analog." RESULTS: Insulin detemir improves glycemic control, based on HbA(1C) reduction and fasting glucose levels, without increasing the risk of hypoglycemia and weight gain. Insulin detemir has lower glycemic variability, with less intra-subject variability in blood glucose levels in patients with type 1 and type 2 diabetes, without increasing the risk of hypoglycemia. When added to oral anti-diabetes agents (OADs) in type 2 diabetes, insulin detemir demonstrates superiority to other basal insulin options. CONCLUSION: Insulin detemir appears to provide better glycemic control with a lower risk of hypoglycemia and less weight gain in the treatment of patients with type 1 and type 2 diabetes.
ABSTRACT
OBJECTIVE: To review intermediate- and long-acting insulins with specific emphasis on the newer insulin analogs. METHODS: A MEDLINE search, in English, was conducted with a cut-off of June 30, 2006, using the terms 'NPH insulin', 'insulin analogs', 'insulin glargine', 'insulin detemir' and 'long-acting insulins'. All clinical trials from within the search period were included. RESULTS: The insulin analogs, insulin glargine and insulin detemir, were introduced in an attempt to improve glycemic control among patients with diabetes, without increasing the risk of hypoglycemia. This review indicates that both insulin analogs demonstrate better glycemic control than NPH insulin, based on measurements of HbA1c, fasting glucose and intra-subject variability in blood glucose. This was accomplished with similar or reduced risk of hypoglycemia. Also, insulin detemir appears to be associated with less body weight increase than NPH insulin or insulin glargine. CONCLUSION: The newer long-acting insulin analogs, insulin detemir and glargine, appear to provide better glycemic control than NPH insulin without increasing the risk of hypoglycemia.
Subject(s)
Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Insulin, Isophane/therapeutic use , Insulin, Long-Acting/therapeutic use , Insulin/analogs & derivatives , Dose-Response Relationship, Drug , Drug Administration Schedule , Humans , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/pharmacokinetics , Injections , Insulin/administration & dosage , Insulin/adverse effects , Insulin/pharmacokinetics , Insulin/therapeutic use , Insulin Glargine , Insulin, Isophane/administration & dosage , Insulin, Isophane/adverse effects , Insulin, Isophane/pharmacokinetics , Insulin, Long-Acting/administration & dosage , Insulin, Long-Acting/adverse effects , Insulin, Long-Acting/pharmacokinetics , Treatment OutcomeABSTRACT
OBJECTIVE: Compare the efficacy, safety, and patient satisfaction of continuous subcutaneous insulin infusion (CSII) therapy with multiple daily injection (MDI) therapy for patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 132 CSII-naive type 2 diabetic patients were randomly assigned (1:1) to CSII (using insulin aspart) or MDI therapy (bolus insulin aspart and basal NPH insulin) in a multicenter, open-label, randomized, parallel-group, 24-week study. Efficacy was assessed with HbA(1c) and eight-point blood glucose (BG) profiles. Treatment satisfaction was determined with a self-administered questionnaire. Safety assessments included adverse events, hypoglycemic episodes, laboratory values, and physical examination findings. RESULTS: HbA(1c) values decreased similarly for both groups from baseline (8.2 +/- 1.37% for CSII, 8.0 +/- 1.08% for MDI) to end of study (7.6 +/- 1.22% for CSII, 7.5 +/- 1.22% for MDI). The CSII group showed a trend toward lower eight-point BG values at most time points (only significant 90 min after breakfast; 167 +/- 48 vs. 192 +/- 65 mg/dl for CSII and MDI, respectively; P = 0.019). A total of 93% of CSII-treated subjects preferred the pump to their previous injectable insulin regimen for reasons of convenience, flexibility, ease of use, and overall preference. Safety assessments were comparable for both treatment groups. CONCLUSIONS: Insulin aspart in CSII therapy provided efficacy and safety comparable to MDI therapy for type 2 diabetes. Patients with type 2 diabetes can be trained as outpatients to use CSII and prefer CSII to injections, indicating that pump therapy should be considered when initiating intensive insulin therapy for type 2 diabetes.
