ABSTRACT
BACKGROUND: Low adherence to the number of insulin injections and glycemic variability are among the challenges of insulin therapy in type 1 diabetes (T1D). The TOP1 study investigated the effect of switching from twice-daily (BID) basal insulin to once daily (OD) insulin glargine 300 U/mL (Gla-300) on glycemic control and quality of life. METHODS: In this 28-week, phase 4 trial, people with T1D aged ≥ 18 years, who were treated with BID basal insulin in combination with prandial rapid-acting insulin for at least 1 year, and had HbA1c between 7.5% and 10.0%, were switched to Gla-300 OD as basal insulin. The present study aimed to evaluate the impact of this change on HbA1c, glycemic profile, treatment satisfaction and safety. The change in HbA1c from baseline to Week 24 was the primary endpoint. RESULTS: One hundred and twenty-three people with T1D (mean age 37 ± 11 years; 54.5% female) were studied. The disease duration was 20.0 ± 9.8 years, baseline HbA1c and fasting plasma glucose (FPG) were 8.6 ± 0.7% and 201 ± 80.3 mg/dL, respectively. After switching from BID to OD insulin regimen, no significant change in HbA1c was observed from baseline to Week 24 (p = 0.873). There were significant reductions in fasting self-monitoring blood glucose (SMBG) from baseline to Week 24 (175 ± 42 vs. 156 ± 38 mg/dL; p < 0.0001), and in glycemic profile (8-point SMBG) at several time points. There was a significant decrease in the proportion of patients with at least one hypoglycemic event (p = 0.025), in numbers of hypoglycemic events per patient-years of any type (p = 0.036), symptomatic (p = 0.007), and confirmed ≤ 70 mg/dL events (p = 0.049) from run-in to the last 4 weeks on treatment. There were significant improvements in treatment satisfaction (p < 0.0001), perceived hyperglycemia (p < 0.0001) scores and satisfaction with the number of injections between post-run-in and Week 24, and a significant decrease in fear of hypoglycemia. CONCLUSIONS: Switch from BID basal insulin to OD Gla-300 as part of basal bolus therapy in T1D resulted in similar glycemic control as measured by HbA1c, but provided significant improvements in SMBG, daily glucose profile, a lower incidence of hypoglycemia and increased patient satisfaction. TRIAL REGISTRATION: NCT03406000.
ABSTRACT
A sanitary evaluation of sand and water from 16 beaches of São Paulo State, Brazil, was undertaken during spring of 1997 and summer of 1998. Ninety six samples each of wet and dry sand and seawater were collected and analysed for fecal indicator bacteria. A parasitological examination and Candida albicans analysis were also performed in sand samples and F-specific bacteriophages were determined in seawater. Statistical analysis of the results demonstrated higher concentrations of fecal coliforms and fecal streptococci in dry sand during summer. Correlation analysis indicated a significant relationship between fecal indicator densities in wet sand and seawater. There was a significant correlation between the densities of fecal coliforms and fecal streptococci for both types of sand, and this correlation was higher in wet sand. Cysts and eggs of parasites were detected in 4.2 percent of the samples and Candida albicans was isolated in 18 percent of the samples. The high concentrations of fecal indicators detected in sand during summer demonstrate that there is a health risk to the users of these recreational areas and suggest the necessity of some criteria for microbiological control. Preventive measures, such as education campaings and some management actions are important precautionary measures.
