The egg or the chicken? Further data on whether good compliance to multi-injection insulin therapy should be a criterion for insulin pump therapy, or does insulin pump therapy improve compliance?

Background: The decisive factor in successful intensive insulin therapy is the ability to deliver need-based-adjusted nutrition-independent insulin dosages at the closest possible approximation to the physiological insulin level. Because this basal insulin requirement is strongly influenced by the patient’s lifestyle, its subtlety is of great importance. This challenge is very different between patients with type 1 diabetes and those with insulin-dependent type 2 diabetes. Furthermore, it is more difficult to finetune a basal insulin dosage with intensified conventional insulin therapy (ICT), due to delayed insulin delivery, compared to insulin pump therapy, which provides continuous delivery of small doses of exclusively short-acting insulin. In all cases, the goal is to achieve an optimal basal delivery rate. Method: We hypothesized that this goal could be achieved with a modeling tool that determined the optimal basal insulin supply based on the patient’s anamnestic data and monitored glucose values. This type of modeling tool has been used in health insurance programs in Germany to improve insulin control in patients that receive ICT. Results: Our retrospective data analysis showed that this modeling tool provided a significant improvement in metabolic control, significant reductions in HbA1c and Q scores, and improved time-in-range values, with reduced daily insulin levels. Conclusion: The model-based basal rate test could provide additional data of the actual effect of the basal insulin adjustment in intensified insulin treated diabetes to the physician or treatment team.

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Use of Automated Bolus Calculators for Diabetes Management

European Endocrinology ◽

10.17925/ee.2013.09.02.92 ◽

2010 ◽

Vol 9 (2) ◽

pp. 92 ◽

Cited By ~ 2

Author(s):

Frank L Schwartz ◽

Cynthia R Marling ◽

◽

Keyword(s):

Insulin Therapy ◽

Glucose Control ◽

Diabetes Management ◽

Insulin Pump ◽

Smart Phone ◽

Glycated Haemoglobin ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Numeracy Skills ◽

Patients With Diabetes

Fewer than 30 % of patients with diabetes who are on insulin therapy achieve target glycated haemoglobin (HbA1c) levels. Automated bolus calculators (ABCs) are now almost universally used for patients on insulin pump therapy to calculate pre-meal insulin doses. Use of ABCs in glucose monitors and smart phone applications have the potential to improve glucose control in a larger population of individuals with diabetes on insulin therapy by overcoming the fear of hypoglycaemia and assisting those with low numeracy skills.

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Should We Monitor Glucose and Biomarkers in Diabetics over Heart Surgery?

Journal of Clinical Medicine ◽

10.3390/jcm10153399 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3399

Author(s):

Elena Z. Golukhova ◽

Ljubov S. Lifanova ◽

Yaroslava V. Pugovkina ◽

Marina V. Grigoryan ◽

Naida I. Bulaeva

Keyword(s):

Insulin Therapy ◽

Postoperative Period ◽

Glucose Control ◽

Insulin Pump ◽

Early Postoperative Period ◽

Insulin Pump Therapy ◽

Diabetic Patients ◽

Pump Therapy ◽

Hs Crp ◽

Bolus Insulin

Hyperglycemia is associated with adverse outcomes after coronary artery bypass grafting (CABG). While there is a consensus that blood glucose control may benefit patients undergoing CABG, the role of biomarkers, optimal method, and duration of such monitoring are still unclear. The aim of this study is to define the efficacy of a continuous glucose monitoring system (CGMS) and link it to pro-inflammatory biomarkers while on insulin pump therapy in diabetic patients undergoing CABG. We prospectively assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing isolated CABG. In diabetics, CGMS was connected to an insulin pump for precise glucose control. On top of conventional biomarkers (HbA1C, lipid profile), high sensitive C-reactive protein (hs-CRP), Regulated upon Activation Normal T cell Expressed and presumably Secreted (RANTES), and leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1 year after CABG. Overall, CGMS revealed high glucose independently from underlying diabetes during first 48 h following CABG but was higher (р < 0.05) in diabetics. The insulin pump improved glycemic control over early follow-up (72 h) post-CABG. There were no hypoglycemic episodes in patients on insulin pump therapy and those receiving bolus insulin therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and RANTES levels were lower in patients with T2DM on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р < 0.05). It is most likely due to the fact that insulin pump therapy decreases systemic inflammatory response. Further controlled trials should assess whether CGMS improves outcomes after cardiac surgery.

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Professional and flash on the monitoring of blood glucose levels of insulin pump therapy and without it

10.47359/978-0-369-40455-8 ◽

2021 ◽

Author(s):

Alexander Dreval

Keyword(s):

Insulin Therapy ◽

Insulin Pump ◽

Self Control ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Glucose Levels ◽

Patients With Diabetes ◽

Control Of Diabetes ◽

Medical University ◽

And Control

A new method of self-control of diabetes based on the results of continuous monitoring of glycemia (HMG) is especially relevant in patients who are on pump insulin therapy, especially since the start of pump insulin therapy is carried out with the mandatory installation of the HMG system [1,3]. Due to the novelty of these two methods (treatment of diabetes and control of glycemia) for a wide clinical practice, there is an urgent need to publish concise practical guides on this topic for doctors, both for self-study of these methods, and for advanced training courses. Based on the above and our experience of teaching at the Department of Endocrinology of the Federal Medical University of MONICA, this guide has been prepared, which will be useful, first of all, for endocrinologists, therapists working with patients with diabetes, as well as for senior students of medical institutes who are interested in new directions in practical medicine.

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Perioperative glycemic control in patients with coronary artery disease and diabetes mellitus type 2 undergoing coronary artery bypass grafting: results of pilot study

Diabetes Mellitus ◽

10.14341/dm10268 ◽

2020 ◽

Vol 23 (1) ◽

pp. 37-45

Author(s):

Elena Z. Golukhova ◽

Naida I. Bulaeva ◽

Liubov S. Lifanova ◽

Yaroslava V. Pugovkina

Keyword(s):

Coronary Artery ◽

Insulin Therapy ◽

Insulin Pump ◽

Artery Bypass ◽

Early Postoperative Period ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Hs Crp ◽

Artery Disease ◽

Bolus Insulin

BACKGROUND: According to different studies, diabetes mellitus type 2 (DM2) is associated with higher mortality after undergoing coronary artery bypass grafting (CABG). Perioperative hyperglycaemia, even in non-DM2 patients, is associated with adverse outcomes after CABG. Thus, successful perioperative blood glucose control (BGC) is mandatory to reduce the risk of death and postoperative complications. Nowadays, the most effective method for BGC in the operating room is still unknown. AIMS: To assess the continuous glucose monitoring (CGM) efficacy in association with insulin pump therapy in patients with coronary artery disease (CAD) and DM2 undergoing CABG in intra- and early postoperative periods. METHODS: The study involved 97 patients undergoing isolated CABG. Patients were divided into two groups: 48 patients with DM2 and 49 patients without DM2. In both groups of patients, we used CGM in intra- and early postoperative periods (72 hours). In some patients with DM2, CGM was associated with insulin pump therapy (MiniMed Paradigm Veo 554/754) to successfully control postoperative glucose level. Besides commonly used tests (such as HbA1C and lipid profile), we analysed high sensitive C-reactive protein (hs-CRP) levels before surgery, and then at 1 hour, 12 hours and 7 days after CABG in order to estimate their prognostic value. RESULTS: During the 48 hours after CABG, there was a trend towards having higher glucose levels in both groups of patients with and without DM2 according to CGM. In patients with DM2, the glucose level was significantly increased (р0,05). Insulin pump therapy resulted in glycemic control improvement in early follow-up (72 hours). Moreover, there were no hypoglycaemic episodes in patients on insulin pump therapy and also in patients prescribed bolus insulin therapy. We revealed the trend towards lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p=0,1). Hs-CRP level was lower in patients with DM2 who were on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р0,05). This most likely confirms that insulin pump therapy decreases systemic inflammatory response. CONCLUSIONS: Thus, we demonstrated the CGM feasibility, safety and efficacy in association with insulin pump therapy in patients with DM2 undergoing CABG.

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Use of Automated Bolus Calculators for Diabetes Management

US Endocrinology ◽

10.17925/use.2013.09.02.124 ◽

2013 ◽

Vol 09 (02) ◽

pp. 124

Author(s):

Frank L Schwartz ◽

Cynthia R Marling ◽

◽

Keyword(s):

Insulin Therapy ◽

Glucose Control ◽

Diabetes Management ◽

Glycated Hemoglobin ◽

Insulin Pump ◽

Smart Phone ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Fear Of Hypoglycemia ◽

Patients With Diabetes

Less than 30 % of patients with diabetes who are on insulin therapy achieve target glycated hemoglobin (HbA1C) levels. Automated bolus calculators (ABCs) are now almost universally used for patients on insulin pump therapy to calculate pre-meal insulin doses. Use of ABCs in glucose monitors and smart phone applications have the potential to improve glucose control in a larger population of individuals with diabetes on insulin therapy by overcoming the fear of hypoglycemia and assisting those with low numeracy skills.

Download Full-text