Abstract #1145: Automated Frequent Insulin Dosage Titrations to Overcome Insulin Therapy Ineffectiveness

2017 ◽  
Vol 23 ◽  
pp. 314
Author(s):  
Israel Hodish ◽  
Mary Johnson ◽  
Eran Bashan ◽  
Davida Kruger ◽  
Anuj Bhargava ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Insulin Dosage

Insulin Dosage Adjustments After Initiation of GLP-1 Receptor Agonists in Patients With Type 2 Diabetes

2021 ◽  
pp. 089719002199362
Author(s):  
Mandy Chen ◽  
Etty Vider ◽  
Roda Plakogiannis
Keyword(s):  
Type 2 Diabetes ◽  
Body Weight ◽  
Insulin Therapy ◽  
Basal Insulin ◽  
Insulin Dose ◽  
Retrospective Chart Review ◽  
Insulin Dosage ◽  
History Of ◽  
Bolus Insulin

Background: Combination of insulin and GLP-1RAs have shown reductions in the HbA1c, body weight, and the risk of hypoglycemia. To date, there are conflicting data regarding the effect of GLP-1RAs on insulin dosage(s). Objective: The objective of this study was to evaluate adjustments of insulin doses upon initiation of GLP-1RAs. Methods: This was a retrospective chart review of patients on insulin therapy initiated on GLP-1RAs at NYU Langone Health. Patients were included in the study if they were at least 18 years of age, history of type 2 diabetes, and were on concurrent basal or mixed insulin therapy. 45 patients met inclusion criteria and were included in the study analysis. The primary endpoint was the median change in overall basal insulin doses. Secondary endpoints included median changes in total basal, mixed, and bolus insulin doses, oral antidiabetic medications and GLP-1RA doses, HbA1c, body weight, fasting glucose, and creatinine clearance. Safety results included any adverse reactions to insulin and/or GLP-1RA. Results: In the per-protocol analysis, there was a significant reduction in overall total basal insulin doses from baseline to week 24 (50 units vs. 44 units, p < 0.05). There was a median reduction in patients receiving glargine (50 units vs. 44 units) and detemir (29 units vs. 21.5 units). Conclusions: Use of GLP-1RAs after 24 weeks resulted in a statistically significant reduction in overall total basal insulin dosages from baseline. The median HbA1C in our patient population was >8%. Consider a ≥10% reduction in the overall basal insulin dose upon initiation of GLP-1RA in patients with a HbA1C >8%.

scholarly journals Model-Based Tool for Personalized Adjustment of Basal Insulin Supply in Patients With Intensified Conventional Insulin Therapy

2019 ◽  
Vol 13 (5) ◽  
pp. 928-934
Author(s):  
Lutz Vogt ◽  
Andreas Thomas ◽  
Gert Fritzsche ◽  
Peter Heinke ◽  
Klaus-Dieter Kohnert ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Insulin Dosage ◽  
Treatment Team ◽  
Pump Therapy ◽  
Modeling Tool ◽  
Conventional Insulin Therapy ◽  
Model Based

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.

scholarly journals It's never too late to look for alternatives to Insulin

ABOUTOPEN ◽  
2018 ◽  
Vol 4 (1) ◽  
pp. 83-85
Author(s):  
Alessio Filippi
Keyword(s):  
Insulin Therapy ◽  
Early Onset ◽  
Basal Insulin ◽  
Low Dose ◽  
Severe Hypoglycaemia ◽  
Macrovascular Complications ◽  
Insulin Dosage ◽  
Long Duration

We report the case of a 61-year-old patient with early onset and long duration of diabetic disease in multi-injected insulin therapy for almost thirty years, who developed micro- and macrovascular complications. The patient has been on dialysis three times a week for 4 years with a glycemic pattern characterized by severe hypoglycaemia related to the dialysis sessions, despite the reduction in insulin dosage. In October 2017 he was offered a treatment with linagliptin in combination with low-dose basal insulin, the latter withdrawn in December 2017. Follow-ups showed a good glycemic balance and no hypoglycaemic episodes (Diabetology).

scholarly journals Adding of Sitagliptin on Insulin Therapy Effectively and Safely Reduces a Hemoglobin A1c Level and Glucose Fluctuation in Japanese Patients with Type 2 Diabetes

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Yuji Tajiri ◽  
Seiko Kawano ◽  
Saori Hirao ◽  
Tamami Oshige ◽  
Shinpei Iwata ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Japanese Patients ◽  
Hypoglycemic Agents ◽  
Stepwise Multiple Regression ◽  
Insulin Dosage ◽  
Outcome Variable ◽  
Oral Hypoglycemic Agents ◽  
Glucose Fluctuation

Aims. Efficacy and safety of DPP-4 inhibitor, sitagliptin, add-on therapy to insulin were investigated in Japanese patients with type 2 diabetes. Subjects and Methods. Two hundred and sixteen patients (126 men, 65 ± 12 years old, BMI 24.9 ± 4.5, means ± S.D.) who had been treated by insulin alone or insulin combined with other oral hypoglycemic agents (OHAs) were recruited, and sitagliptin was added for 3 months. Results. HbA1c was significantly decreased after 3 months of add-on therapy as a whole (8.56 ± 1.50% to 7.88 ± 1.25%, P<0.0001). Body weight did not change and insulin dosage was significantly (P<0.0001) decreased for 3 months. Furthermore, day-to-day glucose variability was significantly reduced (18.3 ± 9.1 to 16.1 ± 8.1%, P<0.05). In stepwise multiple regression analysis on ΔHbA1c as an outcome variable, the higher baseline HbA1c value and a preserved CPR were selected as significant predictive variables. Fifteen patients complained of mild hypoglycemia without any assistance during 3 months of sitagliptin add-on, while no severe hypoglycemic episode was reported. Conclusions. Add-on of sitagliptin to ongoing insulin therapy effectively reduced either HbA1c level or glucose fluctuation and could be a practical and well-tolerated alternative to treat Japanese patients with type 2 diabetes who had been inadequately controlled by insulin with or without other OHAs.

Letter to the Editor

PEDIATRICS ◽  
1969 ◽  
Vol 43 (4) ◽  
pp. 635-636
Author(s):  
Peter A. J. Adam ◽  
Robert Schwartz
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Therapy ◽  
Blood Sugar ◽  
Personal Experience ◽  
Insulin Dosage ◽  
Diabetic Patients ◽  
Letter To The Editor ◽  
Inadequate Information

In his letter to the Editor Robert C. Tibbs, criticizes our suggestion that inadequate information has been published to establish that phenformin is a beneficial adjunct to insulin therapy of diabetes mellitus in children. He cites his personal experience which confirms the impressions of several authors—that combined insulin-biguanide therapy plus the increased supervision such treatment entails has been associated with lowering of insulin dosage, stabilization of blood sugar, and reduction of the tendency to acidosis in a few "brittle" diabetic patients.

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