Modern insulin therapy with insulin analogues detemir and aspart in children and adolescents: The problems and solutions

2013 ◽  
Vol 59 (6) ◽  
pp. 80-86
Author(s):  
T L Kuraeva
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Children And Adolescents ◽  
Human Insulin ◽  
Vascular Complications ◽  
Insulin Analogues ◽  
Diabetic Patients ◽  
Problems And Solutions ◽  
Basal Bolus

DCCT (Diabetes Control and Complications Trial) study showed that intensified insulin therapy associates with significant reduction both of development and progression of vascular complications compared to conventional insulin therapy in type 1 diabetic patients. Modern algorithms of diabetes treatment in children and adolescents reflect the need to achieve and maintenance of glycemic control as closely as possible to normal level. Insulin analogues have improved pharmacokinetic and pharmacodynamic properties, and also have less variability than human insulin. So they have more physiologic and predictable profile actions and, therefore, provide the possibility to achieve optimal glycemic control with low risk of hypoglycemia. Current review demonstrates the benefits of basal-bolus therapy with insulin analogues detemir (Levemir) and aspart (NovoRapid) and advantages of insulin NovoRapid in the continuous subcutaneous insulin infusion (CSII) compared with human insulin in children and adolescents with type 1 diabetes mellitus.

scholarly journals Insulin degludec/insulin aspart is the first co-formulation of basal and prandial insulin analogues

2014 ◽  
Vol 17 (4) ◽  
pp. 108-119
Author(s):  
Ivan Ivanovich Dedov ◽  
Marina Vladimirovna Shestakova
Keyword(s):  
Glycemic Control ◽  
Insulin Therapy ◽  
Insulin Aspart ◽  
Basal Insulin ◽  
Diabetes Management ◽  
Insulin Analogues ◽  
Insulin Degludec ◽  
Diabetic Patients ◽  
Prandial Insulin ◽  
Basal Bolus

Achievement of glycemic control is the major therapeutic aim to prevent or delay the onset and progression of diabetes related complications. Insulin therapy represents a cornerstone in the treatment of diabetes and has been used widely for achieving glycemic goals. The aim for insulin therapy is to mimic the physiological profile of insulin secretion seen in nondiabetic patients. Development of the insulin analogs has offered new opportunities in the diabetes management to achieve greater safety and tolerability of diabetes treatment. Insulin degludec/insulin aspart(IDegAsp) (Ryzodeg?, Novo Nordisk, Denmark) is the first soluble co-formulation of 70% ultra-long acting insulin degludec and 30% rapid-acting prandial insulin aspart, providing both basal insulin coverage and a prandial insulin bolus in a single injection. This review discusses data regarding the efficacy, safety, tolerability and clinical benefits of IDegAsp. According to the clinical development program IDegAspprovides an achievement of similar glycemic control with superiority in lowering FPG with using less number of injections and lower daily insulin dose, and also associated with numerically lower rates of confirmed and nocturnal confirmed hypoglycaemia in comparison with premixed or basal insulin analogues, as well as a basal component for basal?bolus therapy with supplementary mealtime insulin aspart.Trial results suggest that IDegAspQD or BID maybe an appropriate and reasonable option for initiating insulin therapy in type 1 and type 2 diabetic patients inadequately controlled on maximal doses of oral antidiabetic drugs,and also a simple alternative to basal?bolus treatment in patients who require intensification of insulin therapy, especially when adherence to more complex regimens is challenging.

scholarly journals Different insulin treatment regimens in patient with diabetes mellitus type 1: Effects on quality of life

2012 ◽  
Vol 69 (7) ◽  
pp. 569-575 ◽  
Author(s):  
Jelena Stojanovic ◽  
Dragoslav Milosevic ◽  
Ilija Antovic ◽  
Goran Sekulic ◽  
Teodora Beljic-Zivkovic
Keyword(s):  
Glycemic Control ◽  
Metabolic Control ◽  
Insulin Treatment ◽  
Vascular Complications ◽  
Well Being ◽  
Insulin Analogues ◽  
Treatment Regimens ◽  
Type 1 Dm

Background/Aim. Despite of contemporary diabetes mellitus (DM) treatment, one half of patients do not achieve an optimal metabolic control. Considering great psychological burden of diabetic patients, the purpose of this study was to assess the effect of different insulin treatment regimens, glycemic control and the presence of vascular complications on self-reported well-being and quality of life (QoL) of subjects with type 1 DM. Methods. The patients with type 1 DM (n = 122) recruited from the outpatient Diabetes Endocrinology Clinic of Zvezdara University Medical Center were divided into 4 groups according to the specific treatment regimen: 26 were on continuous subcutaneous insulin infusion (CSII), 30 on conventional insulin therapy, 33 on multiple daily injections (MDI) with human insulins, and 33 on MDI with insulin analogues. QoL was assessed by self-reported well-being with the following questionnaires: WHO-5 item Well Being Index (WHO- 5), 36 item Short Form (SF-36) survey, and Insulin Treatment Appraisal Scale (ITAS). Objective metabolic control was assessed by glycosylated hemoglobin (HbA1c), lipid levels and the presence of vascular complications. Statistical analyses used in this crosssectional study included: descriptive statistics, Student?s t-test, Chisqare test, contingency tables, ANOVA and correlation methods. Results. The patients on CSII had significantly better metabolic control than all other treatment groups, especially when compared to the one on conventional therapy (CSII HbA1c 7.07 ? 1.48% vs conventional therapy, HbA1c 10.04 ? 1.44; p = 0.000). No significant difference in glycemic control was observed between patients on MDI with human insulins and insulin analogues. Good glycemic control significantly influenced the reported QoL. The patients with retinopathy and nephropathy reported significantly lower physical well-being, and the patients with polyneuropathy and cardiovascular complications reported also lower psychological well being. Conclusions. Insulin treatment regiment selection affects not only objective metabolic control, but also QoL.

Does Post-Dinner Dietary Intake Compromise Overnight Glycemic Control in Patients with Type 1 Diabetes Treated with Insulin Analogues as Part of Intensive Insulin Therapy?

2013 ◽  
Vol 37 ◽  
pp. S56-S57
Author(s):  
Katherine Desjardins ◽  
Anne-Sophie Brazeau ◽  
Irene Strychar ◽  
Catherine Leroux ◽  
Véronique Gingras ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Dietary Intake ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Insulin Analogues

scholarly journals Characteristics of insulin therapy of diabetes mellitus type 1 in children and adolescents receiving glucocorticoids

2019 ◽  
Vol 22 (3) ◽  
pp. 263-273
Author(s):  
Alisa V. Vitebskaya ◽  
Anastaiya V. Popovich ◽  
Elena Y. Afonina ◽  
Yuliya O. Kostina ◽  
Karina V. Aleksanyan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Children And Adolescents ◽  
Diabetes Mellitus Type 1 ◽  
Diabetes Mellitus Type ◽  
Insulin Requirements ◽  
Acting Insulin ◽  
High Doses

BACKGROUND: In coexistence of diabetes mellitus type 1 (DM1) with severe autoimmune and inflammatory diseases some patients need simultaneous administration of insulin and glucocorticoids (GC). GC therapy in patients with DM1 can worsen glycemic control. AIM: To determine characteristics of insulin therapy of DM1 in children and adolescents receiving GC. DESCRIPTION OF CLINICAL CASES: We observed 5 patients with DM1 receiving GC for juvenile idiopathic arthritis (JIA), juvenile systemic sclerosis (JSS), juvenile dermatomyositis (JDM), ulcerative colitis (UC), and reactive arthritis (RA). Intra-articular administration of GC did not significantly influence glycemic control. In case of GC pulse therapy hyperglycemia and increased insulin requirements were recognized in 36 hours after GC receipt, persisted from few hours up to 3 days after each administration. While therapy with oral GC in high doses the worst glycemic control was registered in daylight hours. To overcome insulin resistance change of time of injection and 10%-increase of long-acting insulin analogue, additional injections of ultrashort-acting insulin analogues, temporal prescription of short-acting human insulin were used. While GC therapy insulin daily dose was individual and could reach 2.0 U/kg. After transition to maintaining doses of GC or discontinuation of GC therapy patients returned to standard or relatively low insulin requirements. Levels of glycosylated hemoglobin differed significantly among patients at different stages of treatment, were maximal while long-term therapy with high doses of oral GC, but mostly depended on patients compliance. CONCLUSION: Bettering of glycemic control while receiving GC can be reached by timely dose correction of insulin therapy, selection of individual schemes, taking into account time of receipt and pharmacokinetic characteristics of GC. Adherence of the patient and his family to treatment of DM1 plays an important role in glycemic control.

scholarly journals Diabetes mellitus type 1 in children and adolescents in Moscow. Data from the Moscow Segment of the Federal Register of Diabetic Patients 2015–2020

2021 ◽  
Vol 67 (6) ◽  
pp. 113-123
Author(s):  
E. E. Petryaykina ◽  
D. N. Laptev ◽  
I. G. Vorontsova ◽  
N. A. Demidov ◽  
Yu. А. Ryapolova
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Children And Adolescents ◽  
Incidence Rates ◽  
Diabetic Coma ◽  
Simultaneous Increase ◽  
Diabetic Patients ◽  
Federal Register

BACKGROUND: Therapy for type 1 diabetes mellitus (T1DM) is still largely an unsolved clinical problem. Despite the introduction into clinical practice of modern insulin preparations, devices for its administration, as well as continuous monitoring of glucose levels, the goals of therapy are often not achieved. At the same time, the International Diabetes Federation (IDF) notes an increase in the prevalence and incidence of T1DM in children and adolescents in the world. The Federal Register of Diabetes Mellitus (FRDM) is a dynamically updated database of patients with diabetes, which allows assessing prevalence and incidence rates, achievement of glycemic control goals and the incidence of diabetes complications.AIM: analyze the epidemiological data of T1DM (prevalence, morbidity) in children and adolescents (patients from birth to 18 years of age) in Moscow according to the FRSD data and to assess their dynamics, as well as the dynamics of achieving the goals of glycemic control and the incidence of T1DM complications in 2015-2020.MATERIALS AND METHODS: The object of the study is a sample from the database of the Moscow segment of the FRDM of a cohort of patients with type 1 diabetes under 18 years of age who were registered for the period 01.01.2015-01.01.2021. Epidemiological prevalence and incidence rates are calculated per 100,000 of the relevant population.RESULTS: the number of children and adolescents with type 1 diabetes in Moscow as of 01.01.2021 was 4024 people (2962 children and 1062 adolescents). Over the period from 2015 to 2020, there was an increase in the prevalence of T1DM (possibly due to an increase in the quality of data registration in the FRSD) and a decrease in the incidence of both children and adolescents. There was also a decrease in the level of HbA1c and the proportion of patients with HbAc1> 8.0% among children with T1DM. Both children and adolescents with T1DM showed a decrease in the incidence of diabetic coma and ketoacidosis with a simultaneous increase in the incidence of severe hypoglycemia, as well as a decrease in the incidence of retinopathy and nephropathy. However, the incidence of neuropathy decreased among children and increased among adolescents.CONCLUSION: The data obtained on the dynamic management of adolescents with T1DM are the basis for considering the development of a profile program for their dynamic observation, taking into account the need for psychological and social support for patients and their families.

scholarly journals Does all the evidence say that insulin analogues are more effective than human insulins?

2021 ◽  
Vol 17 (7) ◽  
pp. 581-588
Author(s):  
M.V. Neborachko ◽  
O.G. Phakadze
Keyword(s):  
Insulin Therapy ◽  
Human Insulin ◽  
Insulin Analogues ◽  
Recombinant Human Insulin ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
National Programs ◽  
The Cost ◽  
Use Factors

Currently, a large amount of data has been accumulated to compare recombinant human insulin with insulin analogues, including meta-analyzes of comparative efficacy and safety, as well as cost-effectiveness data and data on the possible carcinogenicity of new products. Insulin treatment is a necessity for some people with diabetes mellitus (DM) due to the need to maintain optimal blood glucose levels. The authors emphasize the need to keep in mind that new insulin drugs are much more expensive, which may limit their use. Factors such as the effectiveness of treatment, its safety, and patient satisfaction should be taken into account when deciding on the choice of therapy, but the cost of treatment cannot be ignored, given that it is usually reimbursable from the budget. In this regard, insulin therapy should be individually selected taking into account the needs of patients, treatment goals, safety, and cost. The authors propose an analysis of these data on the feasibility of using insulin analogues in comparison with recombinant human insulin for patients with type 1 diabetes and patients with type 2 diabetes and their effectiveness in both types of diabetes. A reasonable policy for the use of insulin therapy should be developed based on available clinical data based on comparative studies in different groups of diabetics and comprehensive analysis of economic data. The feasibility of a new drug should be evaluated and regularly reviewed in light of the practical results of its use in clinical practice. It is also necessary to regularly conduct a retrospective economic analysis to assess the pharmacoeconomic benefits. All of these steps should assist decision-makers and regulators in implementing effective national programs to develop new effective insulin procurement systems.

Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus

2019 ◽  
Vol 32 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Yukiyo Yamamoto ◽  
Toru Kikuchi ◽  
Tatsuhiko Urakami ◽  
Motohide Goto ◽  
Kohji Tsubouchi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Children And Adolescents ◽  
Insulin Analogs ◽  
Japanese Children ◽  
Registration Data ◽  
Basal Bolus

AbstractBackgroundTreatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients.MethodsThe registration data including hemoglobin A1c(HbA1c), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort).ResultsThe proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0–5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA1cvalues between the two cohorts.ConclusionsThe popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.

scholarly journals Inpatient hyperglycemia management: the opportunities of a new basal insulin

2016 ◽  
Vol 10 (2) ◽  
pp. 103 ◽  
Author(s):  
Natalino Simioni
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Hospital Setting ◽  
Insulin Analogues ◽  
Diabetic Patients ◽  
Potential Clinical Benefit ◽  
Sliding Scale ◽  
Bolus Insulin ◽  
Basal Bolus

The management of hospitalized diabetic patients for any cause is often difficult and affected not only by the comorbidities of the patient but also by the hospital setting. It is well known that at the admission the antidiabetic drugs should be discontinued on behalf of insulin therapy with insulin analogues, as a function of a basal-bolus insulin approach according to the phenotype of the patient, type of nutrition (enteral or parenteral rather than oral), or concomitant hyperglycemic therapy (<em>e.g.</em>, steroid). The average stay of diabetic patients hospitalized for any cause is significantly correlated with both the number of hypoglycemia and hyperglycemia. Compared to patients treated with sliding scale patients using a custom algorithm show a significant reduction in the number of hypoglycemia and hyperglycemia episodes and in the length of stay. We analyze the clinical profile of a novel basal insulin, degludec, and explore the potential clinical benefit for diabetic inpatient. The continuation of insulin therapy at home in the immediate post-hospitalization (if necessary), also correlates with a reduction in the rate of re-hospitalization, which combined with close follow-up diabetes can result in a reduction of chronic complications.

scholarly journals Remote monitoring and treatment of children and adolescents with type 1 diabetes

2020 ◽  
Vol 66 (4) ◽  
pp. 50-60
Author(s):  
Dmitry N. Laptev ◽  
Andrey O. Emelyanov ◽  
Yulia G. Samoilova ◽  
Elena B. Khramova ◽  
Elena E. Petriaikina ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Children And Adolescents ◽  
Remote Monitoring ◽  
Insulin Pump ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Number Of Patients

RATIONALE: Continuous subcutaneous insulin infusion (CSII) is an effective method for optimizing glycemic control in children with type 1 diabetes mellitus (DM1). However, the use of CSII does not always result in adequate glycemic control. Telehealth can be applied as one of the methods to improve the effectiveness of treatment.AIMS: To evaluate the use of remote medical support of children and adolescents with DM1 and its influence on glycemic control, quality of life, and incidence of acute complications of DM1.MATERIALS AND METHODS: We conducted a 24-week multi-institutional prospective open-label controlled clinical trial. 180 children and adolescents were included in this study and divided into the following categories: 1) age 8–18 years; 2) DM1 at least 1 year; 3) pump insulin therapy Medtronic Paradigm (Medtronic MiniMed, USA) at least 6 months; 4) self-monitoring of glycemia at least 4 times a day and replacement of the insulin pump infusion system at least once every 3 days; 5) inadequate glycemic control of DM1: the level of glycated hemoglobin (HbA1c) 7.5% or higher. Patients were assigned to a remote consultation group (RC; n=100) or a traditional control group (TC; n=80). All patients were trained on the basic principles of DM1 and CSII, and we measured initial HbA1c, then after 12 and 24 weeks, also registered and analyzed glycemic indicators and daily doses of insulin, evaluated and corrected the treatment. Patients or their parents in the RC group sent pump data via the Internet to the pump insulin therapy center at least once every 2 weeks at home and received treatment recommendations in response.RESULTS: The total number of patients included in the study in all institutions was 180 children at 8–18 years. Patients in both groups did not differ in age, gender, duration of DM1 and CSII, and HbA1c level. The total amount of remote consultations for all institutions was 949. The decrease in the level of HbA1c by the end of the study against the initial one was statistically significantly greater in the RC group: 1.17% compared to 0.59% in the TC group (p<0.05). The proportion of patients who reached the target level of HbA1c (<7.5%) was significantly higher in the RC group (32%) compared to the TC group (12.5%, p<0.05). During the study, the incidence of DKA and severe hypoglycemia in the RC group was statistically significantly lower.CONCLUSIONS: Remote monitoring in children with DM1 resulted in significant improvements in glycemic control (HbA1c, glycemic variability, and hypoglycemic frequency). The accumulation of evidence on the effectiveness and safety of telehealth in DM should contribute to implementing this approach in practical health care.

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