Are fast insulin analogues fast enough? Switching to faster aspart may reduce glycemic variability and the risk of hypoglycemia in type 1 diabetic patients on sensor-augmented insulin pump therapy

For paediatric patients with type 1 diabetes, intensified insulin therapy with either multiple daily injection or insulin pump therapy is currently the only method of treatment. To optimize this therapy, insulin analogues are fixed parts of all therapy regimens. New ultra-rapid insulins seem to be beneficial not only in adults but also in this age group. New developments in long-acting analogues have demonstrated safety and will be regular in paediatrics, we hope, soon. Furthermore, the psychosocial approach for consideration of real-life aspects becomes more the focus of therapeutic regimens and is implemented into international guidelines. Technical improvements, such as continuous glucose monitoring, particularly in combination with pump therapy, support the great success of rapid-acting analogues by reducing hypoglycaemias. Non-insulin agents such as SGLT2-inhibitors show beneficial aspects in people with type 1 diabetes. For outpatient care with these currently off-label-used drugs, special training for measurement of ketones should be imperative.

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Insulin Requirements in Relation to Insulin Pump Indications in Type 1 Diabetes

Notulae Scientia Biologicae ◽

10.15835/nsb739653 ◽

2015 ◽

Vol 7 (3) ◽

pp. 259-263

Author(s):

Gabriela GHIMPEŢEANU ◽

Silvia Ş. IANCU ◽

Gabriela ROMAN ◽

Anca M. ALIONESCU

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Diabetic Patients ◽

Pump Therapy ◽

Daily Insulin ◽

Insulin Requirements ◽

High Hba1c ◽

Basal Bolus

The purpose of the current research was to assess changes in daily insulin requirements in type 1 diabetic patients transitioning from multiple daily injections (MDI) of insulin to continuous subcutaneous insulin infusion (CSII) using an external insulin pump, according to clinical indications for changing therapy. The charts of 70 patients with type 1 diabetes (T1D) initiating insulin pump therapy were retrospectively reviewed before CSII and after optimization of glycaemic profile with CSII during hospital admission. Daily insulin doses, basal/bolus distributions, dose changes during treatment transition and glycaemic outcomes with MDI and optimized CSII according to insulin pump indications were evaluated. Daily insulin doses were not significantly different among indication groups, with both MDI and CSII; likewise, the overall daily distribution of basal/rapid insulin ratio was similar, around 40/60. With optimized CSII, significant differences were found only in basal/bolus distribution in patients initiating CSII for recurrent hypoglycemia, who had a significantly lower basal (6.4% lower) and a complementary higher bolus requirement, compared to patients initiating CSII for HbA1c ≥ 8.5%. At transition, basal insulin needs declined similarly in the high HbA1c and impractical/inflexible MDI groups by approximately 20%, and up to 30% in the recurrent hypoglycaemia group; bolus doses decreased by 20% when the indication was high HbA1c and by approximately 15% for the other indications. Glycaemic control was significantly improved only in patients initiating CSII for high HbA1c (≥8.5%). Insulin pump indication should be considered when starting T1D patients on CSII. These findings may support clinicians in decision making regarding insulin dose changes when initiating insulin pump therapy.

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Metabolic Control of Type 1 Diabetes in Children Treated with Insulin Pump Therapy

Bosnian Journal of Basic Medical Sciences ◽

10.17305/bjbms.2009.2830 ◽

2009 ◽

Vol 9 (2) ◽

pp. 120-124

Author(s):

Sniježana Hasanbegović ◽

Edo Hasanbegović

Keyword(s):

Type 1 Diabetes ◽

Metabolic Control ◽

Insulin Pump ◽

Vascular Complications ◽

Insulin Analogues ◽

Mean Value ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Number Of Patients

In this paper we present study of metabolic control in children suffering from TYPE 1 Diabetes Mellitus (T1DM) who use insulin pump (IP) therapy, and who were treated at Paediatric Clinic in Sarajevo.In retrospective study we followed all T1DM patients with IP therapy introduced in the period from 1st March 2005 to 1st September 2008.We analyzed their age and sex structure, therapy before IP use, and the metabolic control of T1DM represented with glycosylated haemoglobin (HbA1c) value just before and 6 months after IP therapy introducing.The total number of observed patients was 39. There were 24 boys (61,5 %) and 15 girls (38,5 %) with the age range between 12,3 ± 3,2 years. Most patients were from age group 8-14 years. In the same number of patients 17 (43,6 %) diabetes duration was less than 5 years and 5-10 years. Before IP introduction most patient 61,5 % use therapy with insulin analogues. Mean value of HbA1c before IP therapy introduction was 8,57±1,65 % and 6 months after IP therapy introduction HbA1c 7,53 ± 0,81 % (p = 0,0009). There was significant reduction HbA1c values even 6 month after IP therapy introduced.Therapy with IP in children with diabetes was very efficient in achieving therapeutic goal of T1DM treatment (HbA1c<7,0 %) what will protect patients from appearance and progression of chronic micro vascular complications on eyes, kidneys and peripheral nerves.

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Use of rapid-acting insulin analogues in the treatment of patients with type 1 and type 2 diabetes mellitus: Insulin pump therapy versus multiple daily injections

Clinical Therapeutics ◽

10.1016/j.clinthera.2007.12.013 ◽

2007 ◽

Vol 29 ◽

pp. S135-S144 ◽

Cited By ~ 23

Author(s):

B BODE

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Insulin Pump ◽

Insulin Analogues ◽

Insulin Pump Therapy ◽

Pump Therapy ◽

Acting Insulin

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Swarm hybrid optimization for a piecewise model fitting applied to a glucose model

Journal of Systems and Information Technology ◽

10.1108/jsit-10-2017-0103 ◽

2018 ◽

Vol 20 (4) ◽

pp. 404-416 ◽

Cited By ~ 2

Author(s):

Luis Acedo ◽

Marta Botella ◽

Juan Carlos Cortés ◽

J. Ignacio Hidalgo ◽

Esther Maqueda ◽

...

Keyword(s):

Insulin Pump ◽

Model Fitting ◽

Insulin Pump Therapy ◽

Diabetic Patients ◽

Pump Therapy ◽

Content Type ◽

Glucose Levels ◽

Proposed Model ◽

Control Of Parameters

Purpose The purpose of this paper is to study insulin pump therapy and accurate monitoring of glucose levels in diabetic patients, which are current research trends in diabetology. Both problems have a wide margin for improvement and promising applications in the control of parameters and levels involved. Design/methodology/approach The authors have registered data for the levels of glucose in diabetic patients throughout a day with a temporal resolution of 5 minutes, the amount and time of insulin administered and time of ingestion. The estimated quantity of carbohydrates is also monitored. A mathematical model for Type 1 patients was fitted piecewise to these data and the evolution of the parameters was analyzed. Findings They have found that the parameters for the model change abruptly throughout a day for the same patient, but this set of parameters account with precision for the evolution of the glucose levels in the test patients. This fitting technique could be used to personalize treatments for specific patients and predict the glucose-level variations in terms of hours or even shorter periods of time. This way more effective insulin pump therapies could be developed. Originality/value The proposed model could allow for the development of improved schedules on insulin pump therapies.

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