1044-P: Insulin Intensification with a 24-Hour Wearable Insulin Delivery Device in Patients Inadequately Controlled with Basal Insulin Therapy

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1044-P
Author(s):  
TRISHA ZEIDAN ◽  
CARLA C. NIKKEL ◽  
ELIZABETH A. DZIENGELEWSKI
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Insulin Delivery ◽  
Delivery Device ◽  
Insulin Intensification

scholarly journals Novel Simple Insulin Delivery Device Reduces Barriers to Insulin Therapy in Type 2 Diabetes

2015 ◽  
Vol 9 (3) ◽  
pp. 581-587 ◽  
Author(s):  
Norbert Hermanns ◽  
Leslie C. Lilly ◽  
Julia K. Mader ◽  
Felix Aberer ◽  
Anja Ribitsch ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Insulin Therapy ◽  
Insulin Delivery ◽  
Delivery Device

Basal insulin treatment optimization in T2DM: GLP-1 Receptor Agonists in loose addition or in fixed dose combination

2019 ◽  
Vol 22 (1-2) ◽  
pp. 41
Author(s):  
Formoso, G.
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Fixed Dose Combination ◽  
Fixed Dose ◽  
Treatment Optimization ◽  
Insulin Intensification ◽  
Dose Combination ◽  
Glycemic Targets ◽  
Insulin Use ◽  
Time Of Administration

Administration of basal insulin formulations is often used when oral therapies fail to achieve and/or maintain adequate glucose control in T2DM. However, observational studies documented that a large percentage of basal insulin treated subjects fails to achieve glycemic targets. Among the possible strategies to intensify basal insulin therapy, addition of a GLP-1 RA has several advantages. Indeed GLP-1 RA mechanism of action could be seen as complementary to insulin action. Furthermore, studies have shown that addition of a GLP-1 RA to basal insulin improves HbA1c with a minimal increase in the risk of hypoglycemia and null or modest weight gain. Addition of a GLP-1 RA to basal insulin therapy might be easier if performed by switching from daily basal insulin injections to daily injections of a fixed dose combination of a GLP-1 RA+basal insulin preparation. Two such fixed combinations are presently available, IDegLira (Degludec Insulin + Liraglutide) and IGlarLixi (Insulin Glargine+Lixisenatide). Two studies with IDegLira and one study with IGlarLixi have shown that these combinations are more efficacious and safer than mere up-titration of basal insulin. Use of fixed dose GLP-1 RA+basal insulin combination appears therefore an excellent strategy of basal insulin intensification. No studies are availbe directly comparing efficacy and safety of IGlarLixi and IDegLira. Data obtained in registration trials appear numerically better for IDegLira. Furthermore, as compared to IGlarLixi, IDegLira offers a greater flexibility in time of administration. KEY WORDS basal insulin; GLP-1 RA; liraglutide; lixisenatide; fixed dose combination.

scholarly journals When basal insulin is not enough: successful strategies for insulin intensification in patients with type 2 diabetes mellitus

2017 ◽  
Vol 20 (5) ◽  
pp. 363-373
Author(s):  
Elena V. Buryukova ◽  
Abdul Jabbar ◽  
Svetlana V. Elizarova
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Clinical Management ◽  
Basal Insulin ◽  
Insulin Intensification ◽  
Advantages And Disadvantages

Maintaining glycemic control through intensive clinical management of patients with type 2 diabetes mellitus (T2DM) is well recognized to reduce the risk of diabetes-associated complications. Patients in Russia have high rates of microvascular and macrovascular complications as a result of undiagnosed, untreated, or inadequately treated diabetes, emphasizing the need for better clinical management. The introduction of basal insulin therapy is often necessary for patients with T2DM when oral antihyperglycemic drugs and lifestyle management strategies are no longer effective inmaintaining glycemic targets. However, after initiation of insulin, patients often remain on basal insulin for long periods despite suboptimal glycemic control, and intensification of insulin therapy is frequently necessary. Here, we report on several different insulin intensification strategies available to clinicians and their patients to improve glycemic control and the advantages and disadvantages of each approach. These strategies include the use of short- and long-acting insulins administered either as bolus doses or as premixed insulins. When selecting the most appropriate intensification strategy, clinicians should consider the lifestyle and treatment goals of their patients to help ensure treatment success.

Impact of a Structured Patient-Support Program on Adherence and Persistence with Basal Insulin Therapy at 12 Months

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1267-P
Author(s):  
FANG L. ZHOU ◽  
JASON YEAW ◽  
SWAPNA KARKARE ◽  
MITCH DEKOVEN ◽  
TIMOTHY S. REID
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Support Program ◽  
Patient Support ◽  
Patient Support Program

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%.

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