scholarly journals Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care

2022 ◽  
Vol 12 ◽  
Author(s):  
Ileana Mardare ◽  
Stephen M. Campbell ◽  
Johanna C. Meyer ◽  
Israel Abebrese Sefah ◽  
Amos Massele ◽  
...  
Keyword(s):  
Glucose Monitoring ◽  
Insulin Analogues ◽  
Pump Therapy ◽  
Middle Income ◽  
Low Middle Income Countries ◽  
Patients With Diabetes ◽  
Infusion Systems ◽  
Long Acting ◽  
Multiple Daily Insulin Injections ◽  
Hba1c Levels

There are a number of ongoing developments to improve the care of patients with diabetes across countries given its growing burden. Recent developments include new oral medicines to reduce cardiovascular events and death. They also include new modes to improve insulin administration to enhance adherence and subsequent patient management thereby reducing hypoglycaemia and improving long-term outcomes. In the case of insulins, this includes long-acting insulin analogues as well as continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion systems, combined with sensor-augmented pump therapy and potentially hybrid closed-loops. The benefits of such systems have been endorsed by endocrine societies and governments in patients with Type 1 diabetes whose HbA1c levels are not currently being optimised. However, there are concerns with the low use of such systems across higher-income countries, exacerbated by their higher costs, despite studies suggesting their cost-effectiveness ratios are within accepted limits. This is inconsistent in higher-income countries when compared with reimbursement and funding decisions for new high-priced medicines for cancer and orphan diseases, with often limited benefits, given the burden of multiple daily insulin injections coupled with the need for constant monitoring. This situation is different among patients and governments in low- and low-middle income countries struggling to fund standard insulins and the routine monitoring of HbA1c levels. The first priority in these countries is to address these priority issues before funding more expensive forms of insulin and associated devices. Greater patient involvement in treatment decisions, transparency in decision making, and evidence-based investment decisions should help to address such concerns in the future.

scholarly journals Modern basal insulins: an ongoing story or the start of a new era?

2015 ◽  
Vol 18 (4) ◽  
pp. 5-11
Author(s):  
Ivan Ivanovich Dedov
Keyword(s):  
Basal Insulin ◽  
Diabetes Management ◽  
Insulin Analogues ◽  
Diabetes Treatment ◽  
New Era ◽  
Patients With Diabetes ◽  
Neutral Protamine Hagedorn ◽  
Long Acting

Basal insulin represents an essential tool in the treatment of both type 1 and type 2 diabetes mellitus. The development of insulin analogues has improved the possibilities of diabetes treatment. Despite significant progress in understanding the physiology, chemistry, kinetics and action of insulin, currently available basal insulin products do not optimally mimic the endogenous profile of insulin. Although basal insulin analogues have some advantages over neutral protamine Hagedorn insulin in diabetes treatment, hypoglycaemia remains the main problem in the achievement of optimal glycaemic control in most patients with diabetes. These unmet clinical needs have stimulated the development of new basal insulin analogues with improved pharmacological profiles. This article reviews the specific characteristics of new long-acting insulin analogues to try and understand their benefits and limitations in the improvement of diabetes management and their possibilities in physiologic and safe insulin replacement.

scholarly journals Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin?

2018 ◽  
Vol 9 (5) ◽  
pp. 157-166 ◽  
Author(s):  
Torben Biester ◽  
Olga Kordonouri ◽  
Thomas Danne
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Pump ◽  
Real Life ◽  
Glucose Monitoring ◽  
Insulin Analogues ◽  
Insulin Pump Therapy ◽  
Daily Injection ◽  
Great Success ◽  
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.

VP53 Long-Acting Insulin Analogues In Brazil: Clinical And Economic Impact

2019 ◽  
Vol 35 (S1) ◽  
pp. 88-88
Author(s):  
Lays Pires Marra ◽  
Daniel da Silva Pereira ◽  
Gustavo Laine Araújo de Oliveira
Keyword(s):  
Economic Impact ◽  
Budget Impact ◽  
Severe Hypoglycemia ◽  
Insulin Analogues ◽  
Insulin Regimen ◽  
Nocturnal Hypoglycaemia ◽  
Nph Insulin ◽  
Acting Insulin ◽  
Long Acting ◽  
Hba1c Levels

IntroductionThe aim was to evaluate the effectiveness, safety and economic impact of long-acting insulin analogues (LAIA) compared to NPH for type 1 diabetes mellitus (DM1).MethodsA search was performed in five electronic databases to find systematic reviews (SR) comparing at least a LAIA to NPH insulin for DM1. Budget impact analysis was performed from the perspective of Brazilian public health system (SUS), with NPH insulin as the base scenario. The costs were extracted from the Integrated System of Administration of General Services (SIASG). The market share was calculated per month, using a logarithmic function with maximum diffusion of 50% at the end of the time horizon - five years.ResultsA total of 160 studies were identified and seven SR of low to uncertain risk of bias were selected. LAIA have shown modest clinical benefit and its effect is more prominent for the control of severe and nocturnal hypoglycaemia. Insulins glargine and detemir compared to NPH were associated with reduction in HbA1c levels between 0.16% and 0.40% and associated with lower risk of episodes of severe hypoglycemia. Insulin degludec compared to NPH showed no statistically significant difference in the reduction of HbA1c levels and in the episodes of severe hypoglycemia. The budget impact ranges from USD 210 million (detemir) to USD 670 million (degludec) over five years.ConclusionsThe use of LAIA as a basal insulin regimen for DM1 may benefit more patients with recurrent episodes of hypoglycemia. However, the fragility of the outcomes considered to evaluate the clinical impact of LAIA and the high budget impact with its use should be considered, and may compromise SUS sustainability. In view of these aspects, CONITEC recommended the incorporation of one of the LAIA, if the treatment is equal to or less than that of NPH insulin and according to the criteria established by a guideline.

scholarly journals Treatment of Congenital Hyperinsulinism with Lanreotide Acetate (Somatuline Autogel)

2011 ◽  
Vol 96 (8) ◽  
pp. 2312-2317 ◽  
Author(s):  
Dalit Modan-Moses ◽  
Ilana Koren ◽  
Kineret Mazor-Aronovitch ◽  
Orit Pinhas-Hamiel ◽  
Heddy Landau
Keyword(s):  
Insulin Pump ◽  
Glucose Monitoring ◽  
Normal Weight ◽  
Somatostatin Analog ◽  
Good Growth ◽  
Congenital Hyperinsulinism ◽  
Pump Therapy ◽  
Monthly Injection ◽  
Normal Weight Gain ◽  
Long Acting

Abstract Context: Congenital hyperinsulinism (CH) may be treated conservatively in many children with octreotide given by multiple sc injections or via an insulin pump. Objective: We describe two children treated with a once-monthly injection of a long-acting somatostatin analog. Patients and Methods: Both patients presented with hypoglycemia 30 min after birth and were subsequently diagnosed with CH. Patients were initially treated with diazoxide, hydrochlorothiazide, frequent feedings, and octreotide via an insulin pump. With this therapy, they were normoglycemic with a good growth rate, normal weight gain, and excellent neurodevelopment. Treatment with the long-acting somatostatin analog lanreotide acetate (Somatuline Autogel), administered by deep sc injection of 30 mg once a month, was started at the ages of 4½ and 4 yr, respectively. Octreotide infusion was gradually weaned over 1 month. Continuous glucose monitoring after discontinuation of pump therapy showed normoglycemia. The first patient has now been treated with the lanreotide acetate for over 5 yr, and the second for 3 yr. Treatment is well-tolerated, and both the patients and their parents are satisfied with the transition from pump therapy to once-a-month injection and prefer it to pump therapy. Conclusion: Lanreotide acetate may be a safe and effective alternative to octreotide pump therapy in patients with CH, offering an improved quality of life. Longer follow-up of a larger patient group is needed.

scholarly journals Long-acting insulin in a public health system: analysis of compliance with clinical protocol in public pharmacies

2021 ◽  
Vol 26 (6) ◽  
pp. 2301-2310
Author(s):  
Tadeu Uggere de Andrade ◽  
Fabrício Soares Moreira ◽  
Karla Oliveira dos Santos Cassaro ◽  
Manuela Martins Cruz ◽  
Girlandia Alexandre Brasil ◽  
...  
Keyword(s):  
Public Health ◽  
Blood Glucose ◽  
Health Service ◽  
Health System ◽  
Public Health System ◽  
Insulin Analogues ◽  
Clinical Protocol ◽  
Acting Insulin ◽  
Long Acting ◽  
Hba1c Levels

Abstract Diabetes mellitus (DM) is a chronic disease marked by elevated blood glucose levels. Controlling DM involves adequate diet, physical exercises, medicines and monitoring the blood glucose and glycated hemoglobin (HbA1c) levels. This was a retrospective study of the process of dispensing long-acting insulin analogues to users with diabetes (types 1 and 2) who were registered at high-cost public pharmacies in public health system in a southeast state of Brazil, that sought to evaluate the fulfillment of the criteria of all the clinical protocol to provide these analogs. Of the 987 users registered in the health service, 315 met the inclusion criteria for the study. The evaluation of the dispensing processes of the long-acting insulin analogues revealed that the inclusion, exclusion, and suspension criteria of the protocol related with these insulin analogues were in some extend only partially fulfilled. Additionally, there was no difference between the initial and final fasting glycemic and HbA1c levels. It is concluded that the established criteria for dispensing long-acting insulin analogues were partly fulfilled by pharmacies, compromising the rational use of these analogues. It can directly impact the cost of maintaining the public health service and users’ health.

The Impact of Covid 19 on Pregnant Women and Child Health

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1367-1373
Author(s):  
Nikhil Sanjay Mujbaile ◽  
Smita Damke
Keyword(s):  
Social Issues ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
The Social ◽  
Social Separation ◽  
The Impact ◽  
And Child Health ◽  
General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools. 

Risk Factors of Mortality Among Patients with Stroke in Low Middle-Income Countries:  A Series of 180 Patients

2020 ◽  
Author(s):  
Larrey Kamabu ◽  
Hervé Monka Lekuya ◽  
Bienvenu Muhindo Kasusula ◽  
Nicole Kavugho Mutimani ◽  
Louange Maha Kathaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

Effects of wearable technology on patients with diabetes: A systematic review and meta-analysis (Preprint)

2020 ◽  
Author(s):  
Dongjun Wu ◽  
Nicholas Buys ◽  
Guandong Xu ◽  
Jing Sun
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Relapse Prevention ◽  
Diabetes Management ◽  
Meta Analysis ◽  
Intervention Group ◽  
Wearable Technologies ◽  
Patients With Diabetes ◽  
Hba1c Levels

UNSTRUCTURED Aims: This systematic review and meta-analysis aimed to evaluate the effects of wearable technologies on HbA1c, blood pressure, body mass index (BMI), and fastening blood glucose (FBG) in patients with diabetes. Methods: We searched PubMed, Scopus, Embase, the Cochrane database, and the Chinese CNKI database from last 15 years until August 2021. The quality of the 16 included studies was assessed using the PEDro scale, and random effect models were used to estimate outcomes, with I2 used for heterogeneity testing. Results: A significant reduction in HbA1c (-0.475% [95% CI -0.692 to -0.257, P<0.001]) was found following telemonitoring. However, the results of the meta-analysis did not show significant changes in blood pressure, BMI, and glucose, in the intervention group (P>0.05), although the effect size for systolic blood pressure (0.389) and diastolic blood pressure may indicate a significant effect. Subgroup analysis revealed statistically significant effects of wearable technologies on HbA1c when supported by dietetic interventions (P<0.001), medication monitoring (P<0.001), and relapse prevention (P<0.001). Online messages and telephone interventions significantly affected HbA1c levels (P<0.001). Trials with additional online face-to-face interventions showed greater reductions in HbA1c levels. Remote interventions including dietetic advice (P<0.001), medication (P<0.001), and relapse prevention (P<0.001) during telemonitoring showed a significant effect on HbA1c, particularly in patients attending ten or more intervention sessions (P<0.001). Conclusion: Wearable technologies can improve diabetes management by simplifying self-monitoring, allowing patients to upload their live measurement results frequently and thereby improving the quality of telemedicine. Wearable technologies also facilitate remote medication management, dietetic interventions, and relapse prevention.

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