Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy

Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)–mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.

Videocapillaroscopy, Insulin-Induced Skin Lipohypertrophy, and Bruising: A Preliminary Approach

Background: Lipohypertrophy (LH) is a frequent cutaneous complication in people with insulin-treated type-2 DM (IT-T2DM). Its pathogenesis is not fully known, however. Retinal and kidney microangiopathy (MIA) is also frequent in such patients, especially in case of poor metabolic control. Aim: To assess whether specific nailfold video-capillaroscopy (NVC) patterns could be identified in MIA-affected IT-T2DM patients, thus eventually helping explain LH pathogenesis. Methods: 50 IT-T2DM patients with LH and 50 without LH undergoing NVC were enrolled. All followed a multiple daily injection regimen and had established retinal and renal microangiopathic complications. Results: While confirming expected MIA-related skin changes in both groups, our data failed to detect any specific NVC pattern in LH-affected patients yet showed the most severe NVC changes to be significantly associated with HbA1c values over 9%. Conclusion: Severe NVC-assessed MIA lesions reflect longstanding poor metabolic control in IT-T2DM rather than contributing to LH pathogenesis.

Changed Diabetic Treatment from Multiple Daily Injection (MDI), Dulaglutide to Xultophy

The patient is a 56-year old (yo) female with type 2 diabetes mellitus (T2DM). Medical histories include persisting T2DM from 35yo, renal stone at 43yo, hypertension from 45yo, photocoagulation for retinopathy on 54yo. An incidentaloma was found in the left adrenal gland, where endocrinological exams were negative for functional tumor. Her diabetic control situation became worse with HbA1c > 10%, then the treatment has been changed from multiple daily injection (MDI), Dulaglutide to Xultophy which is combined agents of degludec and liraglutide (IDegLira). It was provided 10-18 doses daily, and then glucose variability profile was improved satisfactory, suggesting the dual synergistic effects.

Direction for Basal Insulin Therapy by Once Daily Injection in the Clinical Practice

American Diabetes Association (ADA) has announced the new version of the standards of Medical Care in Diabetes-2021. The guideline of the diabetic patients with Older Adults seems to be used for a wide range of clinical practice. Among them, several impressive comments were found, where “Once-daily basal insulin injection therapy is associated with minimal side effects and maybe a reasonable option in many elder patients”. Recent topic includes Dual Action of Liraglutide and insulin degludec (DUAL) studies, and Xultophy has shown beneficial efficacy. Consequently, the trend would be developed from multiple daily injection (MDI) method to once daily injection.

Clinical Evaluation of Basal-Bolus Therapy Delivered by the V-Go® Wearable Insulin Delivery Device in Patients with Type 2 Diabetes: A Retrospective Analysis

Insulin therapy is frequently required to achieve glycemic targets (A1c) in type 2 diabetes (T2D); however, clinicians and patients face barriers with the complexities of multiple daily injection regimens. Patch-like wearable insulin devices, such as V-Go, may simplify and optimize this complexity. This study evaluated the change in A1C and insulin total daily dose (TDD) in a suboptimally-controlled (not achieving A1C targets) T2D population after switching to V-Go. A retrospective chart analysis at a diabetes clinic was performed to evaluate change in A1c measurements from baseline (V-Go initiation) to end of study observation. Of the 139 patients enrolled, A1C significantly decreased from baseline (−1.5 ± 1.79%; p < 0.001). Patients prescribed insulin at baseline (n = 122) used significantly less insulin TDD (−8 u/day; p = 0.006). The percentage of patients meeting the target of A1C < 8% increased from 14% at baseline to 48% at study completion (p = 0.008). Patients prescribed a basal-bolus regimen prior to V-Go achieved an A1C reduction of 1.5 ± 2.0% (p < 0.0001) and experienced the greatest reduction in TDD (−24 u/day; p < 0.0001). Thus, patients switching to V-Go from a variety of therapies at baseline experienced reductions in A1C while using less insulin, with a reduction in clinically relevant hypoglycemia, indicating the potential benefit of V-Go in optimizing and simplifying T2D care.

Improved Time-in-Range over 1 year is Associated with Reduced Albuminuria in Individuals with Sensor-Augmented Insulin Pump-Treated Type 1 Diabetes

<b>Aim:</b> To investigate the association between treatment-induced change in continuous glucose monitored (CGM) time-in-range (TIR) and albuminuria in persons with type 1 diabetes (T1D) treated with sensor-augmented-pumps (SAP). <p><b>Methods: </b><a></a><a>Twenty-six of fifty-five participants with albuminuria and multiple daily injection-therapy (25% females, 51 (46-63) years, HbA_1c 75 (68-88) mmol/mol [9.0 (8.4-10.4)%], UACR 89 (37-250) mg/g) were in a randomized-controlled trial assigned to SAP-therapy for one year</a>. Anthropometrics, CGM-data, blood and urine samples were collected every three months.</p> <p><b>Results: </b>Mean change (95%-CI) in %TIR was +13.2 (6.2;20.2)%, HbA_1C was -14.4 (-17.4;-10.5) mmol/mol [-1.3 (-1.6;-1.0)%] and urinary albumin-creatinine-ratio (UACR) was -15 (-38;17)%, all p<0.05. UACR decreased with 19 (10;28)% per 10% increase in %TIR (p=0.04), 18 (1;30)% per 10 mmol/mol decrease in HbA_1C (p=0.07), and 31% per 10 mmHg decrease in mean arterial pressure (p<0.001).<b></b></p> <b>Conclusion: </b>In this longitudinal study, treatment-induced increase in %TIR was significantly associated with decrease in albuminuria in T1D.

Improved Time-in-Range over 1 year is Associated with Reduced Albuminuria in Individuals with Sensor-Augmented Insulin Pump-Treated Type 1 Diabetes

<b>Aim:</b> To investigate the association between treatment-induced change in continuous glucose monitored (CGM) time-in-range (TIR) and albuminuria in persons with type 1 diabetes (T1D) treated with sensor-augmented-pumps (SAP). <p><b>Methods: </b><a></a><a>Twenty-six of fifty-five participants with albuminuria and multiple daily injection-therapy (25% females, 51 (46-63) years, HbA_1c 75 (68-88) mmol/mol [9.0 (8.4-10.4)%], UACR 89 (37-250) mg/g) were in a randomized-controlled trial assigned to SAP-therapy for one year</a>. Anthropometrics, CGM-data, blood and urine samples were collected every three months.</p> <p><b>Results: </b>Mean change (95%-CI) in %TIR was +13.2 (6.2;20.2)%, HbA_1C was -14.4 (-17.4;-10.5) mmol/mol [-1.3 (-1.6;-1.0)%] and urinary albumin-creatinine-ratio (UACR) was -15 (-38;17)%, all p<0.05. UACR decreased with 19 (10;28)% per 10% increase in %TIR (p=0.04), 18 (1;30)% per 10 mmol/mol decrease in HbA_1C (p=0.07), and 31% per 10 mmHg decrease in mean arterial pressure (p<0.001).<b></b></p> <b>Conclusion: </b>In this longitudinal study, treatment-induced increase in %TIR was significantly associated with decrease in albuminuria in T1D.