The burden of severe hypoglycemia in type 2 diabetes

Aims: More than 29 million people in the US have type 2 diabetes mellitus (T2DM), a chronic metabolic disorder characterized by a progressive deterioration of glucose control, which eventually requires insulin. Abnormally low levels of blood glucose, a feared side-effect of insulin treatment, may cause severe hypoglycemia (SHO), leading to emergency department (ED) admission, hospitalization, and long-term complications; these, in turn, drive up the costs of T2DM. This study’s objective was to estimate the prevalence and costs of SHO-related hospitalizations and their additional longer-term impacts on patients with T2DM using insulin.

Methods: Using Truven MarketScan claims, we identified adult T2DM patients using basal and basal-bolus insulin regimens who were hospitalized for SHO (inpatient SHO patients) during 2010–2015. Two comparison groups were defined: those with outpatient SHO-related encounters only, including ED visits without hospitalization (outpatient SHO patients), and those with no SHO- or acute hyperglycemia-related events (comparison patients). Lengths of stay and SHO-related hospitalization costs were estimated, and propensity score and inverse probability weighting methods were used to adjust for baseline differences across the groups to evaluate longer-term impacts.

Results: We identified 66,179 patients using basal and 81,876 patients using basal-bolus insulin, of which ～1.1% (basal) to 3.2% (basal-bolus) experienced at least one SHO-related hospitalization. Among those who experienced SHO (i.e. those in the inpatient and outpatient SHO groups), 27% (basal) and 40% (basal-bolus) experienced at least one SHO-related hospitalization. One-third of basal and about one-quarter of basal-bolus patients were admitted directly to the hospital; the remainder were first assessed or treated in the ED. Inpatient SHO patients using basal insulin stayed in the hospital, including time in the ED, for 2.8 days and incurred $6896 in costs; patients using basal-bolus insulin stayed in the hospital for 2.6 days and incurred costs of $5802. Forty-to-fifty percent of inpatient SHO patients were hospitalized again for SHO. Inpatient SHO patients using basal insulin incurred significantly higher monthly costs after their initial SHO-related hospitalization than patients in the other two groups ($2935 vs $1819 and $1638), corresponding to 61% and 79% higher monthly costs; patients using basal-bolus insulin also incurred significantly higher monthly costs than patients in the other groups ($3606 vs $2731 and $2607), corresponding to 32% and 38% higher monthly costs.

Limitations: These analyses excluded patients who did not seek ED or hospital care when faced with SHO; events may have been miscoded; and we were not able to account for clinical characteristics associated with SHO, such as insulin dose and duration of diabetes, or unmeasured confounders.

Conclusions: The burden associated with SHO is not negligible. Nearly one in three patients using only basal insulin and one in four patients using basal-bolus regimens who experienced SHO were hospitalized at least once due to SHO. Not only did those patients incur the costs of their SHO hospitalization, but they also incurred at least $1,116 (62%) and $875 (70%) more per month than outpatient SHO or comparison patients. Reducing SHO events can help decrease the burden associated with SHO among patients with T2DM.     

基础胰岛素联合二甲双胍治疗2型糖尿病的短期疗效和安全性观察

目的对口服降糖药不能很好控制血糖的2型糖尿病患者,改用二甲双胍联合(重组)甘精胰岛素(来得时、长秀霖)或诺和灵N治疗,比较3种治疗方案的疗效和安全性。方法将63例符合标准的2型糖尿病患者分为3组,分别给予诺和灵N(n=23)、来得时(n=20)、长秀霖(n=20)睡前皮下注射,三组均联合二甲双胍口服。观察住院期间空腹血糖的变化和胰岛素剂量及低血糖发生率。结果治疗后三组空腹血糖均明显下降(P<0.05),但组间比较差异无统计学意义。来得时组和诺和灵N组、来得时组和长秀霖组在出院时单位体重胰岛素用量相似,长秀霖组较诺和灵N组在出院时单位体重胰岛素用量多(P=0.017)。(重组)甘精胰岛素组低血糖发生率明显低于诺和灵N组(P<0.05)。结论对口服降糖药控制不佳的2型糖尿病患者,应用二甲双胍联合来得时或长秀霖治疗的疗效和安全性相似;来得时的短期疗效和NPH相似;来得时和长秀霖较诺和灵N有更安全的降糖效果。     

Pharmacokinetics and pharmacodynamics of insulin lispro protamine suspension compared with insulin glargine and insulin detemir in type 2 diabetes

Abstract

Objective:

The primary aim was to evaluate duration of action of a single 0.8?U/kg dose of insulin lispro protamine suspension (ILPS) in type 2 diabetes (T2DM) patients; secondarily to compare onset and duration of action of ILPS, glargine (G), and detemir (D) (0.8?U/kg) and evaluate pharmacokinetic (PK) and pharmacodynamic (PD) dose responses of ILPS.     

Real-world comparative outcomes of US type 2 diabetes patients initiating analog basal insulin therapy

Abstract

Objective:

To evaluate outcomes in insulin-naive patients with type 2 diabetes mellitus (T2DM) who initiated insulin glargine or insulin detemir.     

Adherence patterns in patients with type 2 diabetes on basal insulin analogues: missed,mistimed and reduced doses

Abstract

Objective:

To describe basal insulin analogue dosing irregularities, the effect of these events on patient functioning, well-being and diabetes management, and the identification of patients most at risk.     

Insulin initiation in elderly patients with type 2 diabetes in France: a subpopulation of the LIGHT study

Abstract

Objective:

To examine the management of basal insulin analogue initiation in combination with oral antidiabetic drug (OAD) therapy in elderly patients with type 2 diabetes (aged ≥70 years) by physicians via comparison to the same treatment strategy in younger individuals (<70 years).     

The role of the new basal insulin analogs in addressing unmet clinical needs in people with type 1 and type 2 diabetes

Background: Despite improvements in anti-hyperglycemic therapies, there are many unmet clinical needs that hinder successful glycemic control in people being treated with current basal insulin analogs.

Objective: This paper reviews the unmet needs associated with current basal insulin therapy and describes the most recent basal insulins for the treatment of diabetes.

Methods: PubMed was searched for articles on basal insulin analogs published between 2000 and April 2016.

Results: Although long-acting insulin analogs, such as insulin glargine 100 units/mL and insulin detemir, have come towards approximating physiologic basal insulin levels, limitations such as hypoglycemia and intra- and inter-individual variability are associated with their use resulting in glycemic fluctuations. Some basal insulins lack 24?hour coverage, requiring some patients to split their dose, increasing the number of injections required to maintain glycemic control. Fear of hypoglycemia and the need for additional injections often leads to poor compliance and suboptimal glycemic control. Long-acting insulin analogs, such as insulin glargine 300 units/mL and insulin degludec, have improved upon the shortcomings of the current basal insulin analogs. Improved pharmacodynamic/pharmacokinetic profiles afford lower intra-patient variability and an extended duration of action, providing full and stable 24?hour basal insulin coverage with once daily dosing, and comparable efficacy to insulin glargine with lower rates of hypoglycemia.

Conclusion: The improved pharmacodynamic/pharmacokinetic profiles of new long-acting insulin formulations provide greater glycemic control with once daily dosing. With the growing number of therapeutic choices available, physicians have more scope to individualize patient options for basal insulin therapy.     

胰高血糖素与2型糖尿病病人胰岛素抵抗关系研究

目的　探讨胰高血糖素 (Glu)与 2型糖尿病 (DM)病人胰岛素抵抗 (IR)的关系。方法　对 1 0 0例 2型DM病人分别检测空腹及 75g葡萄糖粉负荷 2h血糖 (BG)、胰岛素 (Ins)、C肽、Glu。并以空腹血糖 /空腹胰岛素 (G/I) <6作为IR指标。将G/I<6 ,G/I≥ 6两组的Glu进行统计学的比较。结果　G/I <6组较G/I≥ 6组Glu空腹及糖负荷后均明显升高 (P <0 0 5 ,P <0 0 1 )。结论　Glu可能参与了 2型糖尿病IR的形成     

老年2型糖尿病患者治疗过程中发生严重低血糖的危险因素

目的考察老年2型糖尿病患者治疗过程中发生严重低血糖的危险因素。方法选择2013年5月-2014年5月收治的发生严重低血糖的糖尿病患者100例并设为观察组,并选取同期收治的未发生严重低血糖的糖尿病患者100例作为对照组,比较两组患者的临床资料,并分析出现严重低血糖的影响因素。结果两组患者的年龄、病程、体重指数（BMI）、血清肌酐（Cr）、尿微量清蛋白（UMA）比较,差异有统计学意义（P〈0.05,P〈0.01）;经Logistic多元回归分析检测,年龄（OR=1.81,P〈0.01）、BMI（OR=0.65,P〈0.05）和UMA（OR=2.39,P〈0.05）是严重低血糖发生的危险因素,其中高BMI是2型糖尿病患者发生严重低血糖的保护性因素,而年龄和UMA则是危险因素。结论2型糖尿病治疗过程中的严重低血糖是多种因素共同作用的结果,减少危险因素并针对性地进行护理有助于降低严重低血糖的发生。     

2型糖尿病患者血清FFA浓度与胰岛素抵抗关系

目的 :探讨2型糖尿病(DM2)患者空腹与餐后2小时游离脂肪酸 (FFA)浓度水平及脂类和胰岛素抵抗关系。方法 :以DM2患者110例 ,正常对照45例为研究对象 ,测定其患者的体重指数 (BMI)、腰臀比 (WHR)、甘油三脂 (TG)、总胆固醇 (TC)、高密度脂蛋白 (HDL)、低密度脂蛋白 (LDL)、空腹胰岛素 (FINS)、糖化血红蛋白 (GHbA1c)、空腹和餐后2小时血糖、游离脂肪酸 (FPG、2PG、FFA、2hFFA) ,胰岛素抵抗(IR)以稳态模式评估法(HomeostasisModelAssessment,HOMA)来评价 ,表达式为〔空腹胰岛素 (mU/L)×空腹血糖 (mmol/L)〕/22.5 ,大于2.75为胰岛素抵抗 ,小于2.75为胰岛素敏感。结果 :DM2患者的FFA、BG、GHbA1c、TG、LDL、均显著增高 ,与HOMA -IR呈明显的正相关 ,与对照组比较 ,P<0.001或P<0.05。结论 :DM2患者体内FFA的增高在胰岛素抵抗的发生过程中可能起了重要作用 ,与DM2的发病机理有密切关系。     

2型糖尿病末梢神经病变影响因素探讨

目的探讨糖尿病末梢神经病变影响因素及与其他慢性并发症的关系。方法选择我院 2型糖尿病住院病人 2 4 5例 ,按是否合并末梢神经病变分为两组 ,观察其年龄、病程、体重指数、空腹血糖 (FBG)、餐后 2小时血糖 (2hPBG)、糖化血红蛋白 (HbA1 c)、甘油三脂、胆固醇及其糖尿病肾病、糖尿病视网膜病变、冠心病的发生率。结果糖尿病末梢神经病变组FBG、2hPBG、HbA1 c较对照组明显增高 (P <0 .0 5或P <0 .0 1 ) ,病程明显延长 (P <0 .0 1 )。其合并糖尿病肾病 ,糖尿病视网膜病变及冠心病的发生率亦高于对照组 (P <0 .0 5或P <0 .0 1 )。结论长期血糖控制不良为糖尿病末梢神经病变的危险因素 ;糖尿病末梢神经病变与其他慢性并发症关系密切     

Comparative evaluation of biphasic insulin with metformin and triple oral hypoglycemic agents (OHA) in type 2 diabetes patients

IntroductionThe prevalence of secondary failure to oral hypoglycemic agents among type 2 diabetes mellitus (T2DM) patients ranges from 30 to 60%. The alternative approaches to overcome this issue are either switching to triple oral hypoglycemic agents (OHA) or intensifying the regimen by adding insulin.ObjectiveTo compare the glycemic control achieved with biphasic insulin plus metformin and triple OHA in T2DM patients who were not adequately controlled with two OHA regimen.MethodsA qualitative prospective study was conducted at Asir diabetes center, Abha, KSA. Poorly controlled T2DM patients with two OHA for at least 1 year with glycated hemoglobin (HbA1c) >7.0% were included. Subjects were divided into group I (a third OHA was added to the existing two OHA regimen) and group II (switched over to Biphasic insulin and metformin). At baseline and 3-month intervals, level of HbA1C, Fasting Plasma Glucose (FPG), Postprandial Plasma Glucose (PPG), Blood Pressure (BP), lipid profile and hypoglycemic episodes were obtained and evaluated for one year.Results41.1% of patients were in group I and 58.9% were in group II. At the end of the study, there was a significant reduction in HbA1c in group II subjects comparing to group I (8.18 ± 1.32 vs 8.79 ± 1.81, p = 0.0238). FPG and PPG were improved also in group II. The mean body weight increased from baseline in group II is +4.48 kg and decreased from baseline in group I (−0.46 kg). 11.3% from group I and 23.7% from group II reported hypoglycaemic incidences.ConclusionBiphasic insulin and metformin regimen could be an appropriate therapeutic option for achieving good glycemic control compared with triple OHA in patients with two OHA failure.     

2型糖尿病并发严重下肢动脉阻塞性病变的相关因素分析

目的总结2型糖尿病并发严重下肢动脉阻塞性病变的相关危险因素。方法将340例2型糖尿病患者按照是否有并发严重下肢动脉阻塞性病变分为观察组（并发下肢动脉阻塞性病变）110例和对照组（无下肢动脉阻塞性病变）230例。记录两组患者年龄、病程、有无高血压史、体重指数、血压（收缩压和舒张压）、总胆固醇、三酰甘油、低密度脂蛋白胆固醇（LDL—C）和高密度脂蛋白胆同醇（HDL—C）、尿酸、糖化血红蛋白（HbAIC）,并使用SPSS进行单因素和逻辑斯蒂多因素回归分析,以总结2型糖尿病并发严重下肢动脉阻塞性病变的危险因素。结果单因素分析结果表明：性别比、年龄、病程、吸烟史、高血压史、HbAlC、三酰甘油、尿酸和踝臂指数是诱发严重下肢动脉阻塞性病变的危险因素（P〈0．05）。多因素回归分析表明：性别、年龄、病程、高血压史、HbAlC、三酰甘油、尿酸是导致2型糖尿病并发严重下肢动脉阻塞性病变的主要原因（P〈0．05）。结论对男性老年患者积极控制血糖、血压、高尿酸和三酰甘油可以较好预防2型糖尿病并发严重下肢动脉阻塞性病变的发生。     

2型糖尿病脂肪肝与胰岛素抵抗的关系

目的：探讨2型糖尿病脂肪肝与胰岛素抵抗的关系。方法：对81例糖尿病并脂肪肝患者与80例未合并脂肪肝患者的血糖， 脂，胰岛素进行测定，计算胰岛素敏感指数（IAI），体重指数（BMI）并进行分析比较，结果：2型尿病并脂肪肝时IAI显著降低，而餐后2小时血糖，甘油三酯，空腹胰岛素，体重指数均显著高于对照组。结论：2型糖尿病人脂肪肝的发生与胰岛素抵抗关系密切，提示改善胰岛素抵抗对糖尿病脂肪肝病人具有重要意义。     

胰岛素泵强化治疗对新诊断2型糖尿病的疗效观察

目的观察短期胰岛素泵强化治疗对新诊断2型糖尿病患者血糖达标时间及3个月后复查糖基化血红蛋白的控制情况,从而改变糖尿病的临床进程。方法66例新诊断2型糖尿病患者随机分成两组,治疗组34例,给予2周时间胰岛素强化治疗后,改口服降糖药治疗;对照组32例给予直接口服药治疗,分别观察2组患者血糖达标时间及3个月后糖基化血红蛋白的控制情况。结果治疗组血糖达标达标时间为（2．5±0．8）d,对照组血糖达标时间为（7．5±1．6）d,2组数据比较差异有统计学意义（P〈0．01）。3个月后糖基化血红蛋白情况,治疗组为（5．4±1．5）％,对照组为（6．3±1．8）％,2组数据对照差异有统计学意义（P〈0．05）。结论新诊断2型糖尿病患者,经短期胰岛素泵强化治疗,能缩短血糖达标时间并维持长时间血糖的良好控制。     

胰岛素强化治疗在2型糖尿病患者中的疗效分析

目的探讨胰岛素强化治疗在2型糖尿病患者中的临床效果。方法将我院收治的60例2型糖尿病患者,随机分为强化组1和强化组2,组1给予门冬胰岛素30治疗,组2给予门冬胰岛素联合甘精胰岛素治疗,比较两组血糖控制情况及不良反应发生情况。结果组1、组2治疗前后FPG、2hPG差异有统计学意义(P<0.05)。组2与组1治疗前、后FPG、2hPG差异无统计学意义(P>0.05)。组2血糖达标时间低于组1,差异有统计学意义(P<0.05)。组2胰岛素用量低于组1,差异有统计学意义(P<0.05)。结论 2型糖尿病患者用门冬胰岛素联合甘精胰岛素强化治疗与用门冬胰岛素30治疗相比,有效性相似,血糖达标快,胰岛素用量少,值得临床推广应用。