Impact of patient education on KAP,medication adherence and therapeutic outcomes of metformin versus insulin therapy in patients with gestational diabetes: A Hospital based pilot study in South India

Background and aimThe study assessed the impact of continuous patient education on Knowledge, Attitude, Practice (KAP), medication adherence and extent of glycemic control in pregnant women with gestational diabetes on insulin or metformin therapy.Methods81 women with gestational diabetes (37 on insulin and 44 on metformin) were assessed for KAP using a validated questionnaire and medication adherence using the 8-items Morisky medication adherence scale, fasting, and postprandial blood glucose levels at the baseline and after two education sessions on drug therapy at one and three months intervals. The difference in mean KAP, medication adherence scores, fasting, and postprandial blood glucose levels and the extent of glycemic control with insulin or metformin therapy were assessed statistically.ResultsThere was a highly significant difference in the mean KAP, medication adherence scores, fasting and postprandial blood glucose levels from baseline to follow-up after three months, (P < 0.0001) indicating that continuous patient education had a positive impact on their KAP, medication adherence, blood glucose levels.ConclusionThe study identified that continuous patient education improved their knowledge and practice of medication adherence which reflected on lowered fasting and postprandial blood glucose levels. Glycemic control was found to be the same with metformin and insulin in gestational diabetes.     

门冬胰岛素与人胰岛素对妊娠合并糖代谢异常患者的有效性及安全性

目的分析对比门冬胰岛素与人胰岛素对妊娠合并糖代谢异常患者的有效性及安全性及其对妊娠结局的影响。方法将2004年1月1日至2010年5月31日接受孕期检查并分娩的应用门冬胰岛素控制血糖的妊娠合并糖代谢异常者纳入分析（Asp组，n=77），其中妊娠合并糖尿病（DM）患者22例、妊娠期糖尿病（GDM）患者55例。选择同期接受孕期检查并分娩的应用人胰岛素控制血糖的妊娠合并糖代谢异常患者（HI组，n=77）按1：1作为对照进行回顾性对比研究。对比2组胰岛素治疗前后血糖变化、血糖下降至正常水平所需时间、胰岛素最大用量、治疗期间低血糖事件发生率及分娩结局。2组数据比较用t检验及秩和检验。结果治疗1周后，Asp组DM患者早餐、晚餐后2h血糖分别为（6．5±1．1）和（7．1±1．1）mmol／L，HI组则分别为（8．0±1．1）和（7．8±0．8）mmol／L；而Asp组GDM患者早餐、午餐和晚餐后2h血糖分别为（6．5±0．7）、（6．8±0．7）和（6．7±0．7）mmol／L，HI组则分别为（7．1±0．9）、（7．3±0．9）和（7．4±0．8）mmol／L；Asp组餐后2h血糖水平均低于Ⅲ组，差异均有统计学意义（均P〈0．05）。Asp组DM患者早餐后2h血糖首次下降至正常水平所需时间为（3．0±2．2）d，HI组则为（5．0±2．1）d；Asp组GDM患者早餐后2h血糖首次下降至正常水平所需时间为（2．3±1．6）d，HI组则为（4．3±2．6）d；Asp组餐后血糖下降至正常水平所需时间均比HI组短，差异均有统计学意义（均P〈0．05）。Asp组低血糖事件发生率为3．9％（DM患者1例，GDM患者2例），HI组为24．7％（DM患者8例，GDM患者11例）（P〈0．05）。Asp组DM患者新生儿低血糖发生率及新生儿转儿科率分别为4．5％、36．4％，而HI组为18．2％、50．0％；Asp组GDM患者巨大儿、新生儿低血糖发生率及转儿科率分别为10．9％、3．6％、25．5％，HI组则分别为18．2％、10．9％、38．2％；Asp组的分娩结局有优于HI组的趋势，但2组间差异均无统计学意义（均P〉0．05）。结论在妊娠合并糖代谢异常孕妇中，相比人胰岛素，门冬胰岛素能更快、更有效地控制血糖，同时可明显降低低血糖事件的发生。对分娩结局的影响方面，Asp组有优于Ⅲ组的趋势。     

Critical illness hyperglycemia in pediatric cardiac surgery

Critical illness hyperglycemia (CIH) is common in pediatric and adult intensive care units (ICUs). Children undergoing surgical repair or palliation of congenital cardiac defects are particularly at risk for CIH and its occurrence has been associated with increased morbidity and mortality in this population. Strict glycemic control through the use of intensive insulin therapy (IIT) has been shown to improve outcomes in some adult and pediatric studies, yet these findings have sparked controversy. The practice of strict glycemic control has been slow in extending to pediatric ICUs because of the documented increase in the incidence of hypoglycemia in patients treated with IIT. Protocol driven approaches with more liberal glycemic targets have been successfully validated in general and cardiac critical care pediatric patients with low rates of hypoglycemia. It is unknown whether a therapeutic benefit is obtained by keeping patients in this more liberal glycemic control target. Definitive randomized controlled trials of IIT utilizing these targets in critically ill children are ongoing.     

Technical Challenges and Clinical Outcomes of Using a Closed-Loop Glycemic Control System in the Hospital

According to large randomized trials, results suggest that maintaining normoglycemia postoperatively through tight glycemic control (TGC) and intensive insulin therapy (IIT) can improve surgical outcomes as well as reduce mortality and morbidity in critically ill patients. However, trials examining the effects of TGC have had conflicting results. Systematic reviews and meta-analyses have also led to differing conclusions. The main reason these clinical trials and meta-analyses show negative results for TGC is the high incidence of hypoglycemia induced by IIT. This could not be prevented because there is no reliable technique that can avoid this condition during IIT. The development of accurate, continuous blood glucose monitoring devices and closed-loop systems for computer-assisted blood glucose control in the intensive care unit (ICU) will probably help avoid hypoglycemia in these situations.The STG closed-loop glycemic control system was introduced to our department to be used and evaluated for strict serum glucose control with no hypoglycemic episodes during IIT in the surgical ICU, to reduce the workload of ICU nurses, and to decrease incidents related to the management of blood glucose levels according to manual conventional venous infusion insulin therapy. The goal of our team was to use the STG closed-loop glycemic control system for perioperative TGC in surgical patients to solve the complications of IIT and reduce risk of hypoglycemia. The challenge at our hospital demonstrated that the STG closed-loop glycemic control system can be expected to achieve TGC with no occurrence of hypoglycemia induced by IIT after surgery.     

A smartphone application of diabetes coaching intervention to prevent the onset of complications and to improve diabetes self-management: A randomized control trial

Background and aimDiabetes mellitus (DM) has been a worldwide public health problem during the last two decades. To examine the effect of a smartphone application of diabetes coaching intervention on improving self-management behaviors and preventing onset diabetes complications.MethodsA randomized control trial, two groups, pre-test, and post-test design with a non-equivalent control group was conducted. The intervention group received a 12-week smartphone application of diabetes coaching intervention to improve diabetes self-management behaviors and to prevent onset diabetes complications. While the control group received the usual care from the community health centers. The smartphone application consisted of narrative App-based coaching, a printed user guide, mindfulness-based coaching; skill-based coaching, and a small App-interaction.ResultsAfter implementation, the self-management behaviors among the experimental group were improved than the control group in terms of dietary control, physical exercise, blood glucose monitoring, medication adherence, and screening of complications. The clinical outcomes were also significantly improved among the experimental group and to the control group.ConclusionsA smartphone application-based diabetes coaching intervention was feasible to apply as a nationwide program to promote diabetes self-management (DSM) during the covid-19 pandemic     

Intensive insulin therapy in critically ill hospitalized patients: making it safe and effective

Intensive insulin therapy (IIT) for hyperglycemia in critically ill patients has become a standard practice. Target levels for glycemia have fluctuated since 2000, as evidence initially indicated that tight glycemic control to so-called normoglycemia (80–110 mg/dl) leads to the lowest morbidity and mortality without hypoglycemic complications. Subsequent studies have demonstrated minimal clinical benefit combined with greater hypoglycemic morbidity and mortality with tight glycemic control in this population. The consensus glycemic targets were then liberalized to the mid 100s (mg/dl).Handheld POC blood glucose (BG) monitors have migrated from the outpatient setting to the hospital environment because they save time and money for managing critically ill patients who require IIT. These devices are less accurate than hospital-grade POC blood analyzers or central laboratory analyzers.Three questions must be answered to understand the role of IIT for defined populations of critically ill patients: (1) How safe is IIT, with various glycemic targets, from the risk of hypoglycemia? (2) How tightly must BG be controlled for this approach to be effective? (3) What role does the accuracy of BG measurements play in affecting the safety of this method? For each state of impaired glucose regulation seen in the hospital, such as hyperglycemia, hypoglycemia, or glucose variability, the benefits, risks, and goals of treatment, including IIT, might differ.With improved accuracy of BG monitors, IIT might be rendered even more intensive than at present, because patients will be less likely to receive inadvertent overdosages of insulin. Greater doses of insulin, but with dosing based on more accurate glucose levels, might result in less hypoglycemia, less hyperglycemia, and less glycemic variability.     

Response to insulin glargine 100 U/mL treatment in newly-defined subgroups of type 2 diabetes: Post hoc pooled analysis of insulin-naïve participants from nine randomised clinical trials

AimsTo assess insulin glargine 100 U/mL (IGlar-100) treatment outcomes according to newly-defined subgroups of type 2 diabetes mellitus (T2DM).MethodsInsulin-naïve T2DM participants (n = 2684) from nine randomised clinical trials initiating IGlar-100 were pooled and assigned to subgroups “Mild Age-Related Diabetes (MARD)”, “Mild Obesity Diabetes (MOD)”, “Severe Insulin Resistant Diabetes (SIRD)”, and “Severe Insulin Deficient Diabetes (SIDD)”, according to age at onset of diabetes, baseline HbA1c, BMI, and fasting C-peptide using sex-specific nearest centroid approach. HbA1c, FPG, hypoglycemia, insulin dose, and body weight were analysed at baseline and 24 weeks.ResultsSubgroup distribution was MARD 15.3 % (n = 411), MOD 39.8 % (n = 1067), SIRD 10.5 % (n = 283), SIDD 34.4 % (n = 923). From baseline HbA1c 8.0–9.6% adjusted least square mean reductions after 24 weeks were similar between subgroups (1.4–1.5 %). SIDD was less likely to achieve HbA1c < 7.0 % (OR: 0.40 [0.29, 0.55]) than MARD. While the final IGlar-100 dose (0.36 U/kg) in MARD was lower than in other subgroups (0.46–0.50 U/kg), it had the highest hypoglycemia risk. SIRD had lowest hypoglycemia risk and SIDD exhibited greatest body weight gain.ConclusionsIGlar-100 lowered hyperglycemia similarly in all T2DM subgroups, but level of glycemic control, insulin dose, and hypoglycemia risk differed between subgroups.     

Starting patients with type 2 diabetes on insulin therapy using once-daily injections of biphasic insulin aspart 70/30, biphasic human insulin 70/30, or NPH insulin in combination with metformin

Transitioning safely to insulin therapy when oral antidiabetic agents fail to provide adequate glycemic control is a critical aspect of care for the patient with type 2 diabetes mellitus (T2DM). We evaluated the clinical effectiveness of starting patients on a relatively simple regimen of once-daily injections of either biphasic insulin aspart 70/30 (10 min before dinner), NPH insulin (at 10 p.m.), or biphasic human insulin 70/30 (30 min before dinner) in combination with metformin. Enrolled patients had T2DM and inadequate glycemic control (AlC≥7.5%) on a previous regimen of metformin as monotherapy or in combination with a sulphonylurea. One hundred and forty (140) patients received metformin monotherapy for 4 weeks followed by 12 weeks of combination treatment with metformin and once-daily insulin injections. AlC levels decreased from baseline by 1.1–1.3% for patients in each of the three treatment groups. Overall, FPG values decreased from baseline by 31% (biphasic insulin aspart), 37% (NPH insulin), and 28% (biphasic human insulin). Subjects whose final FPG level was <126 mg/dl experienced the largest decreases in AlC values (−2.3%, −1.9%, −1.8%, respectively). All three treatment regimens were well tolerated. The results indicate that patients with T2DM can safely and effectively begin insulin therapy using once-daily injections of biphasic insulin aspart 70/30, biphasic human insulin 70/30, or NPH insulin in combination with metformin.     

A prospective randomized trial comparing computerized columnar insulin dosing chart (the Atlanta protocol) versus the joint British diabetes societies for inpatient care protocol in management of hyperglycemia in patients with acute coronary syndrome admitted to cardiac care unit in Alexandria,Egypt

BackgroundHyperglycemia in acute coronary syndrome (ACS) is linked to raised morbidity and mortality. Insulin administration using insulin infusion protocols (IIP) is the preferred strategy to control hyperglycemia in critically ill patients. To date, no specific IIP has been identified as the most efficient for achieving glycemic control.Aimto compare glycemic achievements (safety) (primary objective), and coronary and other clinical outcomes (efficacy) (secondary objective) by hyperglycemia management in Cardiac Care Unit (CCU) using computerized Atlanta Protocol (Group (I)) versus paper-based Joint British Diabetes Societies (JBDS) For Inpatient Care Protocol (Group (II)).Patients and methodsThe study was done on 100 ACS patients admitted to Alexandria Main University hospital CCU with RBG >180 mg/dL. They were randomized into the 2 groups in a 1:1 ratio. CBG was measured hourly for 72 hours and was managed by IV insulin infusion.ResultsGroup (I) showed statistically significant less mean time for target BG achievement (3.52 ± 1.53hours), lower incidence of Level 1 hypoglycemia (2%) than Group (II) (4.76 ± 2.33 hours, 22%, p = 0.013, 0.002 respectively) and statistically significant less mean number of episodes above the glycemic target after its achievement than Group (II) (p < 0.001). Regarding Level 2 hypoglycemia the difference was not significant statistically.ConclusionBoth protocols successfully maintained target BG level with low incidence of clinically significant hypoglycemia, however, the computerized Atlanta protocol achieved better glycemic outcomes. We recommend the use of the computerized Atlanta protocol in CCU rather than JBDS for Inpatient Care Protocol whenever this is feasible.     

胰岛素泵皮下注射和多次胰岛素皮下注射治疗妊娠期糖尿病的疗效比较

目的分析经胰岛素泵开展皮下注射与多次皮下注射胰岛素对妊娠期糖尿病(GDM)的疗效。方法将2017年1月—2019年8月该院收治的GDM患者共72例为研究对象,依据随机数表法分成对照组(多次皮下注射胰岛素)和观察组(经胰岛素泵开展皮下注射),各36例,比较两组治疗前后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、胰岛素用量、血糖达标时间、低血糖及并发症情况。结果治疗前,两组FPG、2 hPG以及HbA1c水平对比差异无统计学意义(P>0.05);治疗后5 d,观察组FPG、2 hPG水平均低于对照组,胰岛素用量少于对照组,血糖达标所需天数短于对照组,差异有统计学意义(P<0.05)。观察组妊高症、早产、羊水过多、产后出血以及巨大儿等并发症出现少于对照组,差异有统计学意义(P<0.05)。结论和多次皮下注射胰岛素对比,予以GDM患者胰岛素泵皮下注射能更好地控制其血糖水平,减少低血糖和母婴并发症出现,效果更佳。     

Improving blood pressure control through a clinical pharmacist outreach program in Diabetes patients in two-high performing health Systems: the adherence and intensification of medications (AIM) cluster randomized controlled pragmatic trial

Background Even in high performing health systems, some diabetes patients have poor blood pressure (BP) control due to poor medication adherence and lack of medication intensification. We examined whether the Adherence and Intensification of Medications (AIM) intervention, a pharmacist-led intervention combining elements found in efficacy studies to lower BP, improved BP among diabetes patients with persistent hypertension and poor refill adherence or insufficient medication intensification in two high-performing health systems. Methods and Results We conducted a prospective, multi-site cluster randomized pragmatic trial with randomization of 16 primary care teams at five medical centers (3 Veterans Affairs and 2 Kaiser Permanente) to the AIM intervention or usual care. The primary outcome was relative change in systolic BP (SBP), comparing 1,797 intervention to 2,303 control team patients, from 6-months preceding to 6-months following the 14-month intervention period. We examined shorter-term changes in SBP as a secondary outcome. The mean SBP decrease from 6 months prior to 6 months after the intervention period was approximately 9 mmHg in both arms. Mean SBPs of eligible intervention patients were 2.4 mmHg lower (95% CI: -3.4 to -1.5; P < 0.001) immediately after the intervention than those achieved by control patients. Conslusions The AIM program more rapidly lowered SBPs among intervention patients, but usual care patients achieved equally low SBP levels by 6 months after the intervention period. These findings show the importance of evaluating in different real-life clinical settings programs found in efficacy trials to be effective before urging their widespread adoption in all settings.     

Maternal and neonatal outcomes after energy-restricted diet for women with gestational diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials

Background:Gestational diabetes mellitus (GDM) affects 1% to 14% of pregnant women annually worldwide and is one of the most common pregnancy complications.Objective:We reviewed studies on maternal and neonatal outcomes after dietary managements for women with GDM comparing caloric-restricted (intervention group) and unrestricted diets (control group).Methods:We systematically searched online databases including Medline, Cochrane Controlled Register of Trials (CENTRAL), ScienceDirect, and Google Scholar from inception until September 2019. We performed a meta-analysis with random-effects model and reported pooled risk ratios (RRs) or pooled mean differences (MD) with 95% confidence intervals (CIs).Results:We analyzed data from 6 randomized controlled trials including 1300 participants, most of them with high bias risks. We found that the women in the intervention group achieved slightly better glycemic control (pooled MD, −0.72 mg/dL; 95% CI, −7.10 to 5.66 mg/dL) and overall pregnancy outcomes (except neonatal hypoglycemia) than the women in the control group.Conclusion:An energy-restricted diet does not seem superior to the usual/standard GDM diet based on maternal or neonatal outcomes. But, clinical recommendations cannot be made as the evidence is inconclusive.     

Do automated calls with nurse follow-up improve self-care and glycemic control among vulnerable patients with diabetes?

PURPOSE: We sought to evaluate the effect of automated telephone assessment and self-care education calls with nurse follow-up on the management of diabetes. SUBJECTS AND METHODS: We enrolled 280 English- or Spanish-speaking adults with diabetes who were using hypoglycemic medications and who were treated in a county health care system. Patients were randomly assigned to usual care or to receive an intervention that consisted of usual care plus bi-weekly automated assessment and self-care education calls with telephone follow-up by a nurse educator. Outcomes measured at 12 months included survey-reported self-care, perceived glycemic control, and symptoms, as well as glycosylated hemoglobin (Hb A1c) and serum glucose levels. RESULTS: We collected follow-up data for 89% of enrollees (248 patients). Compared with usual care patients, intervention patients reported more frequent glucose monitoring, foot inspection, and weight monitoring, and fewer problems with medication adherence (all P -0.03). Follow-up Hb A,, levels were 0.3% lower in the intervention group (P = 0.1), and about twice as many intervention patients had Hb A1c levels within the normal range (P = 0.04). Serum glucose levels were 41 mg/dL lower among intervention patients than usual care patients (P = 0.002). Intervention patients also reported better glycemic control (P = 0.005) and fewer diabetic symptoms (P <0.0001 ), including fewer symptoms of hyperglycemia and hypoglycemia. CONCLUSIONS: Automated calls with telephone nurse follow-up may be an effective strategy for improving self-care behavior and glycemic control, and for decreasing symptoms among vulnerable patients with diabetes.     

Improving Glycemic Control in Type 2 Diabetes Using Mobile Applications and e-Coaching: A Mixed Treatment Comparison Network Meta-Analysis

Objectives:This study compared the effectiveness of glycemic control among usual care, care management using a mobile application (app), and management using an app with additional e-coaching for patients with type 2 diabetes mellitus (T2DM) using a mixed treatment comparison (MTC) network meta-analysis (NMA).Methods:A systematic search for published randomized controlled trials (RCTs) was conducted, which included Pubmed, Web of Science, Cochrane Central Register of Controlled Trials, CINAL, Koreamed, KMbase, and ScienceOn, until October 2020. Among the 10,391 studies identified after removing duplicates, 14 RCTs were finally included in the MTC NMA. Data extraction and methodological quality assessment using version 2 of the Cochrane tool for assessing the risk-of-bias in randomized trials (RoB 2) was performed. The comparative efficacy was analyzed using the random-effects NMA based on a frequentist model by the intervention group and main outcome variables.Results:At the 3-month follow-up after each intervention, a comparison of the P-scores revealed the app plus e-coaching intervention to be the most effective method for reducing the HbA1c level in a homogeneous gender ratio group (P-score 0.92). At the 6-month follow-up period, app intervention was the best in reducing the HbA1c level in the homogeneous gender ratio and under 60 years of age group (P-score 1.00).Conclusions:Based on MTC analysis using the data from published RCTs, mobile apps or apps with e-coaching interventions for T2DM patients were more effective in improving the HbA1c values, FBS, and hypoglycemia frequency than usual care. Nevertheless, further research will be needed to clarify the effects of adding e-coaching to the app.Study registration:Research Registry UIN (reviewregistry780)     

A comparison of insulin lispro and buffered regular human insulin administered via continuous subcutaneous insulin infusion pump

This study compared glycemic control achieved with insulin lispro or buffered regular human insulin in patients with Type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) using an external insulin pump. In this 24-week multicenter, randomized, two-way crossover, open-label trial, 58 patients on CSII with adequate glycemic control received either insulin lispro or buffered regular human insulin for 12 weeks, followed by the alternate treatment for another 12 weeks. Efficacy and safety measures included hemoglobin A_1c (HbA_1c) at baseline and endpoint, home blood glucose monitoring, hypoglycemia, and frequency of pump catheter occlusion. Patients consumed a standard test meal on three occasions, with determinations of fasting, 1- and 2-h postprandial glucose values. Insulin lispro use was associated with a significantly lower HbA_1c than was buffered regular human insulin (7.41±0.97 vs. 7.65±0.85 mmol/l; P=.004). Fasting serum glucose values before the test meal were similar between the two therapies. The 1-h (11.16±4.29 vs. 13.20±4.68 mmol/l; P=.012) and 2-h (9.64±4.10 vs. 12.53±4.64 mmol/l; P=.001) postprandial glucose concentrations were significantly lower during treatment with insulin lispro. No differences between treatments were observed in basal or bolus insulin doses, weight gain, or the incidence and rate of hypoglycemia, hyperglycemia, or pump occlusions. When used in external pumps, insulin lispro provides better glycemic control than buffered regular human insulin with a similar adverse event profile.     

Maternal and neonatal outcomes in women with recurrent gestational diabetes mellitus

Background and aimsThe aim of the study was to evaluate the maternal and neonatal outcomes in women with recurrent gestational diabetes mellitus (GDM), compared to women with GDM.MethodsThis prospective observational cohort study was done on multiparous women with GDM attending the two tertiary care hospitals. Subjects were divided into two groups, recurrent GDM and GDM. Demographics, clinical variables, and maternal and neonatal outcomes were recorded between the two groups. The postpartum glycemic status was determined at six months.ResultsThere were 36 (20.2%) women with recurrent GDM and 142 (79.8%) women with GDM. Women with recurrent GDM were older (32.4 ± 6.2 versus 29.8 ± 5.6 years), had higher frequency of obesity, and insulin resistance than women with GDM. Women with recurrent GDM had poor glycemia at diagnosis as compared to GDM. Although the glycemic goals achieved were comparable but women with recurrent GDM have increased frequency of gestational hypertension, preeclampsia, and need for cesarean section. Women with recurrent GDM significantly had higher frequency of large for gestational age (LGA) and macrosomic neonates. Postpartum diabetes at six months was significantly higher in women with recurrent GDM.ConclusionWomen with recurrent GDM are at increased risk of adverse maternal and perinatal outcomes despite achieving optimal glycemic goals and also at the most significant risk of postpartum diabetes.     

地特胰岛素在特殊类型糖尿病患者中的应用

基础胰岛素类似物（地特胰岛素,Det）对于T1DM患儿和青少年,使用灵活、夜间低血糖风险小,餐后低血糖风险小,提高了患者及家庭的生活质量.妊娠期糖尿病（GDM）优化血糖管理有助于改善孕妇和新生儿的预后,Det能提供良好的血糖控制,且在孕妇中耐受良好.对于老年糖尿病患者,低血糖与心肌梗死、死亡风险、痴呆及骨折等不良事件相关,其可提供有效的血糖控制且对老年患者低血糖风险小.Det由于其作用特点,满足了特殊糖尿病患者的治疗需求.     

中国新诊断2型糖尿病胰岛素分泌和胰岛素抵抗特点调查

目的 研究中国新诊断2型糖尿病患者胰岛素分泌功能(IS)及胰岛素抵抗(IR)状况.方法 对405例新诊断2型糖尿病患者和40名糖耐量正常者(对照组)测量身高、体重;行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验.按空腹血糖(FPG)水平分为4组,与对照组比较.93例FPG≥8.3mmol/L者应用格列齐特(达美康)缓释片进行干预治疗1～3个月,血糖达标后重复OGTT并计算干预后的IR及IS.结果 (1)随着FPG水平的升高,糖尿病各组IR、IS逐级恶化:在FPG≥9.7mmol/L组,胰岛素敏感性为正常组的30%,IS仅为正常组的5%;(2)在FPG<9mmol/L组,IR能解释70%的血糖水平变化,而在FPG高于≥9mmol/L组,IS能解释60%的血糖变化;(3)格列齐特缓释片干预治疗IR及IS有了显著的改善.结论 新诊断2型糖尿病的IR及IS随空腹血糖升高而恶化,但是IS恶化更为严重;这种双重恶化在高血糖状态得到纠正后在相当程度上是可逆的.     

口服降糖药血糖控制不佳的2型糖尿病患者加用地特胰岛素或中效胰岛素治疗的疗效比较

目的 评估口服降糖药血糖控制不佳的T2DM患者联合地特胰岛素（Det）或中效胰岛素（NPH）治疗的有效性和安全性。方法80例血糖控制不佳的T2DM患者随机分为Det组和NPH组。在16周治疗期调整胰岛素剂量至FPG≤6．0mmol／L。记录治疗前后FPG、HbA,c、低血糖事件及体重。结果治疗16周,两组FPG及HbA-c均较基线下降,差异无统计学意义。Det组的体重增加明显低于NPH组,且低血糖风险减少42％。结论相比NPH,Det在有效控制血糖的同时,能降低低血糖发生风险及减少体重增加。     

Patient-Tailored Interventions to Improve Specialty Medication Adherence: Results from a Prospective Randomized Controlled Trial

BackgroundSpecialty medication nonadherence results in poor clinical outcomes and increased costs. This study evaluated the impact of patient-tailored interventions on specialty medication adherence.MethodsA pragmatic, randomized controlled trial was conducted at a single-center health-system specialty pharmacy from May 2019 to August 2021. Participants included recently nonadherent patients prescribed self-administered specialty medications from multiple specialty clinics. Eligible patients were stratified by historical clinic rates of nonadherence and randomized 1:1 to usual care or intervention arms. Intervention patients received patient-tailored interventions and 8 months of follow-up. A Wilcoxon test was used to analyze the difference in 6-, 8-, and 12-month post-enrollment adherence, calculated using proportion of days covered, between the intervention and usual care arms.ResultsFour hundred and thirty eight patients were randomized. Baseline characteristics were similar between groups: mostly women (68%), white (82%), with a median age of 54 years (interquartile range, 40, 64). The most common reasons for nonadherence in the intervention arm were memory (37%) and unreachability (28%). There was a significant difference in median proportion of days covered between patients in the usual care and intervention arms at 8-months (0.88 vs 0.94, P < .001), 6-months (0.90 vs 0.95, P = .003), and 12-months post-enrollment (0.87 vs 0.93, P < .001).ConclusionsPatient-tailored interventions resulted in significant specialty medication adherence improvement compared with standard of care. Specialty pharmacies should consider targeting nonadherent patients for adherence interventions.