Insulin最新文献_第4页

High blood pressure and diabetes 高血压和糖尿病

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80024-9

引用次数: 1

La presión alta y la diabetes 高血压与糖尿病

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80025-0

引用次数: 0

Diabetes in the Caribbean: Trouble in paradise 加勒比地区的糖尿病:天堂里的麻烦

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80018-3

M. Boyne

引用次数: 34

When a unit of insulin is not a unit: Detemir dosing and insulin cost in type 2 diabetes mellitus 当一个单位的胰岛素不是一个单位时：2型糖尿病患者的Detemir给药和胰岛素成本

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80017-1

Christopher K. Johnson BS, Mona Shimshi MD

{"title":"When a unit of insulin is not a unit: Detemir dosing and insulin cost in type 2 diabetes mellitus","authors":"Christopher K. Johnson BS, Mona Shimshi MD","doi":"10.1016/S1557-0843(09)80017-1","DOIUrl":"https://doi.org/10.1016/S1557-0843(09)80017-1","url":null,"abstract":"<div>Background: Increasing acceptance of basal-bolus insulin therapy for the control of diabetes mellitus (DM) has led to newer formulations of basal insulin analogues. The newest one is detemir.Objectives: Clinical evidence suggests that patients with type 2 DM require higher doses of detemir than other basal insulins to achieve equivalent glycemic control. This study examines evidence for greater dosing requirements and the implications of higher doses on the cost of insulin treatment.Methods: We performed a MEDLINE search for randomized, prospective studies comparing detemir with other basal insulins in patients with type 2 DM that were published in English between January 2000 and November 2008. The mean daily doses of basal and bolus insulin and the mean total daily insulin doses were determined. Overall weighted mean doses of the insulins were used to estimate the mean total daily insulin doses required for a 100-kg patient, and published 2008 US retail prices were used to estimate the retail costs of basal-bolus and basal-only insulin regimens.Results: Seven trials involving 3311 patients were identified in the literature search. The mean total daily insulin dose was 0.80 unit/kg for detemir-based regimens and 0.58 unit/kg for comparison regimens. For basal-bolus regimens, the estimated retail cost of the mean total daily insulin dose was $11.24 for detemir-based regimens compared with $8.99 for glargine-based regimens and $6.41 for neutral protamine Hagedorn (NPH)-based insulins. For basal-only regimens, the estimated retail cost of the mean total daily insulin dose was $8.23 for detemir compared with $5.19 for glargine and $2.35 for NPH.Conclusions: It is important for health care providers and patients to know that patients with type 2 DM may require substantially higher doses of detemir than other basal insulins. This should be considered when titrating the dose as well as in cost-benefit analyses of detemir versus other insulins.</div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"4 2","pages":"Pages 87-93"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(09)80017-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72277149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 5

Diabetes in the Caribbean: Trouble in paradise 加勒比地区的糖尿病：天堂里的麻烦

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80018-3

Michael S. Boyne MD

{"title":"Diabetes in the Caribbean: Trouble in paradise","authors":"Michael S. Boyne MD","doi":"10.1016/S1557-0843(09)80018-3","DOIUrl":"https://doi.org/10.1016/S1557-0843(09)80018-3","url":null,"abstract":"<div>Background: Many developing countries, including countries of the English-speaking Caribbean, are undergoing an epidemiologic transition and experiencing rapid increases in the prevalence of diabetes.Objectives: This article examines the epidemiology of diabetes, the types of diabetes, the etiologic factors and complications of diabetes, and the public health burden associated with diabetes in the Caribbean.Methods: An extensive PubMed literature search was conducted for the period 1951 to 2008 using the search terms diabetes, glucose intolerance, Caribbean, Jamaica, Barbados, Trinidad, Bahamas, Guyana, and the names of all the other English-speaking Caribbean countries.Results: Four hundred articles were identified in the literature search. Of these, 131 original articles were selected for inclusion in this review. Prevalence rates for diabetes ranged from 11% to 18% of the population in several countries. The prevalence of atypical diabetes (ketosis-prone diabetes) may be declining because of increases in the proportions of the population with type 2 diabetes mellitus. Ecologic studies show an east-to-west gradient from West Africa to the Caribbean for obesity and obesity-related diseases. The steep increase in the prevalence of obesity and the increase in sedentarism in Caribbean societies are the main risk factors driving the diabetes epidemic. The roles of early-life origins (specifically, in infants with low birth weight and rapid catch-up growth and/or macrosomic infants) and genetic factors await further clarification in this population. Diabetic foot, nephropathy, and stroke are common complications.Conclusions: In the English-speaking Caribbean, diabetes is a major public health burden that threatens the gross domestic product of these developing island nations. Macroeconomic initiatives are needed to start the combat against diabetes.</div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"4 2","pages":"Pages 94-105"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(09)80018-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72277151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 35

Case study 案例研究

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80023-7

Ronald Tamler MD, PhD

引用次数: 0

Erectile dysfunction and diabetes mellitus 勃起功能障碍与糖尿病

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80020-1

Konstantinos Hatzimouratidis MD, PhD, Dimitrios Hatzichristou MD

{"title":"Erectile dysfunction and diabetes mellitus","authors":"Konstantinos Hatzimouratidis MD, PhD, Dimitrios Hatzichristou MD","doi":"10.1016/S1557-0843(09)80020-1","DOIUrl":"https://doi.org/10.1016/S1557-0843(09)80020-1","url":null,"abstract":"<div>Background: Erectile dysfunction (ED) is highly prevalent, affecting ≥50% of men with diabetes mellitus (DM) worldwide.Objective: This article reviews current knowledge on the epidemiology and underlying pathophysiology of ED in men with DM, diagnostic modalities, and treatment options.Methods: A MEDLINE literature search was conducted for articles published in English from inception of the database through November 2008, using the terms erectile dysfunction, diabetes, epidemiology, pathophysiology, phosphodiesterase inhibitors, intracavernosal injection, and penile prosthesis. Data on the epidemiology, diagnosis, and treatment of ED were extracted from all relevant articles.Results: The literature search revealed 685 original articles and reviews, 67 of which were selected for inclusion in this review. DM may cause ED through a number of pathophysiologic changes, including neuropathy, endothe-lial dysfunction, cavernosal smooth muscle structural/functional changes, hormonal changes, and psychological effects. The diagnosis of ED in men with DM is based on their sexual and medical histories and results of validated questionnaires such as the International Index of Erectile Function. Laboratory examinations are usually limited to testosterone and prolactin levels that may independently contribute to ED because specialized examinations are not necessary in most diabetic men with ED. The first step in the treatment of ED in men with DM includes glycemic control and treatment of diabetic comorbidities. The associated hypogonadism must also be treated; otherwise, pharmacologic treatment may be less efficacious or not efficacious at all. Phosphodiesterase type-5 (PDE-5) inhibitors have revolutionized the treatment of ED, and they are considered first-line treatment, with a mean efficacy rate of 50% and a favorable safety profile. Intracavernous administration of vasoactive drugs is the second-line medical treatment when PDE-5 inhibitors have failed. Alprostadil is the most widely used drug for this condition, but the combination of papaverine, phentolamine, and alprostadil represents the most efficacious pharmacologic treatment option for patients whose ED does not respond to monotherapy. Excellent functional and safety results have been reported for penile prosthesis implantation, and this approach, along with proper counseling, can be considered for selected patients with treatment-refractory ED.Conclusions: ED is common in men with DM, who represent one of the most difficult-to-treat subgroups of ED patients. PDE-5 inhibitors are the first-line treatment option, followed by intracavernosal injections and implantation of a penile prosthesis.</div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"4 2","pages":"Pages 114-122"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(09)80020-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72277160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 21

Insulin therapy for inpatients with diabetes: Perceptions of resident physicians from disparate geographic training programs 住院糖尿病患者的胰岛素治疗：来自不同地理培训项目的住院医生的看法

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80019-5

Vasundhara Cheekati MD, Robert C. Osburne MD, Kimberly A. Jameson, Curtiss B. Cook MD

{"title":"Insulin therapy for inpatients with diabetes: Perceptions of resident physicians from disparate geographic training programs","authors":"Vasundhara Cheekati MD, Robert C. Osburne MD, Kimberly A. Jameson, Curtiss B. Cook MD","doi":"10.1016/S1557-0843(09)80019-5","DOIUrl":"https://doi.org/10.1016/S1557-0843(09)80019-5","url":null,"abstract":"<div>Background: Improving diabetes management in hospitalized patients will require educational efforts for all practitioners, particularly resident physicians. Thus, a better understanding of residents' beliefs about diabetes in the hospital must be obtained.Objective: The purpose of this article was to compare and contrast perceptions of resident physicians from 2 geographically distinct training programs regarding management of inpatients with diabetes.Methods: Residents from training programs in the southwestern and southeastern United States were surveyed in 2006 and 2007 about their views on the importance of inpatient glucose control, their perceptions about desirable target glucose ranges, and the problems they encountered when trying to manage hyperglycemia in hospitalized patients.Results: Responses were obtained from 52 of 66 residents at site 1 and from 65 of 85 residents at site 2 (N = 117 total respondents; total response, 77%; mean age, 31 years; 48% men; 61% primary care). Combined analyses revealed that respondents believed that glucose control was “very important” in critically ill patients (96%), perioperative patients (82%), and noncritically ill patients (66%). Most residents indicated that they would target a therapeutic glucose range within published recommendations. Less than half felt “very comfortable” managing inpatient hyperglycemia, hypoglycemia, subcutaneous insulin, or insulin drips. Respondents were not very familiar with existing institutional policies or preprinted order sets for insulin therapy. The most commonly reported barrier to management of inpatient hyper-glycemia was lack of knowledge about appropriate insulin regimens and their use.Conclusions: Trainees from 2 very different educational programs shared common beliefs, knowledge deficits, and perceived barriers about inpatient glucose management. Our findings indicate that trainees were uncertain about how to use insulin therapy in the hospital. Future inpatient diabetes quality-improvement efforts should focus on development of uniform educational programs targeting the management of inpatient diabetes, particularly as it relates to insulin use.</div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"4 2","pages":"Pages 106-113"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(09)80019-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72277156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Case study responses 案例研究回应

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80022-5

Audrey Chun MD , Derek LeRoith MD, PhD

引用次数: 0

Insulin therapy for inpatients with diabetes: Perceptions of resident physicians from disparate geographic training programs 住院糖尿病患者的胰岛素治疗:来自不同地域培训项目的住院医师的看法

Insulin Pub Date : 2009-04-01 DOI: 10.1016/S1557-0843(09)80019-5

Vasundhara Cheekati, R. Osburne, K. Jameson, C. Cook

引用次数: 2