InsulinPub Date : 2008-10-01DOI: 10.1016/S1557-0843(08)80050-4
JosAnn Duane PhD, William Conway MD
{"title":"Weight change in intensive insulin therapy for type 2 diabetes mellitus as a function of glycosylated hemoglobin (A1C) level achieved: The deep south diabetes program","authors":"JosAnn Duane PhD, William Conway MD","doi":"10.1016/S1557-0843(08)80050-4","DOIUrl":"https://doi.org/10.1016/S1557-0843(08)80050-4","url":null,"abstract":"<div><p><strong>Background:</strong> The Deep South Diabetes Program (DSDP) conducted a retrospective study to evaluate weight changes associated with intensive basal-bolus insulin therapy. Results of the effectiveness of the treatment algorithm that was used in this study were published in the April 2008 issue of <em>Insulin</em>.</p><p><strong>Objectives:</strong> The current study was designed to further evaluate the results of the DSDP study. The primary objective was to determine the quantitative relationship between weight gain and the patient's final glycosylated hemoglobin (A1C) level achieved. A secondary objective was to gain a qualitative understanding of the treatment parameters underlying the quantitative results.</p><p><strong>Methods:</strong> Further evaluation of the DSDP treatment algorithm in terms of weight management and A1C levels for achieving normoglycemia or near-normoglycemia was performed retrospectively using data collected in the original DSDP study. This evaluation included all patients who elected intensive basal-bolus insulin therapy and who sustained the treatment for up to 4 years. Glargine was the primary basal insulin, and aspart was the primary bolus insulin. The quantitative relationships among net weight change, net A1C change, and final A1C level achieved were evaluated. A qualitative evaluation of glycemic variability and behavioral variables was made from video recordings of patient visits during the original DSDP study and further observation of study participants after completion of the study.</p><p><strong>Results:</strong> Quantitative evaluation of change in weight as a function of A1C level achieved at the end of the study showed that for the group of patients who achieved normoglycemia, the mean change in weight was a reduction proportional to the corresponding mean reduction in A1C. For the groups of patients who did not achieve normoglycemia or near-normoglycemia, the mean change in weight was an increase proportional to the corresponding mean reduction in A1C.</p><p><strong>Conclusions:</strong> When normoglycemia was achieved and sustained using the DSDP's intensive insulin therapy, the weight gain typically seen with conventional insulin therapy did not occur. Weight gain or loss during intensive insulin therapy using the DSDP treatment algorithm was a function of A1C level achieved.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 4","pages":"Pages 219-231"},"PeriodicalIF":0.0,"publicationDate":"2008-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80050-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91698415","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}
InsulinPub Date : 2008-07-01DOI: 10.1016/S1557-0843(08)80043-7
Steven V. Edelman MD
{"title":"Managing type 1 diabetes for pregnancy","authors":"Steven V. Edelman MD","doi":"10.1016/S1557-0843(08)80043-7","DOIUrl":"10.1016/S1557-0843(08)80043-7","url":null,"abstract":"","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 3","pages":"Pages 199-200"},"PeriodicalIF":0.0,"publicationDate":"2008-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80043-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83723203","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}
InsulinPub Date : 2008-07-01DOI: 10.1016/S1557-0843(08)80035-8
Dawn Smiley MD, Guillermo E. Umpierrez MD
{"title":"Inpatient insulin therapy","authors":"Dawn Smiley MD, Guillermo E. Umpierrez MD","doi":"10.1016/S1557-0843(08)80035-8","DOIUrl":"10.1016/S1557-0843(08)80035-8","url":null,"abstract":"<div><p><strong>Background:</strong> Many diabetic, as well as nondiabetic, hospitalized patients develop hyperglycemia. Numerous studies have demonstrated that critically ill, as well as noncritically ill, hospitalized patients who develop hyperglycemia are at increased risk for morbidity and mortality.</p><p><strong>Objective:</strong> The objective of this article was to review the risks associated with hyperglycemia in hospitalized patients, the biologic rationale for using insulin to prevent increases in glucose levels, and strategies for managing hyperglycemia in the hospital setting.</p><p><strong>Methods:</strong> We conducted a computerized search of biomedical journal literature from MEDLINE, PubMed, and Ovid published from 1994 to March 2008. We reviewed English-language original and review articles found under the subject headings “hospitalization and insulin therapy,” “inpatient diabetes and complications,” and “insulin and inflammation.”</p><p><strong>Results:</strong> More than 200 references were found during the literature search. According to the literature, the adverse outcomes that are associated with hyperglycemia may be attributed to the inflammatory and pro-oxidant effects of elevated glucose levels. The use of insulin, which has anti-inflammatory, vasodilatory, and antioxidant properties as well as the ability to inhibit lipolysis and platelet aggregation, can prevent many of these adverse outcomes.</p><p><strong>Conclusions:</strong> Hospitals should have protocols in place for using insulin to treat and prevent hyperglycemia. Subcutaneous insulin may be used for both purposes in most noncritically ill patients, whereas intravenous infusion of insulin is preferred in critically ill patients.</p></div>","PeriodicalId":100678,"journal":{"name":"Insulin","volume":"3 3","pages":"Pages 152-166"},"PeriodicalIF":0.0,"publicationDate":"2008-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1557-0843(08)80035-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85278470","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}
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