scholarly journals Special aspects of concentrated insulins: basic characteristics and research findings

2020 ◽  
Vol 22 (5) ◽  
pp. 481-490
Author(s):  
Tatiana Y. Demidova ◽  
Olga V. Balutina
Keyword(s):  
Clinical Practice ◽  
Insulin Glargine ◽  
Microvascular Complications ◽  
Severe Hypoglycemia ◽  
Glucose Lowering ◽  
Practice Experience ◽  
Patients With Diabetes ◽  
Research Findings ◽  
Basic Characteristics ◽  
Diabetic Microvascular Complications

The appearance of concentrated insulins in clinical practice determines the need to analyze product priorities in appropriate groups of patients with diabetes. The aim of this article is to summarize the literature on concentrated insulins (i.e. insulin lispro 200 units/mL, insulin degludec 200 units/mL, insulin glargine 300 units/mL) from randomized controlled trials, derive guidance on appropriate and safe use of these agents and demonstrate experience in real clinical practice. Severe hypoglycemia in all studies was generally low (though higher with prandial plus concentrated basal analogue therapy), and statistical improvements in other hypoglycemia categories were observed for concentrated basal insulins versus insulin glargine 100 units/mL. In all analyzed data hypoglycemic effect of insulin glargine 300 units/mL was equitable to insulin glargine 100 units/mL. Other important findings demonstrate more constant and prolonged insulin action with low within-subject/ between-day variability for insulin glargine 300 units/mL versus insulin glargine 100 units/mL, therefore, more physiological treatment might prevent from diabetic microvascular complications. The results of randomized trials are comparable with our clinical practice experience and indicate efficacious and safe glucose-lowering properties without risk of severe hypoglycemia.

scholarly journals Serum Magnesium Concentration Is Inversely Associated with Albuminuria and Retinopathy among Patients with Diabetes

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Jun Lu ◽  
Yuying Gu ◽  
Meixiang Guo ◽  
Peihong Chen ◽  
Hongtao Wang ◽  
...  
Keyword(s):  
Microvascular Complications ◽  
Serum Magnesium ◽  
Multiple Logistic Regression Analysis ◽  
Albumin Excretion Rate ◽  
Normal Serum ◽  
Fundus Photography ◽  
Magnesium Concentration ◽  
Serum Magnesium Concentration ◽  
Patients With Diabetes ◽  
Diabetic Microvascular Complications

Aim. To investigate the association between serum magnesium levels and microvascular complications among patients with diabetes.Methods. Patients with diabetes were recruited between April 2012 and January 2015. All patients received an assay of serum magnesium concentration, were screened for 24 h albumin excretion rate, and underwent nonmydriatic fundus photography. Albuminuria and retinopathy were defined accordingly. A total of 3,100 patients with normal serum magnesium levels were included in this study.Results. Patients with albuminuria and/or retinopathy had lower levels of serum magnesium than patients without these complications (P<0.001). The prevalence of isolated albuminuria, isolated retinopathy, and combined albuminuria and retinopathy decreased as the concentration of serum magnesium increased. Multiple logistic regression analysis indicated that the odds ratio for isolated albuminuria, isolated retinopathy, and concomitant albuminuria and retinopathy decreased by approximately 20% for every 0.1 mmol/L increase in serum magnesium concentration.Conclusion. Serum magnesium levels were negatively associated with the risk of diabetic microvascular complications among patients with serum magnesium levels within the normal range.

scholarly journals Diabetic retinopathy: a tool for cardiovascular risk stratification

2020 ◽  
Vol 22 (5) ◽  
pp. 455-460
Author(s):  
Angelo Avogaro ◽  
Gian Paolo Fadini
Keyword(s):  
Diabetes Mellitus ◽  
Bone Marrow ◽  
Renal Failure ◽  
Diabetic Retinopathy ◽  
Cardiovascular Risk ◽  
Microvascular Complications ◽  
Cardiovascular Complications ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
Diabetic Microvascular Complications

Randomized, cross-sectional, and prospective studies have demonstrated that microvascular complications in patients with diabetes are not only the cause of blindness, renal failure and non-traumatic amputations, but also powerful predictors of cardiovascular complications. The pathophysiology of diabetic microvascular complications is determined by several factors including epigenetic modifications, and reduced release of circulating progenitor cells by the bone marrow. Identifying microvascular complications, in particular retinopathy, increases the ability to stratify patients in terms of cardiovascular risk. There may no longer be a rational to consider microangiopathy and macroangiopathy as entirely separate entities, but they should most likely be viewed as a continuum of the widespread vascular damage determined by diabetes mellitus.

scholarly journals Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

2020 ◽  
Author(s):  
Aimin Yang ◽  
Hongjiang Wu ◽  
Eric S.H. Lau ◽  
Ronald C.W. Ma ◽  
Alice P.S. Kong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glycemic Control ◽  
Severe Hypoglycemia ◽  
Population Based ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Lowering Drug ◽  
Design And Methods

<b>OBJECTIVE</b> There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. <p><b>RESEARCH DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. </p> <p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a></p> <p><b>CONCLUSIONS</b> In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.</p>

scholarly journals Trends in Glucose Lowering Drug Utilization, Glycemic Control, and Severe Hypoglycemia in Adults with Diabetes in Hong Kong 2002-2016

2020 ◽  
Author(s):  
Aimin Yang ◽  
Hongjiang Wu ◽  
Eric S.H. Lau ◽  
Ronald C.W. Ma ◽  
Alice P.S. Kong ◽  
...  
Keyword(s):  
Hong Kong ◽  
Glycemic Control ◽  
Severe Hypoglycemia ◽  
Population Based ◽  
Glucose Lowering ◽  
Dipeptidyl Peptidase 4 ◽  
Dipeptidyl Peptidase 4 Inhibitors ◽  
Patients With Diabetes ◽  
Lowering Drug ◽  
Design And Methods

<b>OBJECTIVE</b> There has been a shift towards new classes of glucose lowering drugs (GLDs) in the past decade but no improvements in glycemic control or hospitalization rates due to severe hypoglycemia (SH) in previous surveys. We examined trends in GLDs utilization, glycemic control and SH rate among patients with diabetes in Hong Kong which introduced a territory-wide, team-based diabetes care model since 2000. <p><b>RESEARCH DESIGN AND METHODS</b> Using population-based data from the Hong Kong Diabetes Surveillance Database, we estimated age- and sex-standardized proportion of GLDs classes, mean hemoglobin A1c (HbA1c) levels and SH rates in 763,809 diabetes patients aged≥20 years between 2002-2016. </p> <p><a><b>RESULTS </b>Between 2002-2016, use declined for sulfonylureas (62.9% to 35.3%) but increased for metformin (48.4% to 61.4%) and dipeptidyl peptidase-4 inhibitors (DPP-4i) (0.01% in 2007 to 8.3%). The proportion of patients with HbA1c of 6.0-7.0% (42-to-53 mmol/mol) increased from 28.6% to 43.4% while SH rate declined from 4.2 per 100-person-years to 1.3 per 100-person-years. The main improvement in HbA1c occurred between 2007 and 2014, decreasing from mean (SD) 7.6 (1.6)% (59.5 [19.0] mmol/mol) to 7.2 (1.7)% (54.8 [18.9] mmol/mol) (p<0.001). The 20-44 age group had the highest proportion of HbA1c≥9% (75 mmol/mol) and rising proportions not on GLDs (from 2.0% to 7.7%).</a></p> <p><b>CONCLUSIONS</b> In this 15-year survey, the modest but important improvement in HbA1c since 2007 coincided with diabetes service reforms, increase in metformin, decrease in sulfonylurea and modest rise in DPP-4i use. Persistently poor glycemic control and under-utilization of GLDs in the youngest group calls for targeted action.</p>

Ruboxistaurin, a Protein Kinase C β Inhibitor, as an Emerging Treatment for Diabetes Microvascular Complications

2005 ◽  
Vol 39 (10) ◽  
pp. 1693-1699 ◽  
Author(s):  
Scott V Joy ◽  
Ann C Scates ◽  
Srilaxmi Bearelly ◽  
Moahad Dar ◽  
Christina A Taulien ◽  
...  
Keyword(s):  
Protein Kinase C ◽  
Protein Kinase ◽  
Intracellular Signaling ◽  
Data Extraction ◽  
Microvascular Complications ◽  
Medline Search ◽  
Kinase C ◽  
Patients With Diabetes ◽  
Pkc Β ◽  
Diabetic Microvascular Complications

OBJECTIVE: To review current clinical data regarding the pharmacologic actions of ruboxistaurin (LY333531) mesylate, an inhibitor of protein kinase C (PKC) β, and its role to potentially reduce the development and/or the progression of diabetic microvascular complications. DATA SOURCES: Primary literature was obtained via a MEDLINE search (1966–August 2004) and through review of pertinent abstracts and presentations at major medical meetings. STUDY SELECTION AND DATA EXTRACTION: Literature relevant to PKC physiology, the pharmacokinetics of ruboxistaurin, and data evaluating the use of ruboxistaurin in treating diabetic microvascular complications in human and relevant animal models was reviewed. DATA SYNTHESIS: PKC is part of a group of intracellular signaling molecules activated in response to various specific hormonal, neuronal, and growth factor stimuli. Hyperglycemia leads to PKC β 1 and 2 isoform activation, which experimentally has been shown to contribute to the development and progression of diabetic microvascular complications (retinopathy, nephropathy, neuropathy) through various biochemical mechanisms. Animal and/or human studies using ruboxistaurin mesylate, a novel, highly selective inhibitor of PKC β, have shown delay in the progression and, in some cases, reversal of diabetic retinopathy, nephropathy, and neuropathy. CONCLUSIONS: Ruboxistaurin mesylate, by inhibiting excessive activation of certain PKC isoforms, has the potential to reduce the burden of microvascular complications for patients with diabetes.

Haemoglobin A1c analysis in the management of patients with diabetes: from chaos to harmony: Table 1

2008 ◽  
Vol 61 (9) ◽  
pp. 983-987 ◽  
Author(s):  
A H Berg ◽  
D B Sacks
Keyword(s):  
Diabetes Mellitus ◽  
Microvascular Complications ◽  
Blood Glucose Control ◽  
Detection Methods ◽  
Haemoglobin A1c ◽  
Patients With Diabetes ◽  
Blood Haemoglobin ◽  
Diabetic Microvascular Complications ◽  
Based Medicine

Effective management of patients with diabetes mellitus requires accurate assessments of blood glucose control. The best characterised marker of long term glycaemic control is whole blood haemoglobin A1c (HbA1c). Published clinical trials have identified quantitative and direct relationships between the HbA1c concentration and risks of diabetic microvascular complications. However, in order to practice evidence-based medicine, assays used to measure patient samples should ideally produce values comparable to the assays used in these trials. Numerous assays using chromatographic and immunological detection methods are used around the world. This paper briefly reviews the scientific evolution of HbA1c and its analysis, discusses the reasons why HbA1c assay standardisation is a challenge, describes the approaches that have been adopted to harmonise HbA1c assays, and addresses the current initiatives to standardise HbA1c globally. These efforts have established HbA1c as an essential component in the management of patients with diabetes mellitus and are likely to lead to the use of HbA1c in the screening/diagnosis of diabetes.

scholarly journals Effects of Selected Anionic β-Cyclodextrins on Persistence of Blood Glucose Lowering by Insulin Glargine after Subcutaneous Injection to Rats

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Keiko Uehata ◽  
Takayuki Anno ◽  
Kayoko Hayashida ◽  
Keiichi Motoyama ◽  
Taishi Higashi ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Insulin Glargine ◽  
Subcutaneous Injection ◽  
Enzymatic Degradation ◽  
Subcutaneous Administration ◽  
Inhibitory Effects ◽  
Glucose Lowering ◽  
Patients With Diabetes ◽  
Glucose Lowering Effect ◽  
Long Acting

Insulin glargine is a synthetic long-acting insulin product used for patients with diabetes mellitus. In this study, to obtain the further desirable blood-glucose lowering profile of insulin glargine, we investigated the effects of β-cyclodextrin sulfate (Sul-β-CyD) and sulfobutylether β-cyclodextrin (SBE7-β-CyD) on physicochemical properties of insulin glargine and pharmacokinetics/pharmacodynamics of insulin glargine after subcutaneous injection to rats. Sul-β-CyD and SBE7-β-CyD increased solubility of insulin glargine. SBE7-β-CyD suppressed the formation of oligomer and enhanced the dissolution rate of insulin glargine from its precipitate, compared to that of Sul-β-CyD. Additionally, we revealed that after subcutaneous administration of an insulin glargine solution, SBE7-β-CyD, but not Sul-β-CyD, increased bioavailability and sustained the blood-glucose lowering effect, possibly due to the inhibitory effects of SBE7-β-CyD on the enzymatic degradation at the injection site. These results suggest that SBE7-β-CyD could be a useful excipient for sustained release of insulin glargine.

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