RESUMEN
Premixed insulins are an important tool for glycemic control in persons with diabetes. Equally important in diabetes care is the selection of the most appropriate insulin regimen for a particular individual at a specific time. Currently, the choice of insulin regimens for initiation or intensification of therapy is a subjective decision. In this article, we share insights, which will help in rational and objective selection of premixed formulations for initiation and intensification of insulin therapy. The glycemic status and its variations in a person help to identify the most appropriate insulin regimen and formulation for him or her. The evolution of objective glucometric indices has enabled better glycemic monitoring of individuals with diabetes. Management of diabetes has evolved from a 'glucocentric' approach to a 'patient-centered' approach; patient characteristics, needs, and preferences should be evaluated when considering premixed insulin for treatment of diabetes.Funding: Novo Nordisk, India.
RESUMEN
The International Conference on Primary Health Care, held at Alma-Ata, present-day Kazakhstan, in September 1978, was a landmark in global health care. The Declaration of Alma-Ata that was adopted at that conference successfully refocused attention and energy on primary health care. In a similar manner, the United Nations resolution of 2006 highlighted the dangers of the diabetes pandemic. The underlying philosophy of the Declaration of Alma-Ata is assessed in this editorial, to determine whether it remains relevant for modern and future diabetes care. We highlight the concordance between the Declaration of Alma-Ata and the principles of present-day diabetes care, and come to the conclusion that the 1978 document is relevant for the management of the diabetes pandemic.
RESUMEN
For decades, sulfonylureas (SUs) have been important drugs in the antidiabetic therapeutic armamentarium. They have been used as monotherapy as well as combination therapy. Focus on newer drugs and concerns about the risk of severe hypoglycemia and weight gain with some SUs have led to discussion on their safety and utility. It has to be borne in mind that the adverse events associated with SUs should not be ascribed to the whole class, as many modern SUs, such as glimepiride and gliclazide modified release, are associated with better safety profiles. Furthermore, individualization of treatment, using SUs in combination with other drugs, backed with careful monitoring and patient education, ensures maximum benefits with minimal side effects. The current guidelines, developed by experts from Africa, Asia, and the Middle East, promote the safe and smart use of SUs in combination with other glucose-lowering drugs.
