Disproportionately increased 24-h energy expenditure and fat oxidation in young men with low birth weight during a high-fat overfeeding challenge.

BACKGROUND: Low birth weight (LBW) associates with increased risk of developing type 2 diabetes. LBW individuals exhibit disproportionately reduced peripheral insulin action and increased fat oxidation after a 5-day high-fat overfeeding (HFO) challenge. Furthermore, LBW men exhibit increased nocturnal fat oxidation during energy balance and low energy expenditure (EE) during fasting. We hypothesized that short-term HFO could further unmask key defects of whole-body energy metabolism in LBW men. METHODS: Eighteen LBW (2717 ± 268 g) and 26 normal birth weight (NBW) (3893 ± 207 g) healthy young men were included in a 5-day HFO (60 E % fat, +50 % calories) study. The 24-h EE, respiratory quotient and substrate oxidation rates were assessed by indirect calorimetry using respiratory chambers. RESULTS: After adjusting for body composition, the LBW subjects displayed increased nighttime EE (P = 0.02) compared with NBW controls during HFO. Nighttime glucose oxidation rate was decreased (P = 0.06, adjusted P = 0.05), while both adjusted 24-h (P = 0.07) and nighttime (P = 0.02) fat oxidation rate was elevated in LBW subjects. The relative contribution of fat oxidation to EE was increased in LBW compared with NBW men during the entire 24-h period (P = 0.06) and during nighttime (P = 0.03). CONCLUSIONS: We suggest that disproportionally enhanced fat oxidation in LBW individuals during short-term HFO represents a compensatory response to reduced subcutaneous adipose tissue expandability and storage capacity. The extent to which this mechanism may lead to, or be replaced by insulin resistance, ectopic fat accumulation and/or glucose intolerance during long-term HFO in LBW needs further studies.

Dose accuracy and durability of a durable insulin pen before and after simulated lifetime use.

BACKGROUND AND OBJECTIVE: NovoPen Echo* is an insulin pen designed specifically for children and adolescents with diabetes. The pen combines half-unit dosing and a simple memory function that records the size of the last dose and the time in hours that has elapsed since last injection. Durability is an essential feature of durable insulin pens in order to ensure accuracy throughout the lifetime of the pen. This study was designed to assess dose accuracy and durability of NovoPen Echo before and after simulated lifetime use. RESEARCH DESIGN AND METHODS: All testing was conducted according to International Organization for Standardization (ISO) guideline 11608-1 for pen injectors. Dose accuracy was measured for the delivery of 0.5 international units** (IU) (5 mg), 15 IU (150 mg) and 30 IU (300 mg) test medium before and after lifetime simulation under standard, cool and hot conditions. Functionality tests were also performed under a number of stress conditions including dry heat, cyclical temperature, vibration, free fall and electrostatic discharge. RESULTS: The dose accuracy of NovoPen Echo meets the requirement stated in ISO 11608-1 for all three doses for all tests before and after lifetime simulation. The pens remained intact and retained dosing accuracy at all doses after exposure to variations in temperature and humidity and before and after physical challenge to simulate lifetime use. CONCLUSIONS: The accuracy of NovoPen Echo was retained under conditions of stress likely to be encountered in everyday use due to its durable design.

Needle with a novel attachment versus conventional screw-thread needles: a preference and usability test among adults with diabetes and impaired manual dexterity.

BACKGROUND: NovoTwist(®) (Novo Nordisk A/S, Bagsværd, Denmark) is an insulin pen needle that features a novel attachment and detachment system. The aim of this test was to assess overall preference and handling of NovoTwist compared with conventional screw-thread needles in people with type 1 or type 2 diabetes. METHODS: One hundred twenty adults with type 1 or type 2 diabetes and manual dexterity dysfunction who were currently self-injecting with an insulin pen were included in this open-label, randomized, crossover test. Participants were stratified according to the impact that manual dexterity problems had on their ability to inject insulin (1 = no effect at all; 4 = a lot), and those rated as 1 were excluded from subanalyses because of low numbers. Following instruction, participants attached the needle to Next Generation FlexPen(®) (Novo Nordisk A/S), made an injection into a foam cushion, and detached the needle; this process was repeated three times with NovoTwist and the participant's current screw-thread needle (or NovoFine(®) [Novo Nordisk A/S]) in a random order. Responses to questions on user experience with each needle were subsequently recorded on a 6-point rating scale (1 = very difficult; 6 = very easy). RESULTS: Significantly more respondents had a preference for NovoTwist (79%) compared with the conventional screw-thread needles (21%, P < 0.001). Significantly more respondents preferred NovoTwist for both ease of attachment (80%, P < 0.001) and ease of detachment (74%, P < 0.001). Most respondents found NovoTwist the most appropriate needle for performing everyday injections (71%, P < 0.001). CONCLUSIONS: Such preference by patients has a positive impact on the treatment of diabetes as NovoTwist may alleviate the burden of performing everyday injections through its ease of use.