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1.
Rev Med Suisse ; 16(680): 264-267, 2020 Feb 05.
Artículo en Francés | MEDLINE | ID: mdl-32022491

RESUMEN

Considering the progressive nature of type 2 diabetes, glycated hemoglobin (HbA1c) goals and treatment plans should be regularly tailored to the patient's need to prevent hypoglycemia. There are individual HbA1c target levels that take into account factors such as age, comorbidity, and risks of treatment. The emergence of new therapeutic classes reducing hypoglycemia has changed ongoing practices. This article presents a potentially preventable case of a patient with hypoglycemia and reflects on the latest European and American recommendations for antidiabetic treatment in elderly patients.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Administración Oral , Anciano , Glucemia/efectos de los fármacos , Hemoglobina A Glucada/análisis , Humanos
2.
Orv Hetil ; 161(5): 193-197, 2020 Feb.
Artículo en Húngaro | MEDLINE | ID: mdl-31984772

RESUMEN

Mortality in type 1 diabetes, although showing a declining trend, is significantly higher than standard mortality. The case study focuses on a woman who lived for 91 years; she was insulin-dependent for 86 years and has been treated by a single physician - the author - for over 55 years. She was diagnosed with diabetes in 1932 at the age of five. Her diabetes was first treated with rapid-acting insulin three times daily, then from 1940 with rapid-acting and protamine zinc insulin once daily, while later on pork, then human crystalline zinc insulin was used, followed by a mixture of rapid-acting and NPH insulin for the last 16 years. The reason behind the above treatment regimen was that the patient obsessively insisted on a once daily insulin dose and the duration was shown to be 24 hours for each insulin. The continuous overdose of a single insulin for decades has resulted in hypoglycemic episodes almost daily, with consequent high fluctuations in blood glucose levels. She performed urine glucose tests using a polarimeter from the mid-1930s to the sixties, then used test strips until the early eighties, and later switched to blood glucose self-testing. Her HbA1c levels have been around 7% (53 mmol/mol) for the last 25 years. She did not develop retinopathy or nephropathy, only severe neuropathy caused complaints during the last years of her life. In addition, her vision continued to deteriorate due to age-related dry macular degeneration. She is a Joslin 75-year medalist. For the last two months of her life, she gave permission for degludec + glulisine insulin intensive treatment. Her death was caused by myocardial infarction. Although minimizing blood glucose fluctuations and sustaining good metabolic control significantly improve the life expectancy of people with diabetes, in our case neither has existed for well over half a century. Therefore, no explanation was found for the extremely long duration of diabetes and longevity. Orv Hetil. 2020; 161(5): 193-197.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes/administración & dosificación , Insulina de Acción Prolongada/administración & dosificación , Infarto del Miocardio/mortalidad , Anciano de 80 o más Años , Glucemia , Resultado Fatal , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Hipoglucemiantes/efectos adversos , Insulina , Insulina Glargina/administración & dosificación , Insulina Glargina/efectos adversos , Insulina de Acción Prolongada/efectos adversos , Infarto del Miocardio/complicaciones , Resultado del Tratamiento
3.
Biochem Med (Zagreb) ; 30(1): 010802, 2020 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-31839727

RESUMEN

Introduction: Hypoglycaemia has been reported as an unusual complication of tramadol use and in a few cases of tramadol poisoning, but the exact mechanism is not known. Case description: An ambulance crew was dispatched to an unconscious 46-year old man. A glucometer point-of-care measurement revealed a profound hypoglycaemia (1.9 mmol/L). Treatment with intravenous glucose was started and the patient was transported to the hospital. The patient had several episodes of pulseless electrical activity requiring cardiopulmonary resuscitation in the ambulance and upon arrival in the hospital. Despite continuous glucose infusion the hypoglycaemia was difficult to correct during the next few hours and the patient developed hypokalaemia. Further investigation to identify the cause of hypoglycaemia revealed that insulin and C-peptide were inappropriately raised. A toxicological investigation revealed the presence of tramadol and its metabolites in lethal concentrations. Also acetaminophen, ibuprofen and lormetazepam were present. Ethanol screening was negative (< 0.1 g/L) and no sulfonylurea were detected. The patient developed multiple organ failure, but eventually recovered. What happened: The hypoglycaemia was caused by inappropriate stimulation of insulin secretion in a patient intoxicated with tramadol. The sudden hypokalaemia was caused by a massive intracellular shift of potassium in response to the hyperinsulinemia, triggered by the intravenous administration of glucose. Main lesson: To our knowledge, we are the first to document a significant rise in endogenous insulin production in a hypoglycaemic patient presenting with tramadol intoxication. Our observation suggests that hyperinsulinemia could be the cause of the hypoglycaemia associated with tramadol use.


Asunto(s)
Analgésicos Opioides/efectos adversos , Hipoglucemia/diagnóstico , Tramadol/efectos adversos , Analgésicos Opioides/uso terapéutico , Glucemia/análisis , Péptido C/sangre , Glucosa/administración & dosificación , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/etiología , Insulina/sangre , Masculino , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Tramadol/uso terapéutico
4.
BMJ ; 367: l5887, 2019 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690574

RESUMEN

Diabetes is a major and costly health concern worldwide, with high morbidity, disability, mortality, and impaired quality of life. The vast majority of people living with diabetes have type 2 diabetes. Historically, the main strategy to reduce complications of type 2 diabetes has been intensive glycemic control. However, the body of evidence shows no meaningful benefit of intensive (compared with moderate) glycemic control for microvascular and macrovascular outcomes important to patients, with the exception of reduced rates of non-fatal myocardial infarction. Intensive glycemic control does, however, increase the risk of severe hypoglycemia and incurs additional burden by way of polypharmacy, side effects, and cost. Additionally, data from cardiovascular outcomes trials showed that cardiovascular, kidney, and mortality outcomes may be improved with use of specific classes of glucose lowering drugs largely independently of their glycemic effects. Therefore, delivering evidence based, patient centered care to people with type 2 diabetes requires a paradigm shift and departure from the predominantly glucocentric view of diabetes management. Instead of prioritizing intensive glycemic control, the focus needs to be on ensuring access to adequate diabetes care, aligning glycemic targets to patients' goals and situations, minimizing short term and long term complications, reducing the burden of treatment, and improving quality of life.


Asunto(s)
Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Calidad de Vida , Glucemia/análisis , Glucemia/efectos de los fármacos , Complicaciones de la Diabetes/sangre , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/normas , Humanos , Hiperglucemia/sangre , Hiperglucemia/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Incidencia , Metaanálisis como Asunto , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/normas , Guías de Práctica Clínica como Asunto , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
5.
Isr Med Assoc J ; 21(11): 724-727, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31713359

RESUMEN

BACKGROUND: The need for postnatal monitoring of infants exposed to intrauterine beta blockers (BBs) has not been clearly defined. OBJECTIVES: To evaluate infants exposed to intrauterine BBs in order to estimate the need for postnatal monitoring. METHODS: This retrospective case-control study comprised 153 term infants born to mothers who had been treated with BBs during pregnancy. Treatment indications included hypertension 76 mothers (49.7%), cardiac arrhythmias 48 (31.4%), rheumatic heart disease 14 (9.1%), cardiomyopathy 11 (7.2%) and migraine 4 (2.6%). The controls were infants of mothers with hypertension not exposed to BBs who were born at the same gestational age and born closest (before or after) to the matched infant in the study group. RESULTS: Compared to the control group, the infants in the study group had a higher prevalence of early asymptomatic hypoglycemia (study 30.7% vs. control 18.3%, P = 0.016), short symptomatic bradycardia events, other cardiac manifestations (P = 0.016), and longer hospitalization (P < 0.001). No life-threatening medical conditions were documented. The birth weight was significantly lower for the high-dose subgroup compared to the low-dose subgroup (P = 0.03), and the high-dose subgroup had a higher incidence of small-for-gestational-age (P = 0.02). CONCLUSIONS: No alarming or life-threatening medical conditions were observed among term infants born to BB treated mothers. These infants can be safely observed for 48 hours after birth close to their mothers in the maternity ward. Glucose follow-up is needed, especially in the first hours of life.


Asunto(s)
Antagonistas Adrenérgicos beta/efectos adversos , Bradicardia/inducido químicamente , Hipoglucemia/inducido químicamente , Enfermedades del Recién Nacido/inducido químicamente , Intercambio Materno-Fetal , Resultado del Embarazo , Adulto , Peso al Nacer , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Masculino , Embarazo , Estudios Retrospectivos , Factores de Riesgo
6.
Postgrad Med ; 131(8): 555-565, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31580737

RESUMEN

Type 2 diabetes (T2D) has a complex pathophysiology composed of multiple underlying defects that lead to impaired glucose homeostasis and the development of macrovascular and microvascular complications. Of the currently available glucose-lowering therapies, sodium-glucose cotransporter-2 inhibitors (SGLT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) both provide effective glycemic control and have been shown to reduce cardiovascular (CV) events in patients with T2D and a high CV risk or established CV disease. Because these agents have complementary mechanisms of action, they are able to act on multiple defects of T2D when used in combination. This review discusses the rationale for and potential benefits of SGLT-2i plus GLP-1RA combination therapy in patients with T2D. A search of the PubMed database was conducted for studies and reviews describing the combined use of SGLT-2is and GLP-1RAs, with a specific focus on identifying clinical studies of combination therapy in patients with T2D. In clinical studies, glycated hemoglobin (A1c) was significantly reduced over 28-52 weeks with SGLT-2i plus GLP-1RA therapy versus the individual agents or baseline. Several CV risk factors, including body weight, blood pressure, and lipid parameters, were also improved. SGLT-2i plus GLP-1RA therapy was generally well tolerated, with a low risk of hypoglycemia and no unexpected findings. Taken together with results from large CV outcomes trials of SGLT-2is and GLP-1RAs, combination therapy with these agents potentially provides effective durable glycemic control and CV benefits due to their complementary actions on the defects of T2D.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Receptor del Péptido 1 Similar al Glucagón/agonistas , Hipoglucemiantes/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Glucemia , Presión Sanguínea , Peso Corporal , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Quimioterapia Combinada , Hemoglobina A Glucada , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Lípidos/sangre , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos
7.
Postgrad Med ; 131(8): 566-571, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31524035

RESUMEN

Background: Compared with traditional outpatient follow up, short message service (SMS) provides more convenience for diabetes self-management. However, the feasibility, effectiveness, and satisfaction of SMS intervention remain unclear.Methods: A systematic retrieval of databases, including PubMed, EMBASE, and Cochrane Library, was used to evaluate the effect of SMS on the diabetes glycemic control. Complete quantitative reports on the changes of glycosylated hemoglobin (HbA1c) before and after intervention were collected. The study type was limited to randomized controlled trials (RCTs).Results: 13 RCTs were identified as eligible for this subject. Overall result revealed a statistical decline of HbA1c by -0.62% (95% CI -0.82 to -0.41). The longest intervention duration was 12 months with the noteworthy improvement of HbA1c by -1.63% (-2.27 to -0.99). Compared with control groups, five trials quantitatively demonstrated a significant decline in fasting plasma glucose (FPG) by -0.45 (95% CI -0.7 to -0.19) and -1.05 (95% CI -1.35 to -0.75) in 2-h postprandial blood glucose (2hPBG).Conclusions: This meta-analysis demonstrated that text message intervention indeed leads to a decline in HbA1c and improvement of blood glucose control. No convincing evidence was found on quality of life improvement, satisfaction, body mass index (BMI), blood lipid levels, the frequency of hypoglycemia, self-monitoring of blood glucose or complications reduction.


Asunto(s)
Diabetes Mellitus Tipo 2/terapia , Automanejo/métodos , Mensaje de Texto , Glucemia , Automonitorización de la Glucosa Sanguínea , Índice de Masa Corporal , Hemoglobina A Glucada , Humanos , Hipoglucemia/inducido químicamente , Lípidos/sangre , Satisfacción del Paciente , Periodo Posprandial , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Medicine (Baltimore) ; 98(36): e17081, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31490412

RESUMEN

OBJECTIVE: The purpose of this study was to assess the efficacy and hypoglycemic risk of sitagliptin versus that of GLP-1 receptor agonists in the management of obese/overweight patients with T2DM. METHODS: EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov were searched; randomized controlled trials comparing the efficacy of sitagliptin versus that of GLP-1 receptor agonists in obese/overweight patients with T2DM were included. The mean BMI of participants for each study was ≥30 kg/m. We conducted a meta-analysis according to the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions. RevMan 5.1 software was used to perform the meta-analysis. The Cochrane Q test and I statistics were used to estimate the heterogeneity among studies. The results are expressed as the mean difference (MD) or risk ratio (RR) with 95% confidence intervals. RESULTS: A total of 8 eligible studies were included in our meta-analysis. Compared with GLP-1 receptor agonists, sitagliptin was less effective at reducing HbA1c (0.42 [0.27, 0.56]), FPG (0.78 [0.36, 1.19]), PPG (2.61 [1.35, 3.87]), and body weight (1.42 [0.71, 2.14]). Conversely, there were no significant differences in SBP reduction (0.38 [-1.14, 1.89]), DBP reduction (-0.30 [-1.00, 0.39]), and hypoglycemic risk (1.09 [0.50, 2.35]). CONCLUSION: For obese/overweight patients, sitagliptin may exert a less potent effect on HbA1C, FPG, PPG, and weight reduction than GLP-1 receptor agonists, but these drugs had a similar efficacy in reducing blood pressure; furthermore, there was no significant difference in hypoglycemic risk.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Obesidad/complicaciones , Fosfato de Sitagliptina/uso terapéutico , Glucemia/efectos de los fármacos , Presión Sanguínea/efectos de los fármacos , Peso Corporal/efectos de los fármacos , Diabetes Mellitus Tipo 2/complicaciones , Receptor del Péptido 1 Similar al Glucagón/agonistas , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/farmacología , Fosfato de Sitagliptina/farmacología
9.
Undersea Hyperb Med ; 46(4): 437-445, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31509900

RESUMEN

Introduction: To determine if hyperbaric oxygen (HBO2) therapy has an effect on diabetic blood glucose levels (BGL) and, if so, the extent of this effect. Also, to examine factors that exacerbate any observed effect. Methods: This was a retrospective review of prospectively collected quality data on diabetics undergoing HBO2. Pre- and post-treatment BGL were recorded. Pre-treatment BGL ⟨120 mg/dL received glucose supplementation. Hypoglycemia was defined as BGL ⟨70 mg/dL. BGL ⟨90 mg/dL was included as an elevated hypoglycemia threshold. Results: 77 patients representing 1,825 treatments were included for analysis. No patient had deleterious side effects or required emergency care. BGL decreased in 75.4% of treatments in this group, with a median decrease of 25 mg/dL (IQR=54 mg/dL; range of decreased 374 mg/dL to increased 240 mg/dL). A statistically significant greater percentage of treatments of patients with type 2 diabetes resulted in a decrease in BGL (1598 or 77.5%) compared to treatments of patients with type 1 diabetes (169 or 51.5%) (χ2(1, N=1767) =55.37, p⟨0.001). 1.1% of treatments had post-HBO2 serum glucose ⟨90 mg/dL, and 0.2% of treatments had post-HBO2 serum glucose ⟨70 mg/dL. The majority (70%) of patients with post-HBO2 BGL ⟨90 mg/dL were maintained on insulin alone (χ2(2, N=20) =12.4, p=0.002). Well-controlled diabetics (i.e., those with all BGLs within 50 mg/dL over all pre-HBO2 treatments) had no post-HBO2 BGL ⟨70 mg/dL or ⟨90 mg/dL. Conclusion: Our results suggest that HBO2 does not cause a clinically significant decrease in diabetic patient BGL. No patient in our study had deleterious side effects or required emergency care. We found that glucose level of ⟨90 mg/dL occurred more often in those who use insulin. Hyperbaric patients who exhibit consistent BGL values may represent a group who could be managed similarly to the non-diabetic population.


Asunto(s)
Glucemia/análisis , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Oxigenación Hiperbárica , Anciano , Diabetes Mellitus/inducido químicamente , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Humanos , Oxigenación Hiperbárica/efectos adversos , Oxigenación Hiperbárica/estadística & datos numéricos , Hipoglucemia/sangre , Hipoglucemia/inducido químicamente , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Masculino , Estudios Retrospectivos , Esteroides/efectos adversos
10.
Expert Opin Investig Drugs ; 28(9): 741-747, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31398075

RESUMEN

Introduction: Type 2 diabetes is a complex metabolic disorder defined by hyperglycemia which occurs because of impaired insulin secretion and sensitivity. There is an ongoing need to develop novel therapies that are effective and safe with minimal side effects and long-term durability. TTP399 is a hepatoselective, glucokinase activator with potential for treating type 2 diabetes. Areas covered: This is a review of the available data regarding the mechanism of action and the pharmacokinetics of TTP399. The efficacy and safety of the drug for treatment of type 2 diabetes will also be examined with an emphasis on the results of a randomized, controlled phase 2 study. Expert opinion: TTP399 could offer significant advantages over currently available therapies for type 2 diabetes. It successfully lowers glucose without side effects such as hypoglycemia, weight gain or dyslipidemia. Larger trials are required to understand long-term efficacy and safety of this medication in various patient populations and to elucidate its effect on the pathologic processes underpinning type 2 diabetes.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/farmacología , Compuestos Orgánicos/farmacología , Animales , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 2/fisiopatología , Glucoquinasa/efectos de los fármacos , Glucoquinasa/metabolismo , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Hígado/metabolismo , Compuestos Orgánicos/efectos adversos , Compuestos Orgánicos/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto
11.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artículo en Inglés | MEDLINE | ID: mdl-31439558

RESUMEN

The increased use of immune checkpoint inhibitors (ICIs) has led to the observation of a variety of immune-related adverse events (irAEs). These irAEs occur usually within the first months after ICIs onset and can involve theorically all organs. We describe two rare irAEs occurring in a 70-year-old caucasian man who was treated with nivolumab for an advanced urothelial cancer of the left kidney. He developed an isolated adrenocorticotropic hormone deficiency that was diagnosed at week 19 and a neurological complication that appeared at week 79 and initially confounded with a lumbar spinal stenosis. Diagnosis of Guillain-Barré syndrome was finally confirmed with the complete resolution of symptoms after 5 days of intravenous immunoglobulin and corticosteroids. We highlight the importance of quickly recognising these potential life-threatening irAEs such as cortisol insufficiency and neurologic adverse events whose initially presentation could be non-specific.


Asunto(s)
Hormona Adrenocorticotrópica/deficiencia , Antineoplásicos Inmunológicos/efectos adversos , Enfermedades del Sistema Endocrino/diagnóstico , Enfermedades Genéticas Congénitas/diagnóstico , Síndrome de Guillain-Barré/diagnóstico , Hipoglucemia/diagnóstico , Nivolumab/efectos adversos , Hormona Adrenocorticotrópica/sangre , Anciano , Diagnóstico Diferencial , Enfermedades del Sistema Endocrino/sangre , Enfermedades del Sistema Endocrino/inducido químicamente , Enfermedades Genéticas Congénitas/sangre , Enfermedades Genéticas Congénitas/inducido químicamente , Síndrome de Guillain-Barré/inducido químicamente , Síndrome de Guillain-Barré/complicaciones , Síndrome de Guillain-Barré/fisiopatología , Humanos , Hipoglucemia/sangre , Hipoglucemia/inducido químicamente , Masculino , Neoplasias Uretrales/tratamiento farmacológico , Neoplasias Uretrales/cirugía
12.
Mayo Clin Proc ; 94(9): 1731-1742, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31422897

RESUMEN

OBJECTIVE: To estimate the contemporary prevalence of intensive glucose-lowering therapy among US adults with diabetes and model the number of hypoglycemia-related emergency department (ED) visits and hospitalizations that are attributable to such intensive treatment. PATIENTS AND METHODS: US adults with diabetes and glycated hemoglobin (HbA1c) levels less than 7.0% who were included in the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2014. Participants were categorized as clinically complex if 75 years or older or with 2 or more activities of daily living limitations, end-stage renal disease, or 3 or more chronic conditions. Intensive treatment was defined as any glucose-lowering medications with HbA1c levels of 5.6% or less or 2 or more with HbA1c levels of 5.7% to 6.4%. First, we quantified the proportion of clinically complex and intensively treated individuals in the NHANES population. Then, we modeled the attributable hypoglycemia-related ED visits/hospitalizations over a 2-year period based on published data for event risk. RESULTS: Almost half (48.8% [10,719,057 of 21,980,034]) of US adults with diabetes (representing 10.7 million US adults) had HbA1c levels less than 7.0%. Among them, 32.3% (3,466,713 of 10,719,057) were clinically complex, and 21.6% (2,309,556 of 10,719,057) were intensively treated, with no difference by clinical complexity. Over a 2-year period, we estimated 31,511 hospitalizations and 30,954 ED visits for hypoglycemia in this population; of these, 4774 (95% CI, 954-9714) hospitalizations and 4804 (95% CI, 862-9851) ED visits were attributable to intensive treatment. CONCLUSION: Intensive glucose-lowering therapy, particularly among vulnerable clinically complex adults, is strongly discouraged because it may lead to hypoglycemia. However, intensive treatment was equally prevalent among US adults, irrespective of clinical complexity. Over a 2-year period, an estimated 9578 hospitalizations and ED visits for hypoglycemia could be attributed to intensive diabetes treatment, particularly among clinically complex patients. Patients at risk for hypoglycemia may benefit from treatment deintensification to reduce hypoglycemia risk and treatment burden.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Hipoglucemiantes/administración & dosificación , Actividades Cotidianas , Factores de Edad , Anciano , Glucemia/análisis , Comorbilidad , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Hemoglobina A Glucada/análisis , Hospitalización/estadística & datos numéricos , Humanos , Hipoglucemia/fisiopatología , Hipoglucemiantes/efectos adversos , Fallo Renal Crónico/epidemiología , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores de Tiempo , Estados Unidos
13.
J Pak Med Assoc ; 69(Suppl 2)(6): S75-S79, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31369537

RESUMEN

Objective: In Vietnam, prevalence of diabetes in adults is estimated at 5.5% and the total cases of diabetes in adults was over 3,5 million in 2017. Hypoglycaemia is one of the most-observed adverse reaction associated with the consumption of insulin and oral hypoglycaemia agents. The objective is to report the hypoglycaemia cases in type 2 diabetes mellitus (T2DM) patients with medication therapies attending a secondary health facility. Methods: We conducted this retrospective research on 1,006 T2DM patients at Lam Dong General Hospital, Lam Dong province in three years between 2016 and 2018 using ICD-10 code of E11. A total of 523 eligible T2DM patients were enumerated to select hypoglycaemia cases while treated with insulin therapy or oral intake of hypoglycaemia agents. Information were extracted from hospital electronic databases, sensitive information was coded. Results: Among 523 eligible T2DM patients, 92.4% (n=483) patients experienced at least one symptom of hypoglycaemia. The mean age of the selected patients was 51.2}5.2. Females were dominated by males in terms of number. Frequency of hypoglycaemia symptoms was 0-1 time per week for most of patients. The main hypoglycaemia symptoms that most of patients with T2DM suffered were sweating and drowsiness (83% and 70% respectively). Seizures, headache and loss of consciousness accounted for lowest percentages. Conclusions: The frequency of hypoglycaemia in T2DM patients in Lam Dong General Hospital was very high. Physician consideration and patient education are necessary in hypoglycaemia management.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/epidemiología , Hipoglucemiantes/efectos adversos , Insulina/efectos adversos , Administración Oral , Adulto , Femenino , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/fisiopatología , Hipoglucemiantes/administración & dosificación , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Estudios Retrospectivos , Centros de Atención Secundaria , Vietnam/epidemiología
14.
Postgrad Med ; 131(7): 423-437, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31382796

RESUMEN

Hyperglycemia on hospital admission is a common phenomenon in acute ischemic stroke patients and represents an independent predictor of poor clinical outcome with or without acute recanalization therapies (systemic thrombolysis or mechanical thrombectomy). Effective restoration of normoglycemia is considered to be beneficial, but conclusive evidence from randomized controlled clinical trials and specific recommendations are lacking. In addition, aggressive glucose control can be complicated by hypoglycemia leading to early neurological deterioration. We conducted a systematic literature review with the aim of addressing several questions: timing of glucose control, target range, type of insulin delivery, duration and practicability of glucose-lowering protocols. Special issues regarding mechanical thrombectomy and glycemic variability can then be investigated in future trials which are also being considered.


Asunto(s)
Isquemia Encefálica/terapia , Hiperglucemia/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Accidente Cerebrovascular/terapia , Glucemia/metabolismo , Isquemia Encefálica/complicaciones , Isquemia Encefálica/metabolismo , Hospitalización , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/metabolismo , Hipoglucemia/inducido químicamente , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/metabolismo , Trombectomía , Terapia Trombolítica
15.
Cardiol Rev ; 27(5): 260-266, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31393288

RESUMEN

Long-acting basal insulins are used for the management of both type 1 and type 2 diabetes mellitus. Long-acting basal insulins were developed utilizing recombinant DNA technology and have been available since 2000 with the approval of insulin glargine U-100 followed by insulin detemir in 2005. In recent years, diabetes management has become more complex with the approval of insulin glargine U-300 and insulin degludec U-100 and U-200. Both insulin glargine U-300 and insulin degludec have been compared with insulin glargine U-100 and have demonstrated longer durations of action, as well as lower rates of hypoglycemia. This review discusses the Food and Drug Administration-approved long-acting insulins with a focus on recently approved agents and their efficacy and safety compared with the first long-acting basal insulins.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Insulina Glargina/uso terapéutico , Insulina de Acción Prolongada/uso terapéutico , Guías de Práctica Clínica como Asunto , Ensayos Clínicos como Asunto , Femenino , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/uso terapéutico , Insulina Glargina/efectos adversos , Insulina de Acción Prolongada/efectos adversos , Masculino
16.
BMJ ; 366: l4894, 2019 08 28.
Artículo en Inglés | MEDLINE | ID: mdl-31462492

RESUMEN

OBJECTIVE: To evaluate if the lowest target level for glycated haemoglobin (HbA1c) of <6.5% is associated with lower risk for retinopathy and nephropathy than less tight control in children and adults with type 1 diabetes. DESIGN: Population based cohort study. SETTING: Swedish National Diabetes Registry, 1 January 1998 to 31 December 2017. PARTICIPANTS: 10 398 children and adults with type 1 diabetes followed from diagnosis, or close thereafter, until end of 2017. MAIN OUTCOME MEASURES: Relative risk (odds ratios) for retinopathy and nephropathy for different mean levels of HbA1c. RESULTS: Mean age of participants was 14.7 years (43.4% female), mean duration of diabetes was 1.3 years, and mean HbA1c level was 8.0% (63.4 mmol/mol). After adjustment for age, sex, duration of diabetes, blood pressure, blood lipid levels, body mass index, and smoking, the odds ratio for mean HbA1c <6.5% (<48 mmol/mol) compared with 6.5-6.9% (48-52 mmol/mol) for any retinopathy (simplex or worse) was 0.77 (95% confidence interval 0.56 to 1.05, P=0.10), for preproliferative diabetic retinopathy or worse was 3.29 (0.99 to 10.96, P=0.05), for proliferative diabetic retinopathy was 2.48 (0.71 to 8.62, P=0.15), for microalbuminuria or worse was 0.98 (0.60 to 1.61, P=0.95), and for macroalbuminuria was 2.47 (0.69 to 8.87, P=0.17). Compared with HbA1c levels 6.5-6.9%, HbA1c levels 7.0-7.4% (53-57 mmol/mol) were associated with an increased risk of any retinopathy (1.31, 1.05 to 1.64, P=0.02) and microalbuminuria (1.55, 1.03 to 2.32, P=0.03). The risk for proliferative retinopathy (5.98, 2.10 to 17.06, P<0.001) and macroalbuminuria (3.43, 1.14 to 10.26, P=0.03) increased at HbA1c levels >8.6% (>70 mmol/mol). The risk for severe hypoglycaemia was increased at mean HbA1c <6.5% compared with 6.5-6.9% (relative risk 1.34, 95% confidence interval 1.09 to 1.64, P=0.005). CONCLUSIONS: Risk of retinopathy and nephropathy did not differ at HbA1c levels <6.5% but increased for severe hypoglycaemia compared with HbA1c levels 6.5-6.9%. The risk for severe complications mainly occurred at HbA1c levels >8.6%, but for milder complications was increased at HbA1c levels >7.0%.


Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/epidemiología , Retinopatía Diabética/epidemiología , Hemoglobina A Glucada/análisis , Hipoglucemia/complicaciones , Adolescente , Adulto , Glucemia/análisis , Glucemia/efectos de los fármacos , Niño , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/etiología , Retinopatía Diabética/sangre , Retinopatía Diabética/etiología , Femenino , Estudios de Seguimiento , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Masculino , Sistema de Registros/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Suecia/epidemiología , Adulto Joven
17.
BMC Endocr Disord ; 19(1): 78, 2019 Jul 23.
Artículo en Inglés | MEDLINE | ID: mdl-31337371

RESUMEN

BACKGROUND: Hypoglycaemia, especially nocturnal, remains the main limiting factor of achieving good glycaemic control in type 1 diabetes. The effect of first generation long-acting insulin analogues in reducing nocturnal hypoglycaemia is well documented in patient with type 1 diabetes. The effect of the newer long-acting insulin degludec on risk of nocturnal hypoglycaemia remains undocumented in patients with type 1 diabetes and recurrent severe nocturnal hypoglycaemia. The HypoDeg trial is designed to investigate whether insulin degludec in comparison with insulin glargine U100 is superior in limiting the occurrence of nocturnal hypoglycaemia in patients with recurrent nocturnal severe hypoglycaemia. This paper reports the study design of the HypoDeg trial. METHODS/DESIGN: A Danish investigator-initiated, prospective, randomised, open, blinded endpoint (PROBE), multicentre, two-year cross-over study investigating the effect of insulin degludec versus insulin glargine U100 on frequency of nocturnal hypoglycaemia in patients with type 1 diabetes and one or more episodes of nocturnal severe hypoglycaemia during the preceding two years as the major inclusion criteria. Patients are randomised (1:1) to basal therapy with insulin degludec or insulin glargine. Insulin aspart is used as bolus therapy in both treatment arms. DISCUSSION: In contrast to most other insulin studies the HypoDeg trial includes only patients at high risk of hypoglycaemia. The HypoDeg trial will compare treatment with insulin degludec to insulin glargine U100 in terms of risk of nocturnal hypoglycaemic episodes in patients with type 1 diabetes with the greatest potential to benefit from near-physiological insulin replacement therapy. www.clinicaltrials.gov : NCT02192450.


Asunto(s)
Ritmo Circadiano/efectos de los fármacos , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemia/epidemiología , Hipoglucemiantes/uso terapéutico , Insulina de Acción Prolongada/uso terapéutico , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Biomarcadores/análisis , Glucemia/análisis , Estudios Cruzados , Esquema de Medicación , Femenino , Estudios de Seguimiento , Humanos , Hipoglucemia/inducido químicamente , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Adulto Joven
18.
Aerosp Med Hum Perform ; 90(8): 735-737, 2019 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-31331425

RESUMEN

INTRODUCTION: Due to the risk of hypoglycemia-related incapacitation, diabetic pilots requiring insulin are assessed as unfit according to the International Civil Aviation Organization and most national authorities. Some authorities, such as those from Canada, the United Kingdom, and the United States, permit selected insulin-treated pilots (ITDM-pilots) to fly subject to a protocol requiring pre- and in-flight capillary glucose measurements to show safe levels (>100-<300 mg · dl-1). Critics of such permission question the practicability of these in-flight measurements and whether clinically desired glycemic targets can be achieved while keeping glucose levels in the safe range. Subcutaneous continuous glucose monitoring (CGM) has recently been approved by the FDA as a stand-alone method to provide accurate glucose levels and treatment decision guidance in patients. This commentary considers that use of CGM by ITDM pilots facilitates practicability and recording of in-flight glucose measurements and facilitates achievement of clinically desired glycemic targets without increasing hypoglycemia risks.Strollo F, Simons R, Mambro A, Strollo G, Gentile S. Continuous glucose monitoring for in-flight measurement of glucose levels of insulin-treated pilots. Aerosp Med Hum Perform. 2019; 90(8):735-737.


Asunto(s)
Medicina Aeroespacial/métodos , Glucemia/análisis , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/prevención & control , Insulina/administración & dosificación , Medicina Aeroespacial/instrumentación , Diabetes Mellitus Tipo 2/sangre , Estudios de Factibilidad , Humanos , Hipoglucemia/sangre , Hipoglucemia/inducido químicamente , Insulina/efectos adversos , Monitoreo Fisiológico/instrumentación , Monitoreo Fisiológico/métodos , Pilotos
19.
JAMA ; 322(4): 326-335, 2019 07 23.
Artículo en Inglés | MEDLINE | ID: mdl-31334795

RESUMEN

Importance: Hyperglycemia during acute ischemic stroke is common and is associated with worse outcomes. The efficacy of intensive treatment of hyperglycemia in this setting remains unknown. Objectives: To determine the efficacy of intensive treatment of hyperglycemia during acute ischemic stroke. Design, Setting, and Participants: The Stroke Hyperglycemia Insulin Network Effort (SHINE) randomized clinical trial included adult patients with hyperglycemia (glucose concentration of >110 mg/dL if had diabetes or ≥150 mg/dL if did not have diabetes) and acute ischemic stroke who were enrolled within 12 hours from stroke onset at 63 US sites between April 2012 and August 2018; follow-up ended in November 2018. The trial included 1151 patients who met eligibility criteria. Interventions: Patients were randomized to receive continuous intravenous insulin using a computerized decision support tool (target blood glucose concentration of 80-130 mg/dL [4.4-7.2 mmol/L]; intensive treatment group: n = 581) or insulin on a sliding scale that was administered subcutaneously (target blood glucose concentration of 80-179 mg/dL [4.4-9.9 mmol/L]; standard treatment group: n = 570) for up to 72 hours. Main Outcomes and Measures: The primary efficacy outcome was the proportion of patients with a favorable outcome based on the 90-day modified Rankin Scale score (a global stroke disability scale ranging from 0 [no symptoms or completely recovered] to 6 [death]) that was adjusted for baseline stroke severity. Results: Among 1151 patients who were randomized (mean age, 66 years [SD, 13.1 years]; 529 [46%] women, 920 [80%] with diabetes), 1118 (97%) completed the trial. Enrollment was stopped for futility based on prespecified interim analysis criteria. During treatment, the mean blood glucose level was 118 mg/dL (6.6 mmol/L) in the intensive treatment group and 179 mg/dL (9.9 mmol/L) in the standard treatment group. A favorable outcome occurred in 119 of 581 patients (20.5%) in the intensive treatment group and in 123 of 570 patients (21.6%) in the standard treatment group (adjusted relative risk, 0.97 [95% CI, 0.87 to 1.08], P = .55; unadjusted risk difference, -0.83% [95% CI, -5.72% to 4.06%]). Treatment was stopped early for hypoglycemia or other adverse events in 65 of 581 patients (11.2%) in the intensive treatment group and in 18 of 570 patients (3.2%) in the standard treatment group. Severe hypoglycemia occurred only among patients in the intensive treatment group (15/581 [2.6%]; risk difference, 2.58% [95% CI, 1.29% to 3.87%]). Conclusions and Relevance: Among patients with acute ischemic stroke and hyperglycemia, treatment with intensive vs standard glucose control for up to 72 hours did not result in a significant difference in favorable functional outcome at 90 days. These findings do not support using intensive glucose control in this setting. Trial Registration: ClinicalTrials.gov Identifier: NCT01369069.


Asunto(s)
Hiperglucemia/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Accidente Cerebrovascular/complicaciones , Anciano , Isquemia Encefálica/complicaciones , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Hiperglucemia/complicaciones , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Infusiones Intravenosas , Inyecciones Subcutáneas , Insulina/efectos adversos , Masculino , Persona de Mediana Edad , Accidente Cerebrovascular/tratamiento farmacológico , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del Tratamiento
20.
Diabetes Metab Syndr ; 13(2): 1413-1429, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31336501

RESUMEN

The fasting in the holy month of Ramadan is passionately practised among the Muslims population around the world. Patients with diabetes are generally considered to have various risks with fasting. The recent pharmacologic and technical advances in the management of diabetes may have enabled these patients to practice safe fasting. The purpose of this review is to scientific evidence on the safety and efficacy of the current hypoglycemic agents during Ramadan. METHODS: An extensive Electronic search via PubMed and Google scholar was accomplished through using different search terms. The eligible studies were limited to only published Randomised controlled trial (RCT) and prospective observational studies from 2007 to 2018 on patients with all types of diabetes on any pharmacological management, who intended to fast in Ramadan. RESULTS AND CONCLUSIONS: The current era witnessed a gradual shift in the management of these patients with diabetes who elected to fast in Ramadan, despite the variable health-related risks with fasting. Results from available RCTs and observational studies in patients with type 2 diabetes showed lower risk of hypoglycemia, similar or better efficacy for glycemic and weight control with SGLT2 inhibitors, incretin mimetics and the newer insulin analogues compared to Sulfonylurea. Gliclazide is a relatively safer option among all sulfonylurea. Patients requiring insulin did better with insulin analogues, especially the newer premixed formulation at the time of breaking fast compared to the former insulin formulation. Current commonly used newer hypoglycemic agents are generally safe during Ramadan, however, their safety in the higher risk diabetes patients is highly needed.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Ayuno , Hipoglucemia/prevención & control , Hipoglucemiantes/administración & dosificación , Seguridad del Paciente , Ensayos Clínicos como Asunto , Humanos , Hipoglucemia/inducido químicamente , Islamismo , Pronóstico , Medición de Riesgo
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