Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.969
Filtrar
1.
Eur J Endocrinol ; 184(2): 267-276, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33434161

RESUMEN

Objective: The European Increlex® Growth Forum Database Registry monitors the effectiveness and safety of recombinant human insulin-like growth factor-1 (rhIGF1; mecasermin, Increlex®) therapy in patients with severe primary IGF1 deficiency (SPIGFD). We present data from patients with and without a reported genetic diagnosis of Laron syndrome (LS). Design: Ongoing, open-label, observational registry (NCT00903110). Methods: Children and adolescents receiving rhIGF1 therapy from 10 European countries were enrolled in 2008-2017 (n = 242). The treatment-naïve/prepubertal (NPP) cohort (n = 138) was divided into subgroups based on reported genetic diagnosis of LS (n = 21) or non-LS (n = 117). Multivariate analysis of the NPP-non-LS subgroup was conducted to identify factors predictive of growth response (first-year-height standard deviation score (SDS) gain ≥ 0.3). Assessments included change in height and weight over 5 years and adverse events (AEs). Results: Height SDS gain from baseline was greater in the NPP-LS than the NPP-non-LS subgroup after 1 years' treatment (P < 0.05). In the NPP-non-LS subgroup, 56% were responders; young age at baseline was a positive independent predictive factor (P < 0.001). NPP-non-LS-responders and the NPP-LS subgroup had a similar mean age (6.07 years vs 7.00 years) at baseline and height SDS gain in year 1 (0.64 vs 0.70), although NPP-non-LS-responders were taller (P < 0.001) at baseline. BMI SDS changes did not differ across subgroups. Treatment-emergent AEs were experienced by 65.3% of patients; hypoglycaemia was most common. Conclusions: In most NPP children with SPIGFD, with or without LS, rhIGF1 therapy promotes linear growth. The safety profile was consistent with previous studies.


Asunto(s)
Trastornos del Crecimiento/tratamiento farmacológico , Pérdida Auditiva Sensorineural/tratamiento farmacológico , Factor I del Crecimiento Similar a la Insulina/deficiencia , Factor I del Crecimiento Similar a la Insulina/uso terapéutico , Síndrome de Laron/tratamiento farmacológico , Proteínas Recombinantes/uso terapéutico , Adolescente , Estatura , Peso Corporal/efectos de los fármacos , Niño , Femenino , Crecimiento/efectos de los fármacos , Humanos , Hipoglucemia/sangre , Hipoglucemia/inducido químicamente , Síndrome de Laron/genética , Estudios Longitudinales , Masculino , Seguridad del Paciente , Pubertad , Resultado del Tratamiento , Adulto Joven
2.
Lakartidningen ; 1182021 01 20.
Artículo en Sueco | MEDLINE | ID: mdl-33474717

RESUMEN

Continuous glucose monitoring (CGM) tracks glucose levels in real-time using a subcutaneous sensor, replacing intermittent blood sampling for self-monitoring of blood glucose (SMBG). CGM is a routine tool in type 1 diabetes management. In 2019, patients with type 2 diabetes were given the indication of CGM use by Swedish authorities; CGM can be considered when a patient despite multi-dose treatment with insulin does not achieve good glucose control and/or has problems with hypoglycaemia. Studies show that CGM provides improved glycaemic control compared to SMBG. The cost of CGM is higher than for SMBG and requires effort both by caregivers and patients. This should be gauged against the possible long-term health economic benefits of preventing diabetes complications.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Hipoglucemia , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control
3.
Adv Exp Med Biol ; 1307: 43-69, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32406022

RESUMEN

In health hypoglycaemia is rare and occurs only in circumstances like extreme sports. Hypoglycaemia in type 1 Diabetes (T1D) and advanced type 2 Diabetes (T2D) are the result of interplay between absolute or relative insulin access and defective glucose counterregulation. The basic mechanism is, failure of decreasing insulin and failure of the compensatory increasing counterregulatory hormones at the background of falling blood glucose. Any person with Diabetes on anti-diabetic medication who behaves oddly in any way whatsoever is hypoglycaemic until proven otherwise. Hypoglycaemia can be a terrifying experience for a patient with Diabetes. By definition, hypoglycaemic symptoms are subjective and vary from person to person and even episode to episode in same person. Fear of iatrogenic hypoglycaemia is a major barrier in achieving optimum glycaemic control and quality of life which limits the reduction of diabetic complications. Diabetes patients with comorbidities especially with chronic renal failure, hepatic dysfunction, major limb amputation, terminal illness, cognitive dysfunction etc. are more vulnerable to hypoglycaemia. In most cases, prompt glucose intake reverts hypoglycaemia. Exogenous insulin in T1D and insulin treated advanced T2D have no control by pancreatic regulation. Moreover, failure of increase of glucagon and attenuated secretion in epinephrine causes the defective glucose counterregulation. In this comprehensive review, I will try to touch all related topics for better understanding of hypoglycaemia.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Hipoglucemia , Glucemia , Comorbilidad , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/tratamiento farmacológico , Insulina/uso terapéutico , Calidad de Vida
4.
Nurs Res ; 70(1): 15-23, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32991530

RESUMEN

BACKGROUND: Hypoglycemia can be a common occurrence in hospitalized patients, both those with and without diabetes. Hypoglycemia poses significant risks to hospitalized patients, including increased mortality. OBJECTIVES: This was a retrospective pre-post study of hypoglycemic patients in an academic medical center of an intervention to improve timely staff nurse adherence to a hypoglycemia protocol. The number of mild and severe hypoglycemia events pre- and postintervention, timeliness of adherence to the hypoglycemia protocol, the number of treatment interventions, and time to return patients to euglycemia were analyzed. METHODS: Data from hospitalizations of patients who experienced hypoglycemia (<70 mg/dl) and met inclusion criteria 1 year prior to intervention and 3 years postintervention were extracted, including demographics, glycemic control medications, diagnostic-related group, length of stay, and Charlson comorbidity index. For clarity and to determine if any significant change was sustained, the analysis compared data from 1 year prior to intervention to the second-year postintervention. RESULTS: A total of 7,895 unique hypoglycemic events in 3,819 patients experiencing 20,094 hypoglycemic measures were included in the analysis. Patients were primarily adult, female, and White. Only 58.7% of the sample had diabetes; the median Charlson comorbidity index was 6. Results demonstrated improvement postintervention to registered nurse hypoglycemia protocol adherence regardless of age category or hypoglycemia severity. There was a significant reduction in median time from the first hypoglycemia measure to the second measure. In addition, there was a significant difference in the number of treatment interventions and reduction in time from the first hypoglycemia measure to return of patient to a blood glucose of ≥70 mg/dl. DISCUSSION: These study results support that the use of a standardized hypoglycemia protocol and appropriate nurse workflows enables nurses to manage hypoglycemia promptly and effectively in most acute and critically ill hospitalized patients. Results also supported a differentiation in nurse workflow for patients with mild versus severe hypoglycemia. Implementing these interventions may result in avoidance or mitigation of the potential consequences of severe and/or sustained hypoglycemia.


Asunto(s)
Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/fisiopatología , Hospitalización/estadística & datos numéricos , Hipoglucemia/inducido químicamente , Hipoglucemia/tratamiento farmacológico , Hipoglucemiantes/efectos adversos , Cumplimiento de la Medicación/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Glucemia/análisis , Niño , Preescolar , Enfermedad Crítica/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Medio Oeste de Estados Unidos , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
5.
Ter Arkh ; 92(10): 54-62, 2020 Nov 24.
Artículo en Ruso | MEDLINE | ID: mdl-33346480

RESUMEN

AIM: To investigate the link between the hypoglycemia (registrated accurately by the professional Continuous Glucose Monitoring CGM; severe hypoglycemia at home) and the hetero-/homozygote carriage of single nucleotide polymorphisms (SNP) of cytochrome systems geneCYP2C9(rs1799853CYP2C9*2 иrs1057910CYP2C9*3) at the patients with Type 2 Diabetes Mellitus (T2DM) used sulphonylurea (SU). MATERIALS AND METHODS: In Study Case-Control 120 T2DM-SU-patients genotyped by SNPs of geneCYP2C9(using PCR-RT) had been done the professional CGM (System iPro2, Medtronic) recorded Time in Range of Hypoglycemia (TIR-HYPO), level of Minimal CGM-hypoglycemia (MinGl) and standard CGM-parameters of Glycemic Variability. Severe hypoglycemia at home was recorded from visit to visit. The odds ratio (OR) of metabolic disturbances had been assessed for carriage SNPs in comparison with wide alleles. RESULTS: The Study established that carriage of SNPsrs1799853andrs1057910geneCYP2C9at T2DM-SU-patients associated with rising of Glycemic Variability and frequency of CGM-hypoglycemia (MinGl decreasing, increasing of TIR-HYPO and number of Glycemia Excursion 4 mmol/L/h), as well as increasing severe hypoglycemia at home (p0.05). Thus, OR at the carriage ofrs1799853andrs1057910respectively equaled: for CGM-hypoglycemia 7.78 (3.0220.01) and 5.80 (0.23145.87); number of Glycemia Excursion 4 mmol/L/h 5.76 (2.2914.43) and 4.44 (1.4313.76); MinGl3.9 mmol/L 4.39 (1.7910.75) and 6.26 (1.8421.30); CV40% (vs30%) 3.63 (1.0412.62) and 15.22 (0.59393.94);p0.05. CONCLUSION: At the real clinical practice the assessment of carriage of SNPs of geneCYP2C9before inclusion of SU to glucose-lowering scheme of T2DM-therapy it necessary to carry out for the detecting patients with a higher risk of hypoglycemia and rising of Glycemic Variability.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Hipoglucemiantes/efectos adversos , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/genética , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/genética , Hipoglucemiantes/uso terapéutico , Farmacogenética
6.
Vnitr Lek ; 66(7): 447-448, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33380125

RESUMEN

Hypoglycemia is a rather frequent complication of diabetes treatment, however it can occur also in non-diabetic patients. The article presents a brief differential diagnosis of hypoglycemia in non-diabetic patients.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Insulinoma , Neoplasias Pancreáticas , Diagnóstico Diferencial , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/diagnóstico , Insulinoma/diagnóstico , Neoplasias Pancreáticas/diagnóstico
7.
Vnitr Lek ; 66(6): 35-42, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33380151

RESUMEN

Hypoglycemia related to treatment of type 2 diabetes mellitus patients constantly represents a substantial problem. It is connected with higher mortality and lower quality of life, mostly displayed with elder patients. Therefore it is vital to revise the antidiabetic therapy regularly and to inquire for the associated risks. Nevertheless, elder patiens are often following the inadvisable treatment by sulphonylureas derivates, which represent the second most risky medication causing hypoglycemia after insulin. In our retrospective study we analysed the occurence of serious hypoglycemia, caused by any factor, with severe diabetics urgently hospitalised at The Department of Internal Medicine of Masaryk Hospital in Ústí nad Labem, in relation to the applied antidiabetic therapy. We suspected a negative influence of hypoglycemizing therapy (above all sulphonylureas) with the elderly patiens. In sum, we hospitalised 32 patients with type 2 diabetes mellitus (average age 76,5 ± 8,2 years), 18 of these using sulphonylureas (average age 77,4, with a relatively wide range from 65 to alarming 93 years). The average figure of estimated glomerular filtration rate (eGFR) was 0,745 (±0,293) ml/s/1,73m2. Moreover, the patients manifested polmorbidity - the average of comorbidities was 3,125, and even 3,5 with patiens on sulphonylureas. Following the arguments summarised above, we believe that hypoglycemic episodes are extremely dangerous especially for elder patients with T2DM, and from this point of view, the medication using sulphonylureas derivates seems to be inappropriate.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Anciano , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/epidemiología , Hipoglucemiantes/efectos adversos , Calidad de Vida , Estudios Retrospectivos , Compuestos de Sulfonilurea/efectos adversos
8.
J Assoc Physicians India ; 68(12[Special]): 43-48, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247663

RESUMEN

The inadequate control of postprandial glucose (PPG) excursions, are linked in some studies with cardiovascular disease. Even though basal insulins, such as insulin glargine 100 U/mL (Gla-100), maintain overall glycemic control, effective PPG control eventually requires intensification of therapy by adding prandial insulins. Compared to conventional basal-bolus or premixed approaches, a stepwise basal-plus or basal-prandial intensification regimen involving the addition of one, two, or three prandial insulins to basal therapy such as Gla-100, has received much attention in recent times. This intensification approach is comparable to other conventional approaches in terms of glycemic control, and offers the additional advantages of fewer hypoglycemic events, personalization of therapy, and a simple self-management algorithm for titration. Owing to such benefits, recent guidelines recommend its use over other approaches for initiating intensification. It is preferred by both physicians and patients and is a better alternative to immediately embarking on a full basal-bolus regimen or introducing premixed insulin preparations for intensification of therapy.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipoglucemia , Insulinas , Glucemia , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes , Insulina , Insulina Glargina
9.
J Assoc Physicians India ; 68(12[Special]): 55-59, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33247665

RESUMEN

Both hyperglycemia and hypoglycemia in hospitalized patients represent a major concern as they are associated with adverse outcomes-including increased rates of infection, longer hospital stay, and even death. Insulin therapy is the mainstay in the management of inpatient hyperglycemia. The traditional approach of sliding scale insulin (SSI) therapy for the temporary management of blood glucose levels in hospitalized patients, has now given way to basal-bolus insulin (BBI) therapy. This is owing to the BBI affording a better glycemic control in non-critical hospital settings as observed in multiple clinical studies using insulin glargine 100 U/mL (Gla-100) as the basal component. Furthermore, a string of clinical studies has also attested to Gla-100 being used effectively even in patients on corticosteroids, enteral or parenteral nutrition, and in perioperative settings. Hence, overall, the existing evidence would point to the growing role of BBI regimens centering around basal insulin like Gla-100 as an effective option with low safety concerns for insulin therapy in both hospitalized and out-patient settings in the treatment of patients with type 2 diabetes mellitus (T2DM).


Asunto(s)
Diabetes Mellitus Tipo 2 , Hiperglucemia , Hipoglucemia , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hiperglucemia/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes , Insulina , Insulina Glargina
10.
Expert Opin Pharmacother ; 21(15): 1799-1803, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33108240

RESUMEN

INTRODUCTION: The majority of patients with type 1 diabetes mellitus (T1DM) do not achieve glycemic targets. In addition, treatment with insulin is associated with increased risk for hypoglycemia and weight gain. Accordingly, there is an unmet need for new safe and effective glucose-lowering agents in this population. Sotagliflozin, a dual inhibitor of sodium-glucose co-transporters 1 and 2, has been recently approved for use in patients with T1DM. AREAS COVERED: The authors review the major trials that have evaluated the safety and efficacy of sotagliflozin and provide their expert opinion. EXPERT OPINION: Even though sotagliflozin reduces HbA1 c levels and does not appear to increase the risk for hypoglycemia in most patients, the substantially increased risk for diabetic ketoacidosis limits the use of this agent to a carefully selected subgroup of patients with T1DM. Based on the existing evidence, sotagliflozin should be considered only in patients who have failed to achieve adequate glycemic control despite optimal insulin therapy, are at low risk for diabetic ketoacidosis, have been adequately trained to recognize this complication and are able to be in close contact with their physician.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Glicósidos/uso terapéutico , Hipoglucemiantes/uso terapéutico , Glucemia/efectos de los fármacos , Diabetes Mellitus Tipo 1/metabolismo , Cetoacidosis Diabética/inducido químicamente , Glicósidos/administración & dosificación , Glicósidos/efectos adversos , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Insulina/administración & dosificación , Riesgo , Transportador 1 de Sodio-Glucosa/metabolismo , Transportador 2 de Sodio-Glucosa/metabolismo
11.
Rev Med Liege ; 75(10): 653-659, 2020 Oct.
Artículo en Francés | MEDLINE | ID: mdl-33030841

RESUMEN

Physical activity is a key step in the management of diabetes, both in type 1 and type 2 diabetes. In diabetic subjects, it is recommended to practice 150 minutes of weekly physical activity spread over at least three days, with a maximum of two consecutive days without exercise. However, more than 60 % of type 1 diabetic patients fail to meet this goal. This is largely explained by the fear of potential adverse effects, in particular the occurrence of hypoglycaemia during exercise, which represents a major obstacle to its safe practice. Therefore, specific therapeutic education should be considered in these subjects in order to promote regular physical activity.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Hipoglucemia , Deportes , Diabetes Mellitus Tipo 1/terapia , Ejercicio Físico , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control
12.
Farm. comunitarios (Internet) ; 12(4): 5-20, oct. 2020. tab
Artículo en Español | IBECS | ID: ibc-197487

RESUMEN

INTRODUCCIÓN: la falta de adherencia implica peor control de la diabetes y aumento del número de complicaciones, lo que a menudo se traduce en un mayor gasto sanitario. Las hipoglucemias, en ocasiones inadvertidas, son una de las principales consecuencias de la no adherencia y su prevención pasa por intervenciones multidisciplinares que ayuden a la mejora de la adherencia. OBJETIVOS: medir la adherencia a hipoglucemiantes, detectar y cuantificar hipoglucemias inadvertidas y recurrentes, conocer la percepción de los pacientes sobre su tratamiento y derivar al médico en casos de no adherencia e hipoglucemias no solucionadas. MATERIAL Y MÉTODOS: estudio observacional, transversal y multicéntrico, en farmacias comunitarias, realizado a partir de abril de 2019 con diabéticos tipo 2 en tratamiento con hipoglucemiantes que lleven ≥12 meses con la misma pauta. Para la detección de hipoglucemias, los que estén en tratamiento con sulfonilureas, glinidas y/o insulinas. Diseño de un cuestionario con datos sociodemográficos, enfermedades y tratamientos. Utilización del test MMAS-8 para detectar no adherencia y del test de Clarke para hipoglucemias. Si se detecta incumplimiento y/o hipoglucemia y no se puede solucionar por el farmacéutico se derivará al médico de familia. ANÁLISIS ESTADÍSTICO: se utilizará el programa STATA13 para Windows®. Se realizarán análisis bivariados y multivariados. La significación se fijará en p < 0,05. Aplicabilidad de los resultados: se espera conocer la falta de adherencia y los factores que la causan y la prevalencia de las hipoglucemias inadvertidas para, en otro proyecto, establecer un programa de intervención farmacéutica que se muestre eficiente para mejorar la adherencia farmacoterapéutica de los pacientes en tratamiento con hipoglucemiantes y disminuir la aparición de hipoglucemias


INTRODUCTION: Lack of adherence results in worse control of diabetes and an increased number of complications, often resulting in higher healthcare spending. Hypoglycemia, which is sometimes unrecognized, is one of the main consequences of non-adherence to treatment. It is prevented through multidisciplinary interventions which help improve adherence. OBJECTIVES: to measure adherence to hypoglycemic agents, to detect and quantify unrecognized and recurrent hypoglycemia, to learn patients' perceptions of their treatment and refer them to doctors in cases of non-adherence and unsolved hypoglycemia. MATERIAL AND METHODS: an observational, cross-sectional, multicenter study in community pharmacies, conducted from April 2019 with type 2 diabetics in treatment with hypoglycemic agents for ≥12 months on the same drug regimen. To detect hypoglycemia, those treated with sulfonylureas, glinides and/or insulin. Design of a questionnaire with sociodemographic data, diseases and treatments. Use of the MMAS-8 test for non-adherence and the Clarke hypoglycemia awareness test. If non-compliance and/or hypoglycemia is detected and cannot be resolved by the pharmacist, it will be referred to the family doctor. Statistical analysis: the STATA13 program will be used for Windows®. Bivariate and multivariate analyses will be conducted. Statistical significance will be set at p < 0.05. APPLICABILITY OF THE RESULTS: we hope to gain awareness of the lack of adherence and its causal factors and the prevalence of unrecognized hypoglycemia so that, in another project, an efficient pharmaceutical intervention program can be established to improve adherence to pharmacotherapy of patients treated with hypoglycemic agents and reduce the occurrence of hypoglycemia


Asunto(s)
Humanos , Masculino , Femenino , Diabetes Mellitus Tipo 2/prevención & control , Cumplimiento de la Medicación/estadística & datos numéricos , Hipoglucemiantes/uso terapéutico , Hipoglucemia/epidemiología , Farmacias/estadística & datos numéricos , Hipoglucemia/inducido químicamente , Estudios Transversales , Encuestas y Cuestionarios , España/epidemiología
13.
Ther Umsch ; 77(7): 328-332, 2020 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-32996423

RESUMEN

Diabetes, hypoglycemia and driving instructions in Switzerland Abstract. Many individuals with diabetes participate in road traffic in a regular and safe manner. Studies suggest that type 1 diabetes leads to more traffic accidents. Hypoglycemia is a risk factor for driving mishaps. Therefore, patients with diabetes medication, which can cause hypoglycemia, have to be informed and adhere to the guidelines regarding suitability for driving. These guidelines are summarized in this review.


Asunto(s)
Conducción de Automóvil , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Accidentes de Tránsito/prevención & control , Humanos , Suiza
14.
Diabetes Res Clin Pract ; 167: 108354, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32739380

RESUMEN

AIMS: Spain has been one of the worst affected countries by the COVID-19 pandemic. A very strict lockdown at home was imposed with a tough restriction of mobility. We aimed to evaluate the impact of this exceptional scenario on glucose profile of patients with T1D prone to hypoglycemia using standalone continuous glucose monitoring. METHODS: Patients with T1D prone to hypoglycemia using multiple daily injections and either a Dexcom G5® or a Free Style Libre® CGM systems for at least 6 months under the funding of National Health Service were included in an observational, retrospective study. Data were collected in two periods: pre-lockdown (PL), February 23rd-March 7th and within lockdown (WL), April 1st-14th 2020. The primary outcome was the difference in the proportion of time in target glucose range of 70-180 mg/dL (TIR). Additional glucometric data were also analysed. RESULTS: 92 patients were included: 40 women, age 42.8 ± 3.9 years, disease duration of 23.1 ± 12.6 years. Seventeen patients used Dexcom G5® and 75 Free Style Libre®. TIR 70-180 mg/dL (59.3 ± 16.2 vs 62.6 ± 15.2%), time > 180 (34.4 ± 18.0 vs 30.7 ± 16.9%), >250 (11.1 ± 10.6 vs 9.2 ± 9.7%) and Glucose Management Indicator (7.2 ± 0.8 vs 7.0 ± 0.8%) significantly improved (PL vs WL, respectively, p < 0.05). Time in hypoglycemia remained unchanged. CONCLUSIONS: Lockdown conditions imposed by the COVID-19 pandemic may be managed successfully in terms of glycemic control by population with T1D prone to hypoglycemia using CGM. The strict daily routine at home could probably explain the improvement in the time in glycemic target without increasing the time in hypoglycemia.


Asunto(s)
Automonitorización de la Glucosa Sanguínea , Control de Enfermedades Transmisibles , Infecciones por Coronavirus/epidemiología , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemia/inducido químicamente , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Monitoreo Ambulatorio , Neumonía Viral/epidemiología , Adulto , Betacoronavirus , Glucemia , Diabetes Mellitus Tipo 1/metabolismo , Femenino , Humanos , Inyecciones , Insulina de Acción Prolongada/uso terapéutico , Insulina de Acción Corta/uso terapéutico , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , España/epidemiología , Medicina Estatal
15.
Med Care ; 58(10): 927-933, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32833937

RESUMEN

BACKGROUND: Hypoglycemia related to antidiabetic drugs (ADDs) is important iatrogenic harm in hospitalized patients. Electronic identification of ADD-related hypoglycemia may be an efficient, reliable method to inform quality improvement. OBJECTIVE: Develop electronic queries of electronic health records for facility-wide and unit-specific inpatient hypoglycemia event rates and validate query findings with manual chart review. METHODS: Electronic queries were created to associate blood glucose (BG) values with ADD administration and inpatient location in 3 tertiary care hospitals with Patient-Centered Outcomes Research Network (PCORnet) databases. Queries were based on National Quality Forum criteria with hypoglycemia thresholds <40 and <54 mg/dL, and validated using a stratified random sample of 321 BG events. Sensitivity and specificity were calculated with manual chart review as the reference standard. RESULTS: The sensitivity and specificity of queries for hypoglycemia events were 97.3% [95% confidence interval (CI), 90.5%-99.7%] and 100.0% (95% CI, 92.6%-100.0%), respectively for BG <40 mg/dL, and 97.7% (95% CI, 93.3%-99.5%) and 100.0% (95% CI, 95.3%-100.0%), respectively for <54 mg/dL. The sensitivity and specificity of the query for identifying ADD days were 91.8% (95% CI, 89.2%-94.0%) and 99.0% (95% CI, 97.5%-99.7%). Of 48 events missed by the queries, 37 (77.1%) were due to incomplete identification of insulin administered by infusion. Facility-wide hypoglycemia rates were 0.4%-0.8% (BG <40 mg/dL) and 1.9%-3.0% (BG <54 mg/dL); rates varied by patient care unit. CONCLUSIONS: Electronic queries can accurately identify inpatient hypoglycemia. Implementation in non-PCORnet-participating facilities should be assessed, with particular attention to patient location and insulin infusions.


Asunto(s)
Registros Electrónicos de Salud , Hipoglucemia/epidemiología , Hipoglucemiantes/efectos adversos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/uso terapéutico , Pacientes Internos , Insulina/administración & dosificación , Insulina/efectos adversos , Insulina/uso terapéutico , Masculino , Persona de Mediana Edad , Centros de Atención Terciaria/normas
16.
Cardiovasc Ther ; 2020: 3612607, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32774458

RESUMEN

Introduction: Severe hypoglycemia can be life-threatening; therefore, it is important to identify the characteristics of the hypoglycemic patients. The aim of this study is to analyze the type and characteristics of diabetic patients with hypoglycemia who visited an emergency room. Methods: We included diabetic patients with hypoglycemia who visited the emergency room of St. Mary's Hospital in Seoul from January 2009 to August 2018 in the study. Hypo_S group patients visited the emergency room once whereas Hypo_M group patients visited twice or more. We also compared the incidence of cardiovascular disease between the groups within 5 years after hypoglycemia. Results: A total of 843 patients were included in this study, with a mean age of 71 ± 14 years and average glycated hemoglobin (HbA1c) level of 6.7 ± 1.4%. For patients with hypoglycemia, lower body mass index, lower HbA1c, shorter diabetes duration, and lower glomerular filtration rate have a statistically significant relationship with patient characteristics in the emergency room group (all p < 0.001). Hypoglycemia symptoms were most frequently observed between 6:00 and 12:00 am (p < 0.001). Cardiovascular diseases within 5 years after discharge were more frequent in the Hypo_S group than in the Hypo_M group; however, there was no statistical significance. The frequency of aneurysms was significantly higher in patients with hypoglycemia than in other patients in the emergency room (p < 0.05). Conclusion: Relatively thin older patients with a diabetes duration shorter than 10 years and good blood sugar control showed higher frequency of visits to the emergency room due to hypoglycemia. For these patients, medical staff should always be mindful of their susceptibility to hypoglycemia when prescribing insulin or OHA and educate them on the prevention of hypoglycemia.


Asunto(s)
Glucemia/efectos de los fármacos , Diabetes Mellitus/tratamiento farmacológico , Servicio de Urgencia en Hospital , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Glucemia/metabolismo , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Hipoglucemia/sangre , Hipoglucemia/diagnóstico , Hipoglucemia/epidemiología , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Seúl/epidemiología , Índice de Severidad de la Enfermedad , Factores de Tiempo
17.
N Engl J Med ; 383(9): 836-845, 2020 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-32846062

RESUMEN

BACKGROUND: A closed-loop system of insulin delivery (also called an artificial pancreas) may improve glycemic outcomes in children with type 1 diabetes. METHODS: In a 16-week, multicenter, randomized, open-label, parallel-group trial, we assigned, in a 3:1 ratio, children 6 to 13 years of age who had type 1 diabetes to receive treatment with the use of either a closed-loop system of insulin delivery (closed-loop group) or a sensor-augmented insulin pump (control group). The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring. RESULTS: A total of 101 children underwent randomization (78 to the closed-loop group and 23 to the control group); the glycated hemoglobin levels at baseline ranged from 5.7 to 10.1%. The mean (±SD) percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter increased from 53±17% at baseline to 67±10% (the mean over 16 weeks of treatment) in the closed-loop group and from 51±16% to 55±13% in the control group (mean adjusted difference, 11 percentage points [equivalent to 2.6 hours per day]; 95% confidence interval, 7 to 14; P<0.001). In both groups, the median percentage of time that the glucose level was below 70 mg per deciliter was low (1.6% in the closed-loop group and 1.8% in the control group). In the closed-loop group, the median percentage of time that the system was in the closed-loop mode was 93% (interquartile range, 91 to 95). No episodes of diabetic ketoacidosis or severe hypoglycemia occurred in either group. CONCLUSIONS: In this 16-week trial involving children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with the use of a closed-loop system than with the use of a sensor-augmented insulin pump. (Funded by Tandem Diabetes Care and the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT03844789.).


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Bombas de Infusión Implantables , Sistemas de Infusión de Insulina , Insulina/administración & dosificación , Adolescente , Glucemia/análisis , Niño , Diabetes Mellitus Tipo 1/sangre , Cetoacidosis Diabética/etiología , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Inyecciones Subcutáneas , Insulina/efectos adversos , Sistemas de Infusión de Insulina/efectos adversos , Masculino , Páncreas Artificial
18.
Cochrane Database Syst Rev ; 8: CD009966, 2020 07 30.
Artículo en Inglés | MEDLINE | ID: mdl-32803882

RESUMEN

BACKGROUND: Kidney transplantation is the preferred management for patients with end-stage kidney disease (ESKD). However, it is often complicated by worsening or new-onset diabetes. The safety and efficacy of glucose-lowering agents after kidney transplantation is largely unknown. This is an update of a review first published in 2017. OBJECTIVES: To evaluate the efficacy and safety of glucose-lowering agents for treating pre-existing and new onset diabetes in people who have undergone kidney transplantation. SEARCH METHODS: We searched the Cochrane Kidney and Transplant Register of Studies up to 16 January 2020 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA: All randomised controlled trials (RCTs), quasi-RCTs and cross-over studies examining head-to-head comparisons of active regimens of glucose-lowering therapy or active regimen compared with placebo/standard care in patients who have received a kidney transplant and have diabetes were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Four authors independently assessed study eligibility and quality and performed data extraction. Continuous outcomes were expressed as post-treatment mean differences (MD) or standardised mean difference (SMD). Adverse events were expressed as post-treatment absolute risk differences (RD). Dichotomous clinical outcomes were presented as risk ratios (RR) with 95% confidence intervals (CI). MAIN RESULTS: Ten studies (21 records, 603 randomised participants) were included - three additional studies (five records) since our last review. Four studies compared more intensive versus less intensive insulin therapy; two studies compared dipeptidyl peptidase-4 (DPP-4) inhibitors to placebo; one study compared DPP-4 inhibitors to insulin glargine; one study compared sodium glucose co-transporter 2 (SGLT2) inhibitors to placebo; and two studies compared glitazones and insulin to insulin therapy alone. The majority of studies had an unclear to a high risk of bias. There were no studies examining the effects of biguanides, glinides, GLP-1 agonists, or sulphonylureas. Compared to less intensive insulin therapy, it is unclear if more intensive insulin therapy has an effect on transplant or graft survival (4 studies, 301 participants: RR 1.12, 95% CI 0.32 to 3.94; I2 = 49%; very low certainty evidence), delayed graft function (2 studies, 153 participants: RR 0.63, 0.42 to 0.93; I2 = 0%; very low certainty evidence), HbA1c (1 study, 16 participants; very low certainty evidence), fasting blood glucose (1 study, 24 participants; very low certainty evidence), kidney function markers (1 study, 26 participants; very low certainty evidence), death (any cause) (3 studies, 208 participants" RR 0.68, 0.29 to 1.58; I2 = 0%; very low certainty evidence), hypoglycaemia (4 studies, 301 participants; very low certainty evidence) and medication discontinuation due to adverse effects (1 study, 60 participants; very low certainty evidence). Compared to placebo, it is unclear whether DPP-4 inhibitors have an effect on hypoglycaemia and medication discontinuation (2 studies, 51 participants; very low certainty evidence). However, DPP-4 inhibitors may reduce HbA1c and fasting blood glucose but not kidney function markers (1 study, 32 participants; low certainty evidence). Compared to insulin glargine, it is unclear if DPP-4 inhibitors have an effect on HbA1c, fasting blood glucose, hypoglycaemia or discontinuation due to adverse events (1 study, 45 participants; very low certainty evidence). Compared to placebo, SGLT2 inhibitors probably do not affect kidney graft survival (1 study, 44 participants; moderate certainty evidence), but may reduce HbA1c without affecting fasting blood glucose and eGFR long-term (1 study, 44 participants, low certainty evidence). SGLT2 inhibitors probably do not increase hypoglycaemia, and probably have little or no effect on medication discontinuation due to adverse events. However, all participants discontinuing SGLT2 inhibitors had urinary tract infections (1 study, 44 participants, moderate certainty evidence). Compared to insulin therapy alone, it is unclear if glitazones added to insulin have an effect on HbA1c or kidney function markers (1 study, 62 participants; very low certainty evidence). However, glitazones may make little or no difference to fasting blood glucose (2 studies, 120 participants; low certainty evidence), and medication discontinuation due to adverse events (1 study, 62 participants; low certainty evidence). No studies of DPP-4 inhibitors, or glitazones reported effects on transplant or graft survival, delayed graft function or death (any cause). AUTHORS' CONCLUSIONS: The efficacy and safety of glucose-lowering agents in the treatment of pre-existing and new-onset diabetes in kidney transplant recipients is questionable. Evidence from existing studies examining the effect of intensive insulin therapy, DPP-4 inhibitors, SGLT inhibitors and glitazones is mostly of low to very low certainty. Appropriately blinded, larger, and higher quality RCTs are needed to evaluate and compare the safety and efficacy of contemporary glucose-lowering agents in the kidney transplant population.


Asunto(s)
Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Hipoglucemiantes/uso terapéutico , Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/tratamiento farmacológico , Adamantano/efectos adversos , Adamantano/análogos & derivados , Adamantano/uso terapéutico , Sesgo , Causas de Muerte , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 2/sangre , Inhibidores de la Dipeptidil-Peptidasa IV/efectos adversos , Ayuno/sangre , Hemoglobina A Glucada/metabolismo , Supervivencia de Injerto/efectos de los fármacos , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/efectos adversos , Insulina/efectos adversos , Insulina/uso terapéutico , Insulina Glargina/efectos adversos , Insulina Glargina/uso terapéutico , Nitrilos/efectos adversos , Nitrilos/uso terapéutico , Pioglitazona , Complicaciones Posoperatorias/etiología , Pirrolidinas/efectos adversos , Pirrolidinas/uso terapéutico , Ensayos Clínicos Controlados Aleatorios como Asunto , Fosfato de Sitagliptina/efectos adversos , Fosfato de Sitagliptina/uso terapéutico , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Tiazolidinedionas/efectos adversos , Tiazolidinedionas/uso terapéutico , Receptores de Trasplantes , Vildagliptina
19.
Expert Opin Pharmacother ; 21(14): 1771-1780, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32693663

RESUMEN

BACKGROUND: With limited real-world insulin glargine 300 unit/mL (Gla-300) data available, we assessed the effectiveness and safety of Gla-300 in the Japanese type 2 diabetes mellitus (T2DM) population. RESEARCH DESIGN AND METHODS: X-STAR was a prospective, observational, 12-month post-marketing study of Gla-300 from 2015 to 2018. T2DM patients received Gla-300 as the first insulin (insulin-naïve) or after treatment with another type of insulin (insulin-experienced). RESULTS: We identified 1,227 insulin-naïve and 3,394 insulin-experienced patients. Insulin-naïve group increased the Gla-300 starting dose by 2.80 U/day during 12 months (7.49 to 10.29 U/day). Mean HbA1c reduced by 1.99% (9.82 to 7.83%), and 28.4% showed HbA1c < 7.0%. Insulin-experienced group had a baseline insulin dose of 14.86 U/day, which increased by 0.73 U/day. Mean HbA1c reduced by 0.18% (7.99 to 7.81%), and 24.6% showed HbA1c < 7.0%. Adverse drug reactions occurred in 3.42% (insulin-naïve) and 4.45% (insulin-experienced); symptomatic hypoglycemia (2.93% and 3.86%, respectively) was the most common in both groups. CONCLUSIONS: Gla-300, in clinical practice, provides an effective and safe therapy as HbA1c was reduced/maintained in insulin-naïve/experienced Japanese T2DM patients without new safety signal. This study provides insights into the current Japanese clinical practices where insulin use is delayed and conservative despite relatively low HbA1c achievement.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Insulina Glargina/uso terapéutico , Anciano , Glucemia/análisis , Diabetes Mellitus Tipo 2/epidemiología , Relación Dosis-Respuesta a Droga , Femenino , Hemoglobina A Glucada/análisis , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Insulina/uso terapéutico , Insulina Glargina/administración & dosificación , Insulina Glargina/efectos adversos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Vigilancia de Productos Comercializados , Estudios Prospectivos , Resultado del Tratamiento
20.
Vasc Health Risk Manag ; 16: 241-248, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32606720

RESUMEN

Aim: Type 2 diabetes (T2D), as a major cause of morbidity and mortality, is predicted to have a prevalence of 629 million by 2045. As diabetic patients show considerable inter-individual variation in response to antidiabetic treatment, this study aimed to investigate the gene polymorphism of cytochrome P450 as well as the effectiveness and safety of glibenclamide and gliclazide for different genotypes of CYP2C9. Besides, the chronic side effects of T2D including retinal microvasculature complications or retinopathy and renal dysfunction due to nephropathy in different genotypes were considered. Patients and Methods: The participants including 80 T2D patients treated with glibenclamide or gliclazide were recruited from university hospitals of Ahvaz Jundishpur University of Medical Sciences, Ahvaz, in the southwest of Iran. Blood samples were collected from the patients at 2.5h after the morning dose of glibenclamide and 12h after the last dose of gliclazide. Genotyping from the extracted DNA was, then, performed using PCR-RFLP. The plasma level of glibenclamide and gliclazide was, in turn, measured by the reverse-phase high-pressure liquid chromatography. Results: The results showed that the wild-type allele, i.e., CYP2C9*1, occurred in the highest frequency (0.8), while the frequency rates of the mutant allele, i.e., CYP2C9*2 and CYP2C9*3, were 0.15 and 0.05, respectively. Moreover, no significant association was found between any of the genotypes as well as the clinical and biochemical characteristics of the patients. The findings also showed that the plasma level of sulfonylureas (i.e., glibenclamide and gliclazide) was the highest in the patients with the CYP2C9*3 allele. It was also found that 75.9% of the patients with variant genotypes had experienced hypoglycemia events. Furthermore, in the absence of wild type allele, a significant increase was observed in retinopathy (p=0.039) and nephropathy (p=0.05). Conclusion: The findings can provide guidelines for the optimal management of the treatment protocols with sulfonylurea intended to control the T2D complications.


Asunto(s)
Glucemia/efectos de los fármacos , Citocromo P-450 CYP2C9/genética , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/genética , Retinopatía Diabética/genética , Gliclazida/uso terapéutico , Gliburida/uso terapéutico , Hipoglucemiantes/uso terapéutico , Variantes Farmacogenómicas , Biomarcadores/sangre , Glucemia/metabolismo , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/genética , Nefropatías Diabéticas/diagnóstico , Retinopatía Diabética/diagnóstico , Femenino , Frecuencia de los Genes , Gliclazida/efectos adversos , Gliclazida/sangre , Gliburida/efectos adversos , Gliburida/sangre , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/genética , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/sangre , Masculino , Persona de Mediana Edad , Factores de Riesgo , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA