Effect of insulin glargine on glycaemic control and weight in obese and non-obese people with type 2 diabetes: data from the AT.LANTUS trial.

AIMS: To explore glucose lowering response to insulin initiation or switch to insulin glargine in obese and non-obese individuals with type 2 diabetes mellitus (T2DM) and to examine weight gain and hypoglycaemic episodes in this group. METHODS: Post hoc subgroup analysis using data of obese and non-obese participants from a large multi-centre (4555 participants with T2DM), multi-national 24-week randomized controlled trial of investigator titrated insulin glargine versus patient self-managed titrated insulin glargine. This analysis was carried out to compare two subgroups: obese (> or =30 kg/m2) and non-obese (<30 kg/m2) participants. RESULTS: The mean body mass index (BMI) values were 33.7 kg/m2(n = 1833) and 25.9 kg/m(2)(n = 2755) in obese and non-obese subjects, respectively. There was a significant reduction in glycated haemoglobin (HbA1c) from baseline in both subgroups but no significant difference between subgroups (1.15 vs. 1.15%, p = 0.50). Overall, there was a 1.21 kg (s.d. 3.3) increase in weight in individuals who were non-obese and a 1.08 kg (s.d. 3.9) increase in obese individuals (p = 0.67). There was no significant difference in the proportion of participants achieving an HbA1c of <7.0% at 6 months in both the subgroups (28.8 vs. 27.1%, p = 0.20). In multiple logistic regression, BMI was not a prognostic factor in achieving a target of HbA1c < or = 7.0%. There was no significant difference in severe hypoglycaemic episodes between obese and non-obese subgroups (1.3 vs. 1.0%); however, significantly more non-obese individuals experienced nocturnal hypoglycaemic episodes(4.5 vs. 2.4%, p < 0.05). CONCLUSIONS: In this study, treatment with insulin glargine in people with T2DM was associated with a significant reduction in HbA1c without differential increase in weight gain in obese and non-obese subgroups. Rates of severe hypoglycaemia were not different between obese and non-obese subgroups.

Improved glycaemic control with insulin glargine plus insulin lispro: a multicentre, randomized, cross-over trial in people with Type 1 diabetes.

AIMS: To compare blood glucose control using insulin glargine + insulin lispro with that on NPH insulin + unmodified human insulin in adults with Type 1 diabetes managed with a multiple injection regimen. METHODS: In this 32-week, five-centre, two-way cross-over study, people with Type 1 diabetes (n = 56, baseline HbA1c 8.0 +/- 0.8%) were randomized to evening insulin glargine + mealtime insulin lispro or to NPH insulin (once- or twice-daily) + mealtime unmodified human insulin. Each 16-week period concluded with a 24-h inpatient plasma glucose profile. RESULTS: HbA1c was lower with glargine + lispro than with NPH + human insulin [7.5 vs. 8.0%, difference -0.5 (95% CI -0.7, -0.3) %, P < 0.001]. This was confirmed by an 8% lower 24-h plasma glucose area under the curve (AUC) (187 vs. 203 mmol l(-1) h(-1), P = 0.037), a 24% reduction in plasma glucose AUC > 7.0 mmol/l1 (47 vs. 62 mmol l(-1) h(-1), P = 0.017) and a 15% lower post-prandial plasma glucose AUC (75 vs. 88 mmol l(-1) h(-1), P = 0.002). There was no reduction in night-time plasma glucose AUC or increase in plasma glucose area < 3.5 mmol/l. Monthly rate of nocturnal hypoglycaemia was reduced by 44% with glargine + lispro (0.66 vs. 1.18 episodes/month, P < 0.001). CONCLUSIONS: Compared with NPH insulin + unmodified human insulin, the combination of insulin glargine with a rapid-acting insulin analogue as multiple-injection therapy for Type 1 diabetes improves overall glycaemic control as assessed by HbA1c and 24-h plasma glucose monitoring to a clinically significant degree, together with a reduction in nocturnal hypoglycaemia.

From the Journals.

MEASURING TEMPERATURE IN WOUND HEALING WATER VAPOUR TRANSMISSION RATES DYNAMIC PULSATION THERAPY.

From the Journals.

STIMULATION OF ANGIOGENESIS BY GROWTH FACTORS CHRONIC VENOUS DISEASE OF THE LEG.

From the Journals.

MEASURING WOUND VOLUME: ACCURACY OF ALGINATE MOULDS HYALURONIC ACID IN HEALING CHRONIC WOUNDS.

From the Journals.

TOXICITY OF ANTISEPTIC WOUND CLEANSERS PSEUDOMONAS FOLLICULITIS ENZYME DEBRIDEMENT.

Using larvae in modern wound management.

Initial clinical experience in the UK with maggot therapy for the treatment of necrotic or infected wounds has proved very encouraging. Sterile larvae have been reared in the Surgical Materials Testing Laboratory for this purpose. This paper reports the use of larvae in six patients and discusses some of the advantages and disadvantages of this form of therapy.

From the Journals.

FINDING THE TRUE PREVALENCE OF LEG ULCERS WOUND CARE AND MRSA.

From the Journals.

NOISE AND WOUND HEALING FOUR-LAYER BANDAGE STUDY MANAGEMENT SYSTEMS NECROTISING FASCIITIS DISFIGURING INJURIES.

Martorell's ulcer.

This paper reports a rare form of ulceration of the lower leg and, as a result of subsequent investigations and literature review, readdresses a recent debate regarding the legitimate classification of these ulcers as a separate disease entity.

From the Journals.

Standardised assessment and evaluation of wounds Nutritional support in wound healing Pressure sores, a review of the literature Gene therapy in skin grafts Surgical techniques in pilonidal disease Prognostic usefulness of serum albumin for pressure ulcer healing.

From the Journals.

Topical cytokines and wound healing A digest and review of wound care issues in other journals Operating theatre practices and wound care Civilian gunshot wounds Wound treatments: old or new? Lasers in surgery.

From the Journals.

Bacterial infection in chronic wounds The care of patients with atopic eczema Venous incompetence and the results of foot volumetry Mortality and surgical wound infection The use of interleukin-1ß in the treatment of pressure sores.

From the Journals.

Clinical trial of a pressure-decreasing mattress Povidone-iodine and wound healing.

From the Journals.

Wound care in patients with HIV The development of pressure sores Gene transcription factors.

From the Journals.

Wound healing in the fetus Community management of patients with chronic leg ulcers Increase in malignant melanoma Pressure sore risk calculators Decreased immune responsiveness in older people.

The effect of daily baked bean (Phaseolus vulgaris) consumption on the plasma lipid levels of young, normo-cholesterolaemic men.

1. Thirteen normo-cholesterolaemic male students consumed one 450 g can of baked beans (Phaseolus vulgaris) in tomato sauce, daily, for 14 d as part of their normal diet. After a 14 d washout period, eleven of the students went on to consume one 440 g can of spaghetti in tomato sauce, daily, for 14 d. 2. Fasting blood samples were taken frequently for measurement of plasma cholesterol, high-density lipoprotein (HDL)-cholesterol, triacylglycerols, glucose, insulin and C-peptide. Diet diaries (3 d) were completed by the subjects during each period. 3. Consumption of beans and spaghetti led to a significant reduction in the amount of fat eaten daily (P less than 0.05). Bean consumption also resulted in significant increases in protein, fibre and sugar intakes (P less than 0.02, P less than 0.001 and P less than 0.05 respectively). 4. During the bean-eating period the mean total plasma cholesterol level of the students fell significantly from 5.1 to 4.5 mmol/l (P less than 0.02). No reduction in plasma cholesterol occurred during the spaghetti-eating period. 5. HDL-cholesterol levels fell significantly during both periods (P less than 0.001), but HDL:total cholesterol ratio was significantly reduced only during the spaghetti-eating period (P less than 0.001). Neither beans nor spaghetti affected triacylglycerol, insulin or C-peptide levels. 6. The benefits of a legume-rich diet are discussed.