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Therapeutic inertia related to insulin treatment, i.e. delays in initiation, especially titration of basal insulin, is a significant problem in daily practice in Southeast European countries. This phenomenon can be traced back to several patient-, physician- and health system-related factors. In recognition of the issue of inadequate insulin titration, 11 leading experts from countries in this region held a consensus-seeking meeting to review the current status of insulin initiation after non-insulin treatment and the potential barriers to insulin titration to provide an algorithm and tools for outpatient physicians and for patients aimed at optimizing basal insulin titration. The experts reached a consensus on the majority of the topics and proposed recommendations on how clinical inertia can be overcome. The outcomes of the meeting have been summarized in this paper.
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INTRODUCTION: Long-acting insulin analogs such as insulin glargine may offer improved glycemic control in patients with type 2 diabetes (T2D) compared to conventional insulin therapies. The objective of this study was to determine whether switching to insulin glargine had beneficial effects on glycemic control, weight gain, and incidence of hypoglycemia in patients with suboptimally managed T2D. METHODS: This prospective observational study was performed on 1041 patients who were suboptimally controlled on pre-mixed insulin therapy and were switched to an insulin glargine regimen. Clinical markers of glycemic control including glycosylated hemoglobin (HbA1c) < 7% (< 53 mmol/mol) and fasting blood glucose (FBG) levels ranging from 3.9 to 7.2 mmol/L were used for the primary outcome measures. Follow-up assessment of primary outcomes, weight gain, incidence of hypoglycemia, and patient satisfaction with the therapy was performed after three and six months of treatment. RESULTS: Target therapeutic values of HbA1c were achieved in 9.3% and 30.2% of patients, whereas FBG target values were achieved in 25.9% and 52.3% of patients after the third and sixth month of therapy, respectively. Both the HbA1c and FBG targets were reached in 7% and 25.9% of patients at the third and sixth month of therapy, respectively. Switching to insulin glargine decreased the incidence of hypoglycemia from 49.5% to 5.2% after six months of therapy; this decrease was associated with weight loss and was well perceived by the patients. CONCLUSION: Insulin glargine-based regimens are beneficial and safe therapeutic alternatives for T2D patients inadequately controlled with pre-mixed insulin. FUNDING: Sanofi-Aventis Croatia d.o.o., Zagreb, Croatia.
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OBJECTIVE: The aim of our research is to determine whether the time of blood sampling and fasting of patients have an impact on TSH values. DESIGN AND METHODS: A total of 198 participants were enrolled in this study and classified into five groups: A--the first sample collection for TSH measurement was taken between 7:00 and 8:00 a.m. at fasting and the second after 140 min without food intake; B--between 7:00 and 8:00 a.m. at fasting and the second after 140 min with food intake; C--between 7:00 and 8:00 a.m. at fasting the previous day and the second one between 7:00 and 8:00 a.m. at fasting the following day; D--between 9:00 and 10:00 a.m. at fasting the previous day and the second one between 9:00 and 10:00 a.m. at fasting the following day, and E--between 9:00 and 10:00 a.m. at fasting the previous day and the second one between 7:00 and 8:00 a.m. on the following day. Serum TSH concentration was measured by electrochemiluminescence immunoassay (ECLIA, Roche Diagnostics, Mannheim, Germany). RESULTS: TSH values (mIU/L) were in group A: 2.50 (2.20-2.81) first samples, 1.74 (1.52-1.96) second samples, p<0.001; B: 2.11 (1.52-2.72) first samples, 1.56 (1.13-1.81) second samples, p<0.001; C: 2.60 (2.28-2.91) first samples, 2.23 (1.92-2.53) second samples, p<0.001; D: 1.80 (1.48-2.11) first samples, 1.77 (1.44-2.09) second samples, p<0.597; and E: 1.32 (1.11-2.16) first samples, 1.67 (1.48-2.93) second samples, p<0.001. CONCLUSION: The time of sample collection must be standardised for the purpose of standardisation and harmonisation of TSH measurements.
