Summary
Objective
It is uncertain whether the addition of biphasic insulin analogues to oral antidiabetic drugs (OADs) is as effective and safe as basal insulin in patients with type 2 diabetes ...mellitus (T2DM). We performed a systematic review to compare glycaemic control and selected clinical outcomes in T2DM patients inadequately controlled with OADs whose treatment was intensified by adding biphasic insulin aspart (BIAsp 30) or insulin glargine (IGlar).
Methods
The analysis included randomised controlled trials (RCTs) identified by a systematic literature search in medical databases (MEDLINE, EMBASE, The Cochrane Library and other sources) up to March 2013. Studies met the inclusion criteria if they compared BIAsp 30 vs. IGlar added to at least one OAD in T2DM patients. Trials applying different OADs in both treatment arms were also included. Results were presented as weighted mean difference (WMD) or odds ratio (OR) with a 95% confidence interval (CI).
Results
Five trials, including a total number of 1758 patients followed up from 24 to 28 weeks, were identified. Quantitative synthesis demonstrated that BIAsp 30 reduced HbA1c level more efficiently than IGlar 5 RCTs; WMD (95% CI): −0.21% (−0.35%, −0.08%). Differences were observed in favour of BIAsp for lower mean prandial glucose increment 3 RCTs; WMD (95% CI): −14.70 mg/dl (−20.09, −9.31); no difference was observed for fasting plasma glucose 3 RCTs; WMD (95% CI): 7.09 mg/dl (−15.76, 29.94). We found no evidence for higher risk of overall 2 RCTs; 63% vs. 51%; OR = 1.77 (0.91; 3.44) and severe hypoglycaemic episodes 4 RCTs; 0.98% vs. 1.12%; OR (95% CI) = 0.88 (0.31, 2.53) in the BIAsp 30 group as compared with IGlar group. Twice‐daily administration of BIAsp 30 resulted in larger weight gain 2 RCTs; WMD (95% CI) = 1.78 kg (1.04; 2.52).
Conclusions
BIAsp 30 added to OAD therapy results in a better glycaemic control as compared with IGlar in T2DM patients. BIAsp 30 use is associated with slightly larger weight gain but no rise in risk of severe hypoglycaemic episodes.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Electrophysiological studies combined with local neurotoxic lesions were conducted on anaesthetized rats in order to determine whether the dorsal raphe nucleus (DRN) inhibits the intergeniculate ...leaflet (IGL) of the lateral geniculate nucleus by means of innervation by serotonin‐containing fibres. In the control animals, electrical stimulation of the DRN induced the long‐latency and long‐lasting inhibition of the neuronal firing of the IGL cells that are characterized by rhythmic, slow‐bursting activity in light conditions. The electrical destruction of the DRN resulted in an increase in the firing rate of the recorded IGL cells, whilst at the same time not affecting the rhythmic, bursting pattern of the activity. In the second group of animals, local neurotoxic lesion of serotonergic fibres was performed by injection of the toxin 5,7‐dihydroxytryptamine into the IGL. After 10 days of postoperative recovery, electrophysiological experiments were performed on the toxin‐treated rats. In these animals, electrical stimulation as well as electrical lesion of the DRN did not induce any change in the firing of the slowly bursting cells in the 5,7‐dihydroxytryptamine‐injected IGL. The results obtained provide evidence that inhibition of the IGL slowly bursting cells, by innervation from the dorsal raphe, is mediated by the release of serotonin. Furthermore, the observed serotonergic inhibition of the light‐dependent activity of slowly bursting cells can contribute to the neuronal mechanism gating the information that flows through this nucleus to the vestibular, visuomotor, circadian and sleep/arousal systems, with which the IGL is strongly interconnected.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
We report two patients who presented with increasing malaise and myalgia, and had biopsy‐ proven polymyositis. Their conditions deteriorated after corticosteroid treatment, and repeat muscle biopsies ...showed adult and larval nematodes. Anthelminthic treatment was completely successful in both cases. The infecting nematode appears to belong to a new genus and is, to our knowledge, the first known muspiceoid nematode to infect humans. Its life cycle and the route of infection are unknown.
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