Hypoglycaemia is the major barrier for glycaemic target achievement in patients treated with insulin. The aim of the present study was to investigate real-world incidence and predictors of ...hypoglycaemia in insulin-treated patients.
More than 300 consecutive patients with type 1 or type 2 diabetes treated with insulin were enrolled during regular out-patient visits from 36 diabetes practices throughout the whole country. They completed a comprehensive questionnaire on hypoglycaemia knowledge, awareness, and incidence in the last month and last six months. In addition, in the prospective part, patients recorded incidence of hypoglycaemic events using a special diary prospectively on a daily basis, through 4 weeks.
At least one hypoglycaemic event was self-reported in 84.1%, and 56.4% of patients with type 1 and type 2 diabetes, respectively, during the prospective period of 4 weeks. 43.4% and 26.2% of patients with type 1 and type 2 diabetes, respectively, experienced a nocturnal hypoglycaemic event. In the same time-period, severe hypoglycaemia was experienced by 15.9% and 7.1% of patients with type 1 and type 2 diabetes, respectively. Lower glycated haemoglobin was not a significant predictor of hypoglycaemia.
Rates of self-reported hypoglycaemia in patients treated with insulin in the largest and most comprehensive study in Slovenia so far are higher than reported from randomised control trials, but comparable to data from observational studies. Hypoglycaemia incidence was high even with high glycated haemoglobin values.
Insulinoma associated with pregnancy is a very rare condition and can be difficult to diagnose. Here, we present an interesting case of insulinoma occurring during pregnancy with special attention ...paid to the use of a continuous glucose monitoring system to detect hypoglycemia.
A 36-year-old white woman in the second trimester of pregnancy presented with recurrent episodes of hypoglycemia associated with neuroglycopenic symptoms. The use of a continuous glucose monitoring system confirmed hypoglycemia. Serum insulin, C-peptide, and proinsulin values confirmed endogenous hyperinsulinism. A tumor mass was localized at the tail of her pancreas by endoscopic ultrasound and confirmed by magnetic resonance imaging. Surgery performed at 21 weeks of gestation by distal pancreatectomy confirmed the presence of a 15 mm diameter endocrine tumor at the tail of her pancreas and led to a cure.
Hypoglycemia during pregnancy could be due to insulinoma. Use of a continuous glucose monitoring system could help to detect hypoglycemia in these patients.
Background: Insulin allergy is a rare condition that poses a great challenge particularly in diabetics who are insulin dependent. If feasible, switching to different antidiabetic agents or ...immunotherapy is the common approach, but the universal consensus on insulin allergy management in diabetics is lacking. Here we present a clinical case of a diabetic with allergy to insulin successfully managed with a combination of degludec and liraglutide.
Case Report: A 51-year-old female patient with type 2 diabetes presented with poorly controlled glycaemia (HbA1c 8.6%) on dual oral antidiabetic treatment, metformin and sitagliptin. Due to pronounced fasting hyperglycaemia the NPH insulin before bedtime, but soon began to complain of urticariform skin lesions on insulin injection sites. Despite the adverse reaction the patient continued to up-titrate the insulin, but the effect on glycaemia was negligible. After switching to different NPH insulin manufacturer, to no avail, the insulin analogs detemir and glargin were introduced, respectively, but produced same adverse reaction. The elevated levels of specific IgE immunoglobulins to human insulin (2.58 klU/L) confirmed the allergy to insulin. Conversely, the novel insulin analog degludec yielded no skin reaction. The patient was then titrated to a fixed combination of degludec and GLP-1 receptor agonist liraglutide which provoked no allergic reaction and promptly improved glycemic control (HbA1c 6.7% 4 months after treatment commencement). Understandably, treatment with sitagliptin was stopped, whereas metformin was continued.
Conclusion: The patient with confirmed IgE mediated allergy to insulin exhibited allergic reaction to all types of basal insulin but degludec. It can be assumed that the unique structure of degludec has different epitopes than other insulin analogues and therefore provides safe and combined with GLP-1 receptor agonist effective therapeutic approach to patient with allergy to insulin.
Disclosure
N. Gregoric: Other Relationship; Self; Lilly Diabetes, Novartis Pharmaceuticals Corporation, Novo Nordisk A/S. M. Ravnik Oblak: None. P. Kopac: Speaker's Bureau; Self; AstraZeneca, Novartis Pharmaceuticals Corporation, Shire.
Abstract Aim Patients with diabetes differ in compliance to diabetes self-management which influences their long-term health. Psychological factors, namely depression and cognitive abilities, are ...associated with diabetes self-management behavior. The aim of the study was to identify independent association of particular cognitive functions with diabetes self-management. Methods In a cross sectional study 98 adults with type 2 diabetes attending Diabetes Outpatient Clinic were examined using the measures of diabetes self-management (Summary of Diabetes Self-Care Activities (SDSCA) measure), depression (Hamilton Depression Inventory (HDI)), diabetes distress (Problem Areas In Diabetes scale (PAID)), and the neuropsychological battery of tests for assessment of cognitive functions. Sociodemographic and diabetes-related data were collected. Univariate and multivariate regression analyses were used to identify and evaluate the predictors of diabetes self-management. Results Specific cognitive functions, namely immediate memory, visuospatial/constructional abilities, attention, and specific executive functions (planning and problem solving) were significantly associated with diabetes self-management. Among cognitive factors, planning and problem solving abilities were strongest predictors; furthermore, in a multivariate regression their association was independent from depression. Conclusions Specific cognitive abilities, particularly planning and problem solving, play an independent role in diabetes self-management behaviors. Assessing patients’ cognitive abilities may be of value for adjusting self-management education and treatment regimen.
Diabetes mellitus predisposes to a range of different and unusual infections, including psoas and spinal epidural infections. We report on the case of a 47-year-old man, with learning difficulties, ...heavy alcohol consumption and, poorly controlled diabetes on insulin therapy, who had recurrent infections at different locations for the last 3 years.
Aim: Comparison of the effectiveness of combined therapy vs. an insulin regimen in NIDDM patients with secondary failure of oral hypoglycemic agents.
Research design, patients and methods: 27 NIDDM ...patients were randomly allocated to Group A (
n = 14, insulin) and Group B (
n = 13, insulin and sulfonylurea) with crossover after 3 months. After the next 3 months a decision was made about the further treatment according to the metabolic control. The patients were then treated for another year with the more successful regimen. Metabolic control, residual β-cell secretory capacity, degree of peripheral insulin resistance (clamp) and insulin dose were followed during the whole study.
Results: (median, interquartile range, in brackets;
∗, statistically significant difference at
P < 0,05): the combined therapy was better then insulin alone in
2
3
of patients. Glycemic control was better (HbA
1c at 3 months: Group A = 7.9(1.1)% vs. Group B = 7.0(0.5)%
∗; HbA
1c at 6 months: Group A = 7.4(1.5)% vs. Group B = 8.1(1.5)%. Insulin dose was lower during the combined therapy in the first 3 months: Group A = 0.62(0.18) U/kg body weight vs. Group B = 0.39(0.16) U/kg body weight
∗. Combined treatment was associated with increased C-peptide excretion both fasting and postprandially. No significant differences in peripheral insulin resistance were noted between the two groups. The combined treatment remained successful even after one year. The two groups of patients with different effective treatment did not differ significantly in any of the observed parameters.
Conclusions: the combined therapy was more effective than insulin alone. Its favourable effect persisted after treatment for a year. It seems better to start the treatment of the oral failure with combined therapy compared with insulin first and later followed by combined therapy. On the basis of the observed parameters it is impossible to determine in advance which kind of treatment is more suitable for the individual patient.
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