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Biomedical subjects

Irl B Hirsch

Publications and source records attributed to Irl B Hirsch.

At least 19 recordsLinked to original sources
PubMed2026

The management of type 1 diabetes in adults. The updated 2026 consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

This 2026 consensus report from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) builds on the 2021 consensus report to provide guidance for managing type 1 diabetes in adults. Reflecting the rapid advances in the field, this update places particular emphasis on the integration of new technologies, while all sections have been revised to incorporate new evidence, advances in clinical practice and novel therapies, including interventions to delay the onset of stage 3 type 1 diabetes. It also broadens its scope to screening for long-term diabetes complications, and the management of obesity and cardiovascular risk factors. Psychosocial care and diabetes self-management education and support (DSMES) remain key elements. The report was developed using the Accurate Consensus Reporting Document (ACCORD) framework. The guidance aligns with the current ADA 'Standards of Care in Diabetes' (Standards of Care) and relevant EASD and ADA documents and aims to support clinicians globally in delivering high-quality, personalised care for adults with type 1 diabetes, with recommendations that can be adapted across diverse healthcare systems and resource settings.

Adjunctive therapy↗
PubMed2026

The Management of Type 1 Diabetes in Adults. The Updated 2026 Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).

This 2026 consensus report from the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) builds on the 2021 consensus report to provide guidance for managing type 1 diabetes in adults. Reflecting the rapid advances in the field, this update places particular emphasis on the integration of new technologies, while all sections have been revised to incorporate new evidence, advances in clinical practice, and novel therapies, including interventions to delay the onset of stage 3 type 1 diabetes. It also broadens its scope to screening for long-term diabetes complications, and the management of obesity and cardiovascular risk factors. Psychosocial care and diabetes self-management education and support (DSMES) remain key elements.

Journal Article↗
PubMed2006

Sertraline for prevention of depression recurrence in diabetes mellitus: a randomized, double-blind, placebo-controlled trial.

CONTEXT: In patients with diabetes mellitus, depression is a prevalent and recurrent problem that adversely affects the medical prognosis. OBJECTIVE: To determine whether maintenance therapy with sertraline hydrochloride prevents recurrence of major depression in patients with diabetes. DESIGN: A randomized, double-blind, placebo-controlled, maintenance treatment trial. Patients who recovered from depression during open-label sertraline treatment continued to receive sertraline (n = 79) or placebo (n = 73) and were followed up for up to 52 weeks or until depression recurred. SETTING: Outpatient clinics at Washington University, St Louis, MO, the University of Washington, Seattle, and the University of Arizona, Tucson. PATIENTS: One hundred fifty-two patients with diabetes (mean age, 52.8 years; 59.9% female; 82.9% with type 2 diabetes) who recovered from major depression (43.3% of those initially assigned) during 16 weeks of open-label treatment with sertraline (mean dose, 117.9 mg/d). INTERVENTION: Sertraline continued at recovery dose or identical-appearing placebo. MAIN OUTCOME MEASURES: The primary outcome was length of time (measured as the number of days after randomization) to recurrence of major depression as defined in DSM-IV. The secondary outcome was glycemic control, which was assessed via serial determinations of glycosylated hemoglobin levels. RESULTS: Sertraline conferred significantly greater prophylaxis against depression recurrence than did placebo (hazard ratio = 0.51; 95% confidence interval, 0.31-0.85; P = .02). Elapsed time before major depression recurred in one third of the patients increased from 57 days in patients who received placebo to 226 days in patients treated with sertraline. Glycosylated hemoglobin levels decreased during the open treatment phase (mean +/- SD glycosylated hemoglobin level reduction, -0.4% +/- 1.4%; P = .002). Glycosylated hemoglobin levels remained significantly lower than baseline during depression-free maintenance (P = .002) and did not differ between treatment groups (P = .90). CONCLUSIONS: In patients with diabetes, maintenance therapy with sertraline prolongs the depression-free interval following recovery from major depression. Depression recovery with sertraline as well as sustained remission with or without treatment are associated with improvements in glycosylated hemoglobin levels for at least 1 year.

Age of Onset↗
PubMed2006

Isn't this just bedtime snacking? The potential adverse effects of night-eating symptoms on treatment adherence and outcomes in patients with diabetes.

OBJECTIVE: Night-eating syndrome is characterized by excessive eating in the evening and nocturnal awakening with ingestion of food. Psychosocial variables and emotional triggers may be associated with these behaviors. In patients with diabetes, such behaviors may lead to glucose dysregulation and contribute to obesity and complications. RESEARCH DESIGN AND METHODS: In 714 tertiary care patients with type 1 and 2 diabetes, we determined the proportion of patients reporting eating >25% of their daily food intake after regular suppertime. We also screened patients for major depression, childhood maltreatment histories, nonsecure attachment styles, and emotional eating triggers. We examined whether patients reporting night-eating behaviors had greater psychosocial distress, higher HbA(1c) (A1C) levels, more obesity, and more diabetes complications compared with patients without night-eating behaviors. RESULTS: Night-eating behaviors were reported in 9.7% of patients. Compared with patients without night-eating behaviors, those with these behaviors were less adherent with diet, exercise, and glucose monitoring and more likely to be depressed, to report childhood maltreatment histories, to have nonsecure attachment styles, and to report eating in response to anger, sadness, loneliness, worry, and being upset. Controlling for age, sex, race, and major depression, patients with night-eating behaviors, compared with patients without night-eating behaviors, were more likely to be obese (odds ratio 2.6 [95% CI 1.5-4.5]), to have A1C values >7% (2.2 [1.1-4.1]) and to have two or more diabetes complications (2.6 [1.5-4.5]). CONCLUSIONS: Night-eating behaviors are associated with adverse outcomes in patients with diabetes. Use of clinical screening tools may help identify patients with night-eating behaviors.

Adolescent↗
PubMed2005

Optimal initiation of insulin in type 2 diabetes.

Treatment goals for glycemic control in patients with type 2 diabetes are often not achieved or are difficult to maintain as the disease progresses. Too often, insulin therapy is either delayed or is suboptimal. We discuss how the introduction of new insulin analogs may help overcome some of the barriers to insulin use. If combination therapy with oral agents does not achieve glycemic control, the addition of a once-daily intermediate- or long-acting insulin is a simple and highly effective strategy for initiating insulin. If glycemic control is still not achieved, a short- or rapid-acting insulin may be needed prior to meals (basal-prandial approach). A patient's baseline glycosylated hemoglobin (A1C) can guide whether glycemic control can be achieved with basal insulin or will require basal-prandial replacement. In addition to A1C, a patient's age, lifestyle, competence, personal preferences, and comorbidities can be used to help determine the choice of insulin therapy.

Diabetes Mellitus, Type 2↗
PubMed2005

Insulin analogues.

Explore the source record for details and available documents.

Blood Glucose Self-Monitoring↗
PubMed2005

Intensifying insulin therapy in patients with type 2 diabetes mellitus.

The current paradigm for pharmacologic management of type 2 diabetes mellitus (DM) is to progress with oral agents until severe insulin deficiency develops, at which time insulin can be initiated. Reexamination of data from the Diabetes Control and Complications Trial (DCCT) suggests that glycemic variability may be an important factor involved in the pathogenesis of microvascular complications. It is now appreciated that oxidative stress from overproduction of reactive oxygen species may be the result of this glycemic variability, suggesting that an overemphasis of basal insulin may not be the ideal strategy for insulin replacement, even though basal insulin is often the only insulin used initially. Although finding the best insulin program for treatment of type 2 DM is an important area of research, almost all patients with severe insulin deficiency will require both basal and prandial replacement. Use of adequate lag times (time between injecting the prandial insulin and eating), U-500 insulin (500 U/mL human regular insulin), and home blood glucose monitoring to determine "glycemic trend" are important tools that are readily available to all patients.

Biomarkers↗
PubMed2005

Hospital management of diabetes.

The evidence continues to strengthen our understanding that improved glycemic control with the use of insulin therapy may significantly improve morbidity and mortality in hospitalized patients with hyperglycemia, with or without a previous diagnosis of diabetes. However, many questions remain concerning the impact and relative contributions of blood glucose and insulin per se. Nevertheless, the publication of numerous and consistent studies have made it clear that the topic of glycemic management in the hospital requires a larger priority among clinicians caring for these patients. The recently published guidelines by the American Association of Clinical Endocrinologists are the first formal recommendations on this topic,but national guidelines for blood glucose levels cannot take into account all of the different challenges facing different hospitals. This suggests that each institution will require individualization of protocols even though the ultimate metabolic goals are identical. Furthermore, it is not realistic to expect those unfamiliar with diabetes therapy to appreciate all of the nuances and vagaries of insulin treatment. Like any medical treatment, a significant amount of time will need to be invested by the providers involved with the.care of these patients before a mastery of the therapy can be achieved. Nevertheless, because the rewards to our patients can be significant, we need to strive to improve the systems where we work. Individual clinicians with vast experience in diabetes care cannot be successful for the inpatient with diabetes unless the hospital has systems in place to effectively and efficiently facilitate the management of the metabolic needs of this population. The main challenge now is the safe and effective implementation of these guidelines in both small and large hospitals given the limited level of re-sources available in today's medical environment. Therefore, our single most important recommendation is to ensure that all clinicians involved in the management of these patients are in agreement about general philosophies of diabetes management. We would recommend that there are "champions" for each discipline: endocrinology, cardiology, anesthesiology, surgery, nursing,and pharmacy, all of which have developed hospital-specific guidelines for glycemic management. These recommendations can be slowly adapted, one unit at a time, until the entire hospital has transitioned to a more "diabetes-friendly" environment. The ultimate goal of well-controlled glycemia with minimal hypoglycemia should be possible for most hospitals, and we hope this review will assist clinicians in achieving this objective. We await additional outcome research with carefully controlled studies to confirm the value of these recommendations at different levels of glycemic control. We believe that we can already state with confidence that the preliminary evidence shows that, like outpatient diabetes management,metabolic control matters during acute illness.

Algorithms↗
PubMed2005

New insulin infusion protocol Improves blood glucose control in hospitalized patients without increasing hypoglycemia.

BACKGROUND: Aggressive treatment of hyperglycemia in hospitalized patients can improve clinically important outcomes. At the University of Washington Medical Center a quality improvement project was conducted to develop and implement a standardized insulin infusion protocol for use throughout the institution. METHODS: The insulin infusion protocol was piloted on critical and non-critical care inpatient units. Safety and efficacy data were collected for a one-month period on each unit. RESULTS: A total of 156 patients were evaluated. The incidence of hypoglycemia was lower for the study group than the historical controls, as was the mean percentage of time patients were hyperglycemic, 15% +/- 2.3% vs. 33% +/- 2.6% for the critical care subgroup (p < .0001) and 18% +/- 2.4% vs. 56% +/- 2.3% for the non-critical care subgroup (p < .0001). CONCLUSIONS: The insulin infusion protocol better met the insulin requirements of our patients and achieved better glycemic control than previous protocols at the institution. In addition, there was no increase in hypoglycemia despite the use of the protocol in non-critical care units with higher patient-to-nurse ratios, suggests that insulin infusion therapy can be safely used outside of critical care units.

Blood Glucose↗
PubMed2005

Continuous subcutaneous insulin infusion (CSII) of insulin aspart versus multiple daily injection of insulin aspart/insulin glargine in type 1 diabetic patients previously treated with CSII.

OBJECTIVE: Multiple daily injection (MDI) therapy of bolus insulin aspart and basal insulin glargine was compared with continuous subcutaneous insulin infusion (CSII) with aspart in type 1 diabetic patients previously treated with CSII. RESEARCH DESIGN AND METHODS: One hundred patients were enrolled in a randomized, multicenter, open-label, crossover study. After a 1-week run-in period with aspart by CSII, 50 subjects were randomly assigned to MDI therapy (aspart immediately before each meal and glargine at bedtime) and 50 subjects continued CSII. After 5 weeks of the first treatment, subjects crossed over to the alternate treatment for 5 weeks. During the last week of each treatment period, subjects wore a continuous glucose monitoring system for 48-72 h. RESULTS: Mean serum fructosamine levels were significantly lower after CSII therapy than after MDI therapy (343 +/- 47 vs. 355 +/- 50 micromol/l, respectively; P = 0.0001). Continuous glucose monitoring profiles over a 24-h time period showed that glucose exposure was 24 and 40% lower for CSII than MDI as measured by area under the curve (AUC) glucose >/=80 mg/dl (1,270 +/- 742 vs. 1,664 +/- 1,039 mg . h . dl(-1); P < 0.001) and AUC glucose >/=140 mg/dl (464 +/- 452 vs. 777 +/- 746 mg . h . dl(-1), CSII vs. MDI, respectively; P < 0.001). Similar percentages of subjects reported hypoglycemic episodes (CSII: 92%, MDI: 94%) and nocturnal (12:00 a.m. to 8:00 a.m.) hypoglycemic episodes (CSII: 73%, MDI: 72%). Major hypoglycemia was infrequent (CSII: two episodes, MDI: five episodes). CONCLUSIONS: In a trial of short duration, CSII therapy with insulin aspart resulted in lower glycemic exposure without increased risk of hypoglycemia, as compared with MDI with insulin aspart and glargine.

Adult↗
PubMed2004

Treatment of patients with severe insulin deficiency; what we have learned over the past 2 years.

The initial injection in 1922 of a pancreatic extract, or insulin as it came to be known, into a patient with diabetes mellitus has since been followed by the successive introduction of longer-acting insulins, more highly purified insulins, and insulins that have been modified to more closely match insulin activity to patients' physiologic requirements. The recently introduced rapid-acting insulin analogues lispro and aspart and the long-acting analogue glargine are further refinements of insulin therapy. Current treatment strategies for severe insulin deficiency are based on the need to provide 2 components of insulin replacement: basal and postprandial. Rapid-acting insulin has been shown to provide superior postprandial glucose control compared with regular insulin. Truly effective control of basal insulin has been achieved by the introduction of the insulin pump in the 1980s and insulin glargine in 2001. Insulin glargine is the first insulin analogue to provide, in a majority of patients, a continuous level of insulin without a pronounced peak after a single daily injection, closely mimicking the normal pancreatic release of basal insulin in healthy individuals. Clinical experience is providing many insights into how basal and prandial components of insulin therapy can be best combined, although evidence from controlled trials will take some years to accumulate. Experience and observations since 2001 indicate that insulin therapy should be introduced earlier in patients with type 2 diabetes to control blood glucose levels. More importantly, the greatest benefit of insulin glargine has been to change positively the way physicians and patients think about insulin therapy. Newer insulin analogues, improved devices for home glucose monitoring, and pulmonary inhaled insulin are other innovations that promise improvement of hemoglobin A(1c) levels.

Diabetes Mellitus↗