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Results for “Glycemic variability”

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At least 487 records · Page 27Linked to original sources

PubMed2004

Sleep-disordered breathing, glucose intolerance, and insulin resistance: the Sleep Heart Health Study.

Clinic-based studies suggest that sleep-disordered breathing (SDB) is associated with glucose intolerance and insulin resistance. However, in the available studies, researchers have not rigorously controlled for confounding variables to assess the independent relation between SDB and impaired glucose metabolism. The objective of this study was to determine whether SDB was associated with glucose intolerance and insulin resistance among community-dwelling subjects (n=2,656) participating in the Sleep Heart Health Study (1994-1999). SDB was characterized with the respiratory disturbance index and measurements of oxygen saturation during sleep. Fasting and 2-hour glucose levels measured during an oral glucose tolerance test were used to assess glycemic status. Relative to subjects with a respiratory disturbance index of less than 5.0 events/hour (the reference category), subjects with mild SDB (5.0-14.9 events/hour) and moderate to severe SDB (> or =15 events/hour) had adjusted odds ratios of 1.27 (95% confidence interval: 0.98, 1.64) and 1.46 (95% confidence interval: 1.09, 1.97), respectively, for fasting glucose intolerance (p for trend < 0.01). Sleep-related hypoxemia was also associated with glucose intolerance independently of age, gender, body mass index, and waist circumference. The results of this study suggest that SDB is independently associated with glucose intolerance and insulin resistance and may lead to type 2 diabetes mellitus.

Aged↗

PubMed1994

Dietary NaCl restriction deteriorates oral glucose tolerance in hypertensive patients with impairment of glucose tolerance.

This study investigated whether the change of glycemic response to oral glucose loading with an increase of dietary NaCl intake is different between salt-sensitive and salt-resistant groups, or whether it is related to glucose tolerance on a low NaCl diet independent of salt sensitivity. The plasma glucose and insulin response to 75 g oral glucose intake was assessed on low (34 mmol/day) and high (342 mmol/day) NaCl diets in 31 patients with essential hypertension, and the area under the curve for both variables (AUCglu and AUCins) was calculated. The data on the high NaCl diet were corrected for change in hematocrit. The percentage change in systolic, diastolic, and mean blood pressure between the two diets was defined as the salt sensitivity index (SSI) for systolic blood pressure (SSISBP), diastolic blood pressure (SSIDBP), and mean blood pressure (SSIMBP), respectively. The mean values of both AUCglu and AUCins decreased significantly with increase of NaCl intake; however, there was no significant correlation between SSI (SSISBP, SSIDBP, or SSIMBP) and the percentage changes in AUCglu and AUCins. Meanwhile, the percentage changes in AUCglu and AUCins significantly correlated with the respective values of AUCglu and AUCins on the low NaCl diet. These results suggest that extreme NaCl restriction may deteriorate glucose metabolism in hypertensive patients, especially in those with diabetes mellitus or impaired glucose tolerance.

Adult↗

PubMedDate not supplied

Personality factors and disordered eating in young women with type 1 diabetes mellitus.

The authors examined the association between the presence of personality variables implicated in the pathogenesis of eating disorders and the presence of eating disorder symptoms in 51 women with type 1 diabetes. Subjects were assessed with interview instruments and self-report questionnaires, including scales measuring eating disorder symptoms, borderline personality characteristics, and perfectionism. Fourteen subjects displayed moderate to severe eating disorder symptoms. Perfectionism was related to attitudinal aspects of eating disorders (e.g., weight preoccupation), and borderline personality characteristics were related to disordered behaviors (e.g., insulin omission) and poor glycemic control. The results suggest that personality factors are related to disordered eating and poor glycemic control in diabetic women.

Adolescent↗

PubMed2005

Hepatic steatosis associated with hepatitis C virus infection.

Hepatic steatosis (including microvesicular and macrovesicular fat) is a significant histologic feature associated to the chronic hepatitis C (HCV). The purpose of this paper was to analyze the incidence of hepatocyte steatosis in patients with HCV and the potential role of some the known variables as risk factors possibly involved in the occurrence of steatosis: age, sex, obesity, biological parameters, diabetes mellitus, degree of necroinflammation (NI) and stage of fibrosis. 96 of 125 (76.8%) patients had hepatic steatosis (mild 76%, moderate and severe 24%); in comparison with patients without steatosis, those with HCV and steatosis were more frequently women (males/females: 1/1.9) of older age (49.97 vs. 47.7 years), with a greater ICM (index of corporal mass) (26.55 sqm vs. 23.52 sqm), with raised glycemic values (13 of the 14 patients with HCV and diabetes mellitus had steatosis), an average value of serum ALT significantly raised (95.38 U/l vs. 78.96 U/l), and an average score of NI activity significantly higher (9.39 vs. 6.75).

Adult↗

PubMedDate not supplied

Evaluation of asymptomatic central neuropathy in type I diabetes mellitus.

OBJECTIVES: Diabetic neuropathy is recognized as the most common clinical picture of nervous system disorders caused by diabetes mellitus (DM). Although peripheral and autonomic nervous system involvements are frequently encountered, there exists a few data about the incidence of central diabetic neuropathies. Central nervous system degeneration is a well known pathology in diabetic patients in the long term. It is possible to reveal central nervous system involvement at the early stages by using evoked potentials (EP). The aim of this study is to evaluate the auditory, visual and sensorial abnormalities in type I diabetic patients, who also have normal nerve conduction studies, with somatosensory, brainstem auditory and visual EP studies (SEP, VEP BAEP); to determine the frequency of these abnormalities and to investigate the relationship between other variables such as age, gender, duration of the diabetes and degree of the metabolic control. PATIENTS AND METHODS: A total of 36 asymptomatic type I DM children, ages ranging between 6-17 (mean age 11 +/- 3.24) taking insulin treatments were included in this study. Control group was made up of healthy children. EPs were evaluated and comparisons were made between the two groups. RESULTS: In a large group of diabetic children (47.2%), independent from parameters such as age, gender, glycemic control degree, auditory and visual deficits, retinopathy, joint movement limitation; but dependent on the peripheral SEP pathologies and disease duration there were central electrophysiological disturbances. In 13 (36.1%) of the patients SEP pathologies; in 9 (25%) of the patients VEP pathologies and in 14 (38.9%) of the patients BAEP pathologies were detected. CONCLUSION: Besides independent from peripheral pathologies, central nervous system involvement could also be observed in diabetic children. EP changes can be detected in asymptomatic patients that would be a predictor of future symptoms.

Adolescent↗

PubMed1995

Insulin binding in non-insulin-dependent diabetes mellitus (NIDDM) is correlated with glycemic control: clinical evidence for abnormal receptor regulation in NIDDM.

Insulin binding has been reported to be decreased in non-insulin-dependent diabetes mellitus (NIDDM). Although elevated basal insulin concentrations have been correlated with decreased insulin binding in obesity, this relationship has not been found in NIDDM. To determine the potential cause(s) of the decrease, we measured 125I-insulin binding to circulating monocytes isolated from 31 non-insulin-treated patients with NIDDM who had a fasting plasma glucose (FPG) concentration greater than 7.8 mmol/L and 13 control subjects. We examined the influence of obesity, insulin concentration, glycemic control, and treatment with oral hypoglycemic agents on insulin binding in a cross-sectional study. Insulin binding was significantly decreased in the entire NIDDM group (mean +/- SEM, %/10(7) monocytes: 4.65 +/- 0.33) as compared with controls (6.45 +/- .70, P < .02). Subgroups defined by obesity (relative body weight > 1.2) and poor glycemic control (FPG > 11.1 mmol/L) and those not taking oral hypoglycemic agents had significantly lower insulin binding (P < .02). However, neither relative body weight nor insulin concentrations (basal or stimulated) correlated with insulin binding. Stepwise linear regression analysis showed that only FPG significantly correlated with insulin binding (r = -.45, P = .002) even when oral hypoglycemic agent-treated patients were removed from the analysis (r = -.50, P = .003). There was no significant contribution to explain insulin binding by the other variables, including diagnosis of diabetes, obesity, insulin concentration, or treatment with oral hypoglycemic agents. We conclude that poor metabolic control is associated with an alteration in insulin receptor regulation in NIDDM.

Adult↗

PubMed2000

Interdialytic weight gain and survival in hemodialysis patients: effects of duration of ESRD and diabetes mellitus.

BACKGROUND: Medical mortality determinants in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) are well known. More recently, associations have been established between the dose of dialysis administered and patient survival. We showed in a prospective study that both dialyzer type and patient compliance with the dialysis prescription were independently associated with survival. Although several parameters of dialytic technique and patient compliance are associated with differential survival in patients with ESRD treated with HD, the association of interdialytic weight gain (IWG) with survival is unclear. No study has assessed the relationship between IWG and mortality in HD patients, controlled for multiple medical risk factors. The aim of our study was to determine whether IWG was associated with survival in patients with ESRD treated with HD, controlling for multiple medical and dialytic risk factors. METHODS: We prospectively conducted an observational, longitudinal, multicenter study of 283 urban HD patients to determine the relationship of IWG with several dialytic parameters and patient survival. Medical risk factors such as demographic indices and comorbid conditions were assessed. We studied Kt/V, the protein catabolic rate (PCR), serum albumin and anthropometric measurements, behavioral compliance indices, dialyzer characteristics, and serum electrolyte concentrations, and correlated these with IWG. In addition, the duration of dialysis was assessed in HD patients with and without diabetes mellitus. Cox proportional hazards models assessed the relative mortality risk of increased IWG, controlling for variations in medical comorbidity and other mortality determinants. RESULTS: The mean (+/- SD) age of our population was 54.6 +/- 14.1 years, and the mean time they were treated with HD was 30.4 +/- 46.9 months. The mean IWG was 1.54 +/- 0.71% dry wt/day. Correlations were found between increased IWG and younger age, and lower midarm circumference, and increased Kt/V, PCR, and serum potassium concentration. The mean follow-up period was 48.9 +/- 10.6 months. An increase in IWG was associated with a significantly increased relative mortality risk in diabetic ESRD patients treated with HD when variations in age, comorbidity, serum albumin concentration, and dialyzer type and site were controlled. There was, however, no association of increased mortality risk with increased IWG in the larger population of patients without diabetes. In further analyses, the increased mortality risk associated with increased IWG was found to be present only in patients with diabetes mellitus who had recently started HD therapy for ESRD. CONCLUSION: IWG is correlated with several nutritional and dialytic variables and with parameters that predict survival in HD patients. Increased IWG is independently associated with decreased survival of diabetic ESRD patients treated with HD, after adjusting for variation in other medical risk factors. The population of incident diabetic HD patients is particularly susceptible to increased risk associated with increased IWG. The mechanisms underlying these results are obscure, but IWG might be associated with poorer survival in this population if it were linked to worsened hypertension, cardiovascular stress, or poorer glycemic control. Interventions to improve compliance with IWG in incident diabetic HD patients are warranted.

Adult↗

PubMed1998

Factors associated with glycemic control. A cross-sectional nationwide study in 2,579 French children with type 1 diabetes. The French Pediatric Diabetes Group.

OBJECTIVE: To determine on a large scale the multiple medical and nonmedical factors that influence glycemic control in the general population of children with diabetes, we performed a nationwide French cross-sectional study. RESEARCH DESIGN AND METHODS: We enrolled 2,579 patients aged 1-19 years with type 1 diabetes of > 1 year's duration. The study was center based: 270 centers were identified, 206 agreed to participate, and 147 included at least 90% of their patients. Questionnaires were completed by physicians interviewing patients and family, and HbA1c measurements were centralized. To identify explanatory variables for HbA1c level and frequency of severe hypoglycemia, we performed multiple regression analysis using all the quantitative variables collected and stepwise logistic regression for the qualitative variables. RESULTS: Mean HbA1c value for the whole population was 8.97 +/- 1.98% (normal 4.7 +/- 0.7% [SD]). Only 19 children (0.7%) had ketoacidosis during the 6 months before the study, whereas 593 severe hypoglycemia events occurred in 338 children (13.8%). Control was better in university-affiliated hospitals and centers following > 50 patients, reflecting the importance of access to experienced diabetologists. Children had a mean of 2.3 injections, allegedly performed 2.8 glucose measurements per day, and were seen an average of 4.6 times per year at the center. In the multiple regression analysis, 94% of the variance of HbA1c was explained by our pool of selected variables, with the highest regression coefficient between HbA1c and age (Rc = 0.43, P < 0.0001), then with daily insulin dosage per kilogram (Rc = 0.28, P < 0.0001), mother's age (Rc = 0.26, P < 0.0001), frequency of glucose measurements (Rc = 0.21, P < 0.0001), and diabetes duration (Rc = 0.14, P < 0.0001). Logistic regression identified quality of family support and dietary compliance, two related qualitative and possibly subjective variables, as additional explanatory determinants of HbA1c. The frequency of severe hypoglycemia was 45 per 100 patient-years and correlated with diabetes duration, but not with HbA1c levels or other variables. CONCLUSIONS: Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c < 8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.

Adolescent↗

PubMed1999

Age-related increase in visceral adipose tissue and body fat and the metabolic risk profile of premenopausal women.

OBJECTIVE: Age-related differences in body fat and, more specifically, in the accumulation of abdominal visceral adipose tissue (AT) were examined as potential covariates of the age-related difference in the metabolic profile predictive of cardiovascular disease (CVD) risk observed in young, as compared with middle-aged, premenopausal women. RESEARCH DESIGN AND METHODS: Body composition, AT distribution, plasma lipoprotein-lipid levels, glucose tolerance, and plasma insulin concentrations were assessed in a sample of 122 young women (27.4+/-7.5 years, mean +/- SD) and compared with a sample of 52 middle-aged premenopausal women (49.5+/-5.3 years) who still had a normal menstrual cycle. RESULTS: Middle-aged women were characterized by elevated levels of total abdominal and visceral AT and greater body fat mass and waist circumference, as well as by higher plasma levels of total cholesterol, LDL cholesterol, apolipoprotein (apo)B, and LDL-apoB compared with younger women. Furthermore, middle-aged women showed a greater glycemic response to a 75-g oral glucose load than young women (P < 0.01). In both young and middle-aged subjects, visceral AT accumulation was significantly correlated with plasma triglyceride, apoB, and LDL-apoB levels and with the cholesterol/HDL cholesterol ratio, as well as with plasma glucose, insulin, and C-peptide levels measured in the fasting state and after the oral glucose load, and negatively correlated with HDL cholesterol levels (-0.41 < or = r < or = 0.65, P < 0.05). When variables were adjusted for levels of visceral AT and fat mass, age-related differences that were initially found in plasma apoB and LDL-apoB levels, as well as in fasting glycemia and glucose tolerance, were eliminated. CONCLUSIONS: Results of the present study suggest that even before the onset of menopause there is an age-related deterioration in the metabolic risk profile and an increase in visceral AT deposition in middle-aged women compared with young control subjects. Furthermore, our results provide support for the notion that the age-related increase in visceral AT accumulation is a significant factor involved in the deterioration of the CVD risk profile noted in premenopausal women with age.

Adipose Tissue↗

PubMed1987

The usefulness of fructosamine determination in diabetic patients and its relation to metabolic control.

In 116 diabetics and 101 control subjects, we measured both HbA1 and fructosamine values, neither could definitely separate the 2 populations. We observed an excellent correlation between both variables and between each of them and various other parameters of metabolic control. It appeared that the correlation with recent (4 weeks) diabetes control was better with fructosamine than with HbA1 levels. The opposite was true when a 8 week period was considered. The presence of diabetic complications did not modify the fructosamine levels. These results confirm the value of fructosamine measurement in the evaluation of recent diabetes control, but clearly, HbA1 determination remains the best parameter of long-term glycemic control.

Blood Glucose↗

PubMed1997

[Glycemic thresholds in spontaneous abortion during the first trimester in pregnant women with insulin dependent diabetes].

BACKGROUND AND AIM: To evaluate the hypothesis that insulin-dependent diabetic (IDDM) pregnant women have a threshold of glycemic control during the first trimester of pregnancy for an increased risk of spontaneous abortion. MATERIALS AND METHODS: Seventy IDDM pregnant women were enrolled before the 9th week of gestation and monitored throughout pregnancy. Fifteen pregnancies (21.4%) led to spontaneous abortion within the first trimester (study group) and 55 (76%) continued until term (control group). In order to evaluate the differences between the study group and the control group variance analysis and Student's t-test were used for constant variables and chi 2 and Fisher's exact test for discrete variables; p < 0.05 was considered statistically significance. RESULTS: Mean levels of glycosylated hemoglobin (HbA1c) and fructosamine at the initial prenatal visit were significantly higher in the study group (p < 0.03) compared to the control group. The threshold for an increased risk of spontaneous abortion in the first trimester was found to be initial concentrations > 8% for HbA1c and > 300 mmol/l for fructosamine. CONCLUSIONS: Pregnant women suffering from IDDM with initial HbA1c levels higher than 8% and fructosamine > 3 mmol/l have an increased risk of spontaneous abortion in the first trimester of pregnancy. Below this threshold the risk of spontaneous abortion during the first trimester of pregnancy is similar to that for non-diabetic pregnant women.

Abortion, Spontaneous↗

PubMed1999

Energy sources and risk of cancer of the breast and colon-rectum in Italy.

Dietary habits are thought to be involved as determinant of breast and colorectal cancer. Nevertheless results of epidemiological studies on diet show several inconsistencies. This is true for the findings related to energy and its sources. Between 1991 and 1996, 2569 women with incident breast cancer (median age: 55 years) and 2588 controls (median age: 56 years), and 1953 subjects with cancer of the colon-rectum (median age: 62 years) and 4154 controls (median age: 58 years) were interviewed in the hospitals of six Italian areas. The validated food frequency questionnaire included questions on 78 foods and recipes and specific questions on individual fat intake pattern. Significant risks for breast and colorectal cancer emerged with increasing intake of energy (odds ratios in highest vs. lowest quintile were 1.32 and 1.49 respectively). Due to the high interrelations existing among the various sources of energy, the separated analysis of each macronutrient didn't achieve the independent estimates of the effects. In order to overcome this situation, we used a completely partitioned model in which all the main sources of energy were entered simultaneously as continuous variables in the regression. High intake of starch led to an increase of cancer risk (odds ratios for an addition of 100 kcal/day were 1.08 and 1.10 for breast and colorectal cancer respectively). A positive association was also found for saturated fat (odds ratios 1.16 for breast and 1.12 for colorectal cancer). High intakes of polyunsaturated fatty acids (chiefly derived from olive and seed oils) were protective more markedly for breast cancer. A possible interpretation of the risk for starch, implies the glycemic overload and hyperinsulinemia due to the high grade of refinement of cereals (the main source of starch) eaten in Italy.

Breast Neoplasms↗

PubMed2003

Glucose-responsive hepatic insulin gene therapy of spontaneously diabetic BB/Wor rats.

Hepatic insulin gene therapy (HIGT) ameliorates hyperglycemia in multiple rodent models of diabetes mellitus, with variable degrees of glucose control. We demonstrate here that adenoviral delivery of a glucose-regulated transgene into rat hepatocytes produces near-normal glycemia in spontaneously diabetic BB/Wor rats without administration of exogenous insulin. We compared growth, glycemia, counterregulatory hormones, and lipids in HIGT-treated diabetic rats to nondiabetic rats and diabetic rats treated with either insulin injections or sustained-release insulin pellets. HIGT-treated rats achieved near-normal blood glucose levels within 1 week and maintained glycemic control for up to 3 months. Rats treated with sustained release insulin implants had similar blood sugars, but more hypoglycemia and gained more weight than HIGT-treated rats. HIGT-treated rats normalized blood glucose within 2 hr after a glucose load, and tolerated a 24-hr fast without hypoglycemia. HIGT treatment suppressed ketogenesis similarly to peripheral insulin. However, glucagon levels and free fatty acids were increased in HIGT-treated rats compared to either nondiabetic controls or rats treated with exogenous insulin. In addition to extending successful application of HIGT to a rat model of autoimmune diabetes, these findings emphasize the relative contribution of hepatic insulin effect in the metabolic stabilization of diabetes mellitus.

3-Hydroxybutyric Acid↗

PubMed1994

Coronary artery disease is associated with increased lipoprotein(a) concentrations independent of the size of circulating apolipoprotein(a) isoforms.

Lipoprotein(a) [Lp(a)] concentration and apolipoprotein(a) [apo(a)] isoforms (identified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis [SDS-PAGE] and Western blotting) were determined in a group of 508 asymptomatic Caucasian members of the community and in 318 Caucasian patients with angiographically defined coronary artery disease (CAD). Conventional risk factors for CAD were also measured. Lp(a) concentration was almost twice as high in subjects with CAD (geometric mean, 152 mg/L [geometric SD, 10 to 1398 mg/L]) as in asymptomatic control subjects (geometric mean, 84 mg/L [geometric SD, 21 to 334 mg/L]). Asymptomatic women had higher concentrations of Lp(a) than asymptomatic men. Patients with CAD were older and were more likely to have smoked and to have a first-degree relative with premature CAD (< 55 years of age), and a higher proportion were male. Patients with CAD had higher concentrations of Lp(a) independently of the number of isoform bands expressed. When apo(a) isoforms were allocated to 1 of 10 classes on the basis of their molecular size (Rf versus apoB in SDS-PAGE), patients with CAD did not express an excess of low-molecular-mass (higher concentration) isoforms but did express a higher proportion of double-band phenotypes with fewer "null" phenotypes. The relationship between the two isoform bands in a double-band phenotype was the same in both populations. Isoform mobility was defined as a continuous variable equal to the mobility of a single isoform band (single-band phenotypes) or the mean of the two isoforms in a double-band phenotype. Two variables, isoform mobility and the number of isoform bands expressed, were used to summarize the large range of isoform patterns (at least 45) that could be identified. Isoform mobility, the number of isoform bands expressed, and the presence of CAD were the three most important independent predictors of Lp(a) concentration (descending order). Only sex and LDL cholesterol were additional independent predictors of Lp(a) concentration in step-wise regression models including a wide range of demographic factors and lipid and glycemic risk factors. We conclude that Lp(a) concentration is associated with CAD independently of the isoform pattern expressed. The apo(a) gene locus exerts a strong control over circulating Lp(a) concentration, and a better understanding of the control of expression of the apo(a) gene will be essential to understand the relationship between Lp(a) and CAD.

Apolipoproteins A↗

PubMed1998

Validation of home blood glucose meters with respect to clinical and analytical approaches.

OBJECTIVE: To evaluate the clinical and analytical accuracy of home blood glucose meters. RESEARCH DESIGN AND METHODS: Six blood glucose meters--Reflolux S (Boehringer Mannheim, Mannheim, Germany), One Touch II (LifeScan, Milpitas, CA), Glucocard Memory (Menarini, Florence, Italy), Precision QID (Medisense, Cambridge, U.K.), HaemoCue (HaemoCue, Angelholm, Sweden), and Accutrend alpha (Boehringer Mannheim, Mannheim, Germany)--were compared with a reference method (Beckman Glucose Analyzer II) under controlled conditions (glucose clamp technique). Validation of the blood glucose meters was accomplished by clinically oriented approaches (error grid analysis), statistical approaches (variance components analysis), and by the criteria of the American Diabetes Association (ADA), which recommend a target variability of < 5%. RESULTS: A total of 1,794 blood glucose monitor readings and 299 reference values ranging from 2.2 to 18.2 mmol/l were analyzed (705 readings < 3.89 mmol/l, 839 readings between 3.89 and 9.99 mmol/l, and 250 readings > 9.99 mmol/l). According to error grid analysis, only Reflolux S and Glucocard M had 100% of estimations within the clinically acceptable zones A and B. Assessment of analytical accuracy revealed substantial differences between the glucose meters after separation of the data into defined glycemic ranges. None of the devices met the ADA criteria. CONCLUSIONS: To evaluate accuracy of blood glucose meters, error grid analysis, as well as statistical models, are helpful means and should be performed together. Analytical performance of currently available home blood glucose meters differs substantially within defined glycemic ranges.

Blood Glucose Self-Monitoring↗

PubMed2005

Effect on glycemic control of the addition of 2.5 mg glipizide GITS to metformin in patients with T2DM.

AIMS: This study evaluated the effects on glycemic control of the addition of 2.5 mg glipizide GITS to metformin in patients with mild-to-moderate, but suboptimally controlled type 2 diabetes. METHODS: In this multicenter, double-blind, placebo-controlled study, 122 patients with type 2 diabetes inadequately controlled (A1c 7-8.5%) on metformin (> or =1000 mg/day for > or =3 months) were randomized to 16 weeks treatment with 2.5 mg/day glipizide GITS (n=61) or placebo (n=61), in addition to their current metformin dose. The primary efficacy variable was the change in A1c from baseline to endpoint. Changes in fasting plasma glucose (FPG), insulin concentrations, lipid profile and safety variables were also measured. RESULTS: The addition of glipizide GITS to metformin gave significantly greater improvements in mean A1c and FPG from baseline to endpoint than placebo addition (p<0.0002). Significantly more patients in the glipizide GITS group than in the placebo group achieved the target A1c level of A1c<7.0% (p<0.0001) and an A1c<6.5% (p<0.0033). Fasting insulin concentrations were similar in both groups and unchanged by treatment. Addition of glipizide GITS to metformin did not produce any significant or clinically relevant weight gain or changes in BMI. Both treatment regimens were well tolerated. CONCLUSIONS: This study showed that the addition of 2.5 mg glipizide GITS to metformin significantly improved glucose control in patients with type 2 diabetes inadequately controlled by metformin monotherapy.

Blood Glucose↗

PubMed1991

[Multicenter evaluation of a diabetes program in primary care in Tarragona].

To evaluate a provincial diabetes program for primary care in Tarragona 14 months after its implementation, the data provided by all centers were evaluated. The participants were 8 CAPS and the professionals of a rural area, with a reference population of 170,159. A total of 1,766 diabetic patients were sensed. 131 were type I (7.4%) and 1,635 type II (90.6%). The health care variables of 1,197 patients (67.7%) and the rate of complications of 654 (54.6%) were assessed. A high prevalence of hypertension (50.0%) and dyslipemia (40.5%) were found associated with diabetes. Overall 868 individuals (72.5%) received individualized education in the clinic; 112 of these (12.9%) were included in collective education programs for groups. At the time of this evaluation, the proportion of patients treated with insulin (174/545) was significantly higher than that found before the program (79/402, p less than 0.0001). The practice of glycemic self assessment at home was also significantly increased (82/691 versus 440/1, 124; p less than 0.0001). The initial impact on the professional and diabetic patients of our area has been remarkable. Although the planning of multicentric evaluation systems in complex, it is possible to implement it if the data and recording system are coordinated.

Diabetes Mellitus↗

PubMedDate not supplied

Insulin treatment in type 1 diabetes.

OBJECTIVE: To present key aspects and strategies for use of insulin therapy in patients with type 1 diabetes mellitus. METHODS: Limitations and advantages of various insulin regimens are discussed, and issues pertaining to insulin analogues are reviewed. RESULTS: Rapid-acting insulin analogues provide better and safer postprandial glucose coverage than does human regular insulin. Premixed insulin preparations do not provide the flexibility to address the individual needs of patients adequately to control postprandial glucose excursions. Because of its peak, short duration, and high variability, NPH insulin is inappropriate for patients with type 1 diabetes and patients with type 2 diabetes who require continuous basal coverage. Continuous infusion of soluble insulin by means of an insulin pump is currently the most physiologic approach available for treatment of type 1 diabetes. Use of insulin glargine or insulin detemir with a rapid-acting insulin analogue at meals is an effective and reasonable alternative to insulin pump therapy. CONCLUSION: Both rapid-acting and long-acting insulin analogues improve glycemic control. This improvement involves controlling hemoglobin A1c levels, reducing glucose excursions, and decreasing hypoglycemia, particularly during the night. Clinicians should prescribe insulin regimens that yield physiologic results in patients with type 1 diabetes.

Blood Glucose↗