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- May 17, 2008 |
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"Sustaining Long-Term Glycemic Control"Dr. Stuart A Ross (biography)
English - 2002-10-05 - 39 minutes
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Summary :
A lot about diabetes care has changed in recent years. We now have multiple drug therapies, and specific targets and goals to reach as outlined by the CDA. In spite of this, target glucose levels are difficult to achieve. The UKPDS and other studies have shown a deterioration of glucose control after monotherapy with agents such as the sulfonylureas and metformin. Further research has indicated that the use of multiple drug therapies improves the initial outcome of glucose control. We will need to use combination therapy early on in the management of Type 2 Diabetes. The use of insulin-sensitizing drugs with other anti-hyperglycemic agents will be needed to provide long-term glucose control and management of the metabolic syndrome. We will need to aggressively manage all aspects of the metabolic syndrome including glucose, blood pressure and lipids. The opportunity to decrease or even prevent the terrible complications of diabetes has never been greater.
Learning objectives :
The participant will learn about the drawbacks of traditional treatments for Type 2 Diabetes, as revealed by studies such as UKPDS. Introduction to different combination therapies and their long-term success rates; and some insights into the treatment of obesity.
Bibliographic references :
A comparative study of insulin lispro and human regular insulin in patients with type 2 diabetes mellitus and secondary failure of oral hypoglycemic agents.
Ross SA, Zinman B, Campos RV, Strack T;
Canadian Lispro Study Group.
University of Calgary, Alta.
saross@cadvision.com
OBJECTIVE:
To compare the effects of insulin lispro (LP) and human regular insulin (HR) when given twice daily with NPH insulin on glycemic control (HbA1c), daily blood glucose profiles and rates of hypoglycemia in patients with type 2 diabetes mellitus after failure to respond to sulfonylurea drugs.
RESEARCH DESIGN AND METHODS:
A 5.5-month randomized, open-label, parallel study of 148 patients receiving either LP (n = 70) or HR (n = 78). Eight-point blood glucose profiles and HbA1c measurements were collected at baseline, 1.5, 3.5 and 5.5 months.
RESULTS:
Two-hour post-breakfast and 2-hour post-supper blood glucose levels (means [and standard errors]) were significantly lower for LP than for HR at the end point (9.5 [0.4] mmol/L v. 10.9 [0.4] mmol/L and 8.4 [0.4] mmol/L v. 9.7 [0.4] mmol/L, respectively, p = 0.02 in both cases). HbA1c improved from 10.5% (0.2%) (LP) and 10.3% (0.2%) (HR) to 8.0% (0.1%). Hypoglycemia rates were similar during the day; however, there was an overnight trend to reduced rates with LP (0.08 [0.03] episodes/30 d v. 0.16 [0.04] episodes/30 d, p = 0.057). Quality-of life assessment showed significant improvement (p < 0.05) in the diabetes-related worry scale for LP subjects whereas HR subjects slightly worsened.
CONCLUSIONS:
With traditional twice-daily insulin administration algorithms, LP improves 2-hour postprandial glucose levels, quality of life and overnight hypoglycemia rates while delivering an equivalent level of glycemic control (HbA1c) compared with HR to insulin-naive patients with type 2 diabetes who require insulin.
Clin Invest Med 2001 Dec;24(6):292-8
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