Insulin detemir as first-line diabetes treatment
The American Diabetes Association and the European Association for the Study of Diabetes released a consensus statement on the approach to the management of hyperglycemia in patients with type 2 diabetes (Diabetes Care. 2009;32:193-203). The recommendation includes intervention at the time of diagnosis with metformin in combination with lifestyle changes, which include medical nutrition therapy and exercise.
Clinicians should monitor glycemic goals and intensify pharmacologic therapy with additional agents, including early initiation of insulin therapy, to reach a glycemic goal of hemoglobin (Hb)A1c <7% in most patients. Initiation of insulin at the time of diagnosis of type 2 diabetes is recommended for individuals presenting with weight loss or other severe hyperglycemic signs or symptoms.
According to the consensus statement, the precise drug or exact sequence may not be as important as achieving and maintaining glycemic targets safely. A study compared insulin detemir with neutral protamine hagedorn (NPH) insulin as add-on therapy to oral glucose-lowering drugs in people with type 2 diabetes (Diabetes Care. 2006;29:1269-1274). Investigators concluded that the addition of basal insulin to oral drug therapy in people with suboptimal control of type 2 diabetes achieves guideline-recommended HbA1c values in most people with aggressive titration. Compared with NPH insulin, insulin detemir achieves the same glycemic goal with reduced hypoglycemia and less weight gain. — Eileen F.
Treatment For Hyperglycemia - News
The American Diabetes Association and the European Association for the Study of Diabetes released a consensus statement on the approach to the management of hyperglycemia in patients with type 2 diabetes (Diabetes Care. 2009;32:193-203).
Pre-existing nausea, vomiting and diarrhea should be adequately controlled before beginning therapy with ZOLINZA. Hyperglycemia has been observed in patients receiving ZOLINZA. Serum glucose should be monitored, especially in diabetic or potentially
However, hyperglycemia (blood sugar levels in excess of 250 mg/dL) was observed nearly a third of the time. "You say to yourself, [the parents] heard the alarms, why didn't they do something? Well, many of them discontinued the high alarm because it
AFREZZA(R) is a novel, ultra rapid acting mealtime insulin therapy being developed by MannKind Corporation for the treatment of adult patients with type 1 and type 2 diabetes for the control of hyperglycemia. It is a drug-device combination product,
Conversely, hyperglycemia was twice as common with standard treatment targets (18.8% of the standard group versus 8.8% of the intensive group glucose values exceeded 200 mg/dL, P<0.0001). Again patients who ran opposite the expected pattern appeared to
Hyperglycemia in the intensive care unit | Medicine Port
Hyperglycemia and insulin resistance are common in critically ill patients even if they did not have diabetes before their illnesses.
Hyperglycemia in the intensive care unit (ICU) setting has been shown to be associated with an increased mortality, and restoration of nor-moglycemia using intensive insulin therapy has decreased mortality for the following populations:myocardial infarction, burn, and stroke.
Specifically, in the surgical ICU setting, the use of intensive insulin therapy to achieve nor-moglycemia in hyperglycemia in the intensive care unit has resulted in a lower incidence of nosocomial infections.
The most compelling study by Van den Berghe et al. showed that, for hyperglycemia in the intensive care unit setting on the ventilator, intensive insulin therapy to achieve normoglycemia (80 to 110 mg/dL = 4.4 to 6.1 mmol/L) resulted in a 43% reduction in mortality (8% compared with 4.6%) when compared with patients treated with sliding scale insulin with the aim of achieving a glucose level between 180 and 200 mg/dL (10.0 to 11.1 mmol/L).
The lowered mortality was largely accounted for in the group with an ICU stay of more than 5 days whose mortality from multiple organ failure was lowered.
Additional outcomes associated with normoglycemia included fewer bacteremias, reduced requirement for hemodialysis, fewer transfusions, and shorter duration on the ventilator and in the ICU.
Although hyperglycemia in the intensive care unit population was skewed toward postoperative cardiac surgery patients, the-ICU-stay population in whom the mortality reduction was more striking, and therefore a better balanced group.
Accordingly, the currently available evidence favors aiming for normoglycemia (blood glucose level of less than 110 mg/dL = 6.1 mmol/L) through intravenous insulin infusion in adult surgical ICU patients. It has not been proven that the same improved outcomes will be found in nonadult or nonsurgical ICU patients.
The use of intensive insulin infusion can result in hypoglycemia either from excess insulin or from improvement in the patients conditions (with a fall in insulin resistance).
Many ICUs counteract this risk of hypoglycemia by also placing the patient on an infusion of dextrose during insulin administration for hyperglycemia in the intensive care unit .
Frequent blood glucose monitoring (on the order of hourly) is an important part of the treatment protocol in insulin infusion to avoid hypoglycemia.
Lifestyle modification is an effective and important treatment component for hyperglycemia and associated risk factors in patients with T2DM
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What are the effects of using detemir as first-line treatment for type 2 ? Treatment For Hyperglycemia - Bookshelf
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