IntroductionThe aim of the present study was to describe clinical outcomes in a real-world population of Swiss patients with long-standing, poorly controlled type 2 diabetes after switching to IDegLira [a combination of insulin degludec (IDeg) and liraglutide (Lira)].MethodsThis was a prospective, open-label, single-center observational follow-up at the Cabinet Medical de Diabétologie, Lausanne, Switzerland, of 61 patients [HbA1c 9.2% (77 mmol/mol) and 56.1 U total insulin] initiated with IDegLira at 20 dose steps (20 U IDeg/0.72 mg Lira), except in insulin-naïve patients who began treatment at 16 dose steps. Thereafter, the dose was titrated by four dose steps once weekly, according to individualized fasting blood glucose targets. Information about glycemic control, total insulin dose, weight, and blood pressure, along with any adverse events, was collected from medical records and patient reports during clinic visits at baseline, 3 months, and end of follow-up.ResultsOver 6 months of follow-up, mean HbA1c improved (decrease of 1.7%) to 7.5% with concomitant weight loss. Switching to IDegLira resulted in a lower (−14.6 U) total insulin dose compared with baseline for those patients previously on insulin. There were no episodes of severe hypoglycemia during treatment with IDegLira. There were small decreases in both mean systolic and mean diastolic blood pressure with IDegLira. Six patients discontinued treatment early because of adverse gastrointestinal events with IDegLira.ConclusionSwitching to IDegLira, mostly from regimens using insulin in conjunction with oral antidiabetic medications in a real-world population of patients with type 2 diabetes, resulted in improved glucose control with a lower insulin dose and weight loss.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0234-y) contains supplementary material, which is available to authorized users.
Overweight woman with type 1 diabetes (T1D) treated with insulin pump and what else? Our understanding of type 1 diabetes and our capacity to standardize care as well as reduce the burden connected to the daily fluctuations of blood sugar remain largely unsatisfactory.The daily life of a person with T1D shows that insulin therapy alone does not suffice to get the targeted glucose control in a majority of patients.In the literature, data on the use of agonists of the receptor of Glucagon-like peptide-1 (AR GLP-1) in the patient with T1D are very few, but let us imagine that a positive impact can be expected. In particular, semaglutide has been studied a lot in the reduction of cardiovascular risk in persons with type 2 diabetes (T2D), but there is no data to date in the patient with T1D, neither on glycemic control, nor, or even less, on secondary complications. This article exposes the clinical case of a woman with T1D, treated by insulin pump with then the addition of semaglutide. Using a flash type continuous glucose monitoring system, the monitoring parameters will be illustrated. The addition of semaglutide seems to have the ability to reduce the glucose variability, improve the glucose control and reduce weight in a patient with long time evolving T1D.
IntroductionThe aim of this study was to evaluate the effectiveness of a real-life clinical physical activity program (DIAfit) on improving physical fitness, body composition, and cardiometabolic health in an unselected population with type 2 diabetes mellitus, and to compare the effects of two variants a different exercise frequencies on the same outcomes.Research design and methodsThis was a cluster randomized-controlled assessor-blind trial conducted in 11 clinical centres in Switzerland. All participants in the clinical program with type 2 diabetes were eligible and were randomized to either standard (3 sessions/week for 12 weeks) or alternative (1 session/week for the first four weeks, then 2 sessions/week for the rest of 16 weeks) physical activity program each consisting of 36 sessions of combined aerobic and resistance exercise. Allocation was concealed by a central office unrelated to the study. The primary outcome was aerobic fitness. Secondary outcome measures included: body composition, BMI, HbA1c, muscle strength, walking speed, balance, flexibility, blood pressure, lipid profile.ResultsAll 185 patients with type 2 diabetes (mean age 59.7 +-10.2 years, 48% women) agreed to participate and were randomized in two groups: a standard group (n=88) and an alternative group (n=97)). There was an 11% increase in aerobic fitness after the program (12.5 Watts; 95% CI 6.76 to 18.25; p<0.001). Significant improvements in physical fitness, body composition, and cardiometabolic parameters were observed at the end of the DIAfit program (improvements between 2-29%) except for lean body mass, triglycerides and cholesterol. No differences were observed between both programs, except for a larger weight reduction of -0.97kg (95% CI -0.04 to -1.91; p=0.04) in the standard program.ConclusionsBoth frequency variants of the nation-wide DIAfit program had beneficial effects on physical fitness, HbA1c, body composition, and blood pressure in type 2 diabetes patients and differences were negligible.Clinical trial registrationclinicaltrials.gov, identifier NCT01289587.
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