Compliance with, and understanding of, mealtime advice in patients with type 2 diabetes

Frandsen, Kirstine Brown; Kristensen, J S

doi:10.1016/s0168-8227(00)81646-0

Cited by 5 publications

(7 citation statements)

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“…As the need to achieve nearnormoglycemia becomes recognized in the light of the findings of large prospective studies, hypoglycemia is likely to become an increasingly common feature of type 2 diabetes (6,7). In addition, sulfonylurea therapy may introduce restrictions in patients' daily lives because of the increased hypoglycemic risk associated with missed or delayed meals (8).…”

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confidence: 99%

Optimizing Insulin Secretagogue Therapy in Patients With Type 2 Diabetes

et al. 2002

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OBJECTIVE -Repaglinide, a novel antidiabetic agent that has a rapid onset and short duration of action, was developed for mealtime dosing. The purpose of this pharmacodynamic study was to validate a prandial regimen of repaglinide by comparing meal-related dosing with a regimen in which the same total daily dose was divided into only two doses at morning and evening meals. RESEARCH DESIGN AND METHODS -The study was a double-blind, randomized, parallel-group trial in 19 antidiabetic agent-naive subjects with type 2 diabetes (mean age 58 years, known duration of diabetes 3.5 years, HbA 1c 7.3%, and BMI 32 kg/m 2 ). Patients were randomly assigned to receive repaglinide either before each of the three main meals or before breakfast and before the evening meal. Patients in both groups received the same total daily dose of repaglinide. Twenty-four hour profiles of blood glucose, plasma insulin, and plasma Cpeptide concentrations were measured at baseline and after 4 weeks of treatment.RESULTS -Repaglinide increased postprandial insulin levels and markedly reduced postprandial glucose levels relative to baseline in both groups. Significant reductions were also recorded in fasting blood glucose and HbA 1c levels. The repaglinide regimen, in which a dose was taken before each main meal, was more effective in improving glycemic control (including postprandial glucose and HbA 1c levels) than the same total dose of repaglinide divided into morning and evening mealtime doses.CONCLUSIONS -These data support the strategy of mealtime dosing with repaglinide. The improvements in glycemic control observed in these patients are encouraging. In addition to classic parameters of glycemic control, improvements in postprandial glucose excursions may prove to be important because postprandial hyperglycemia has been suggested to be an independent risk factor for cardiovascular disease in diabetes. Diabetes Care 25:342-346, 2002T ype 2 diabetes is characterized by impaired insulin secretion, usually with concomitant impaired insulin sensitivity (1,2). Insulin secretagogue therapy is therefore a logical part of therapy of type 2 diabetes when diet and lifestyle modifications fail. Secretagogue therapy is the appropriate means to augment circulating insulin levels in patients with a moderate degree of ␤-cell dysfunction; in individuals with more advanced ␤-cell dysfunction, exogenous insulin therapy may be necessary.Sulfonylureas have been used for almost five decades as insulin secretagogues in the management of type 2 diabetes. Sulfonylureas stimulate insulin secretion and thereby reduce hyperglycemia, with few side effects. Nevertheless, the long plasma half-life and the long-lasting effect of some sulfonylureas increase the risk of hypoglycemia, especially in elderly patients and in patients with renal insufficiency (3-5). As the need to achieve nearnormoglycemia becomes recognized in the light of the findings of large prospective studies, hypoglycemia is likely to become an increasingly common feature of type 2 diabetes (6,7). In add...

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confidence: 99%

Optimizing Insulin Secretagogue Therapy in Patients With Type 2 Diabetes

et al. 2002

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“…Since one-third of all hypoglycaemic episodes requiring hospital admission in people taking sulphonylureas are caused by missed meals (as discussed by Nattrass and Lauritzen 11 in this publication), and missed or delayed meals are common, 12 the risk of hypoglycaemia is not insignificant. Over-zealous glucose reduction following mismatched treatmentaexercise and food intake also compromise stable glycaemic control.…”

Section: Achieving Good Metabolic Control: Hurdles and Hoopsmentioning

confidence: 92%

“…12 Quantitative data on lifestyle, eating habits and diabetes information resources were gathered from focus groups of 8-10 members drawn from Europe and the USA. Qualitative data were gathered from questions and questionnaires at screening and during focus group discussions.…”

Section: Achieving Good Metabolic Control: Hurdles and Hoopsmentioning

confidence: 99%

“…Inadequate information about basic diabetes pathophysiology precludes an understanding of the rationale for treatment; improved glycaemic control is then thwarted by misconceptions and inappropriate behavioural modi®cations. 12 One of the commonest misconceptions is that eating regularly is a part of diabetes treatment, rather than a compensatory behaviour necessitated by the longacting OHAs. 12 This can work against attempted weight loss and cause confusion and subsequent demotivation.…”

Section: Achieving Good Metabolic Control: Hurdles and Hoopsmentioning

confidence: 99%

“…12 One of the commonest misconceptions is that eating regularly is a part of diabetes treatment, rather than a compensatory behaviour necessitated by the longacting OHAs. 12 This can work against attempted weight loss and cause confusion and subsequent demotivation.…”

Section: Achieving Good Metabolic Control: Hurdles and Hoopsmentioning

confidence: 99%

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1999

Int J Obes

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Diabetes currently affects at least 120 million people worldwide, and this ®gure is rising steadily. Intensive treatment improves outcome in terms of morbidity from late diabetic complications and quality of life, but in order for patients to reap such bene®ts, they must commit to major, long-term changes in lifestyle. The physician's concept of diabetes is often very different from the patient's; and the implementation of a treatment plan acceptable to both is only possible when open communication fosters discussion and patient autonomy, and treatment is seen as logical, acceptable and feasible within the daily life of each patient. Barriers that impair patients' ability to achieve good glycaemic control include those relating to lifestyle, education, psychology and their environment. An appreciation of barriers to good glycaemic control from the patient's perspective underlies the ability to minimise obstacles and improve outcome in terms of quality of life and metabolic control.

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Prandial glucose regulation with repaglinide: its clinical and lifestyle impact in a large cohort of patients with Type 2 diabetes

Landgraf

Frank²,

Bauer

et al. 2000

Int J Obes

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OBJECTIVE: Prandial glucose regulation has the potential for achieving good metabolic control with a low risk of hypoglycaemia and increased¯exibility with regard to eating patterns. Comparative studies have suggested that the prandial glucose regulator repaglinide is at least equivalent to sulphonylureas in terms of ef®cacy, but incurs a lower risk of major hypoglycaemia. However, these trials employed ®xed dosing and mealtime regimens, so repaglinide was not used as intended. This prospective investigation in a daily clinical setting aimed to assess the ef®cacy and tolerability pro®le of¯exible prandial glucose regulation with repaglinide in Type 2 diabetes. DESIGN: 5985 patients with Type 2 diabetes in Germany were surveyed prospectively. These patients were assessed before and after a mean of 46 days treatment with repaglinide. At baseline, available data showed that 64% of patients had previously received therapy with conventional oral antidiabetic drugs, 22% were on diet alone, and 13% were naõ Ève to any treatment. RESULTS: Overall, mean HbA 1c decreased from 8.6 to 7.4%, fasting blood glucose from 183.9 to 134.2 mgadl (10.2 to 7.4 mmolal), blood glucose prior to main meals from 198.5 to 141.4 mgadl (11 to 7.8 mmolal), and blood glucose 2 hours after main meals from 219.3 mgadl to 153.2 mgadl (12.2 to 8.5 mmolal).Subgroup analysis showed signi®cant improvements in each of these parameters (P`0.0001) in therapy-naõ Ève patients, in patients switched from other oral antidiabetic drugs, and in patients receiving repaglinide as combination therapy. Body weight decreased slightly (1.2 AE 2.7 kg). Only 49 hypoglycaemic episodes were reported, of which 38 cases were mild and no adverse sequelae to these events have been reported. Repaglinide also led to a liberating effect on lifestyle when patients were switched from other oral hypoglycaemic agents (OHAs), with 80% reporting a sense of relief at the prospect of being able to miss meals. The proportion of these patients reporting lifestyle restrictions as a result of ®xed mealtimes declined from 36% to 7%. Before switching, 38% of the patients admitted to eating when not hungry for fear of hypoglycaemia, but only 10% continued this behaviour and patients took fewer supplementary snacks after switching to repaglinide. CONCLUSION: Prandial glucose regulation with repaglinide improves metabolic control in patients with Type 2 diabetes without causing weight gain and with few hypoglycaemic episodes. This bene®cial effect is seen in patients who are therapy-naõ Ève, have switched from alternative OHAs, or are in need of combination therapy. The prandial approach to treatment has a liberating effect with regard to eating behaviour that is welcomed by most patients switched from alternative therapies.

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Compliance with, and understanding of, mealtime advice in patients with type 2 diabetes

Cited by 5 publications

References 0 publications

Optimizing Insulin Secretagogue Therapy in Patients With Type 2 Diabetes

Optimizing Insulin Secretagogue Therapy in Patients With Type 2 Diabetes

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Prandial glucose regulation with repaglinide: its clinical and lifestyle impact in a large cohort of patients with Type 2 diabetes

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