Hypoglycemic events and glycosylated hemoglobin values in patients with type 2 diabetes mellitus newly initiated on insulin glargine or premixed insulin combination products

Bullano, Michael F.; Fisher, Mary L.; Grochulski, W. D.; Menditto, Laura; Willey, Vincent J.

doi:10.2146/ajhp050552

Cited by 25 publications

(15 citation statements)

References 27 publications

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“…The risk of cardiovascular events is at least two to four times higher in patients with diabetes, and this is a result of damage to vagal and sympathetic nerves [197][198][199] . The first step in the treatment of diabetic neuropathy (and delay of the onset of other complications; table 4 ) following diagnosis is glycemic control by blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections are needed to control blood glucose levels [189,196,200,[201][202][203][204] .…”

Section: A View On Diabetic Neuropathy and Nephropathymentioning

confidence: 99%

Free Radicals, Antioxidants and Diabetes: Embryopathy, Retinopathy, Neuropathy, Nephropathy and Cardiovascular Complications

et al. 2006

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The metabolic disturbances in the insulin-dependent diabetes mellitus or type 1 and noninsulin-dependent diabetes mellitus or type 2 are associated with a number of complications including cardiovascular diseases, nephropathy, neuropathy, retinopathy leading to blindness and embryopathy or congenital malformations. Maternal diabetes is associated with a high incidence of congenital malformations and fetal abortions. Heart and kidney anomalies, along with central nervous system defects are frequent manifestations of a maternal diabetic environment. Glycation products from excess glucose can chemically modify DNA causing mutations and complex DNA rearrangements. Therefore, DNA damage in fetal tissues as a result of maternal diabetes may reflect a level of genomic injury sufficient to affect embryonic development. The formation of advanced glycation end products can accelerate vascular occlusion by quenching the vasodilating agent nitric oxide. Interaction with high-affinity receptors located on monocytes and macrophages can enhance the production of free radicals and reactive oxygen/nitrogen species, the secretion of tumor necrosis factor-α, interleukin-1 and insulin-like growth factor 1 which can proliferate endothelial, mesangial and smooth muscle cells and hence contribute significantly to the pathogenesis of cardiovascular complications. Retinopathy is characterized by increased vascular permeability, by vascular closure, together with the growth of new blood vessels on the retina and posterior surface of the vitreous. Reactive oxygen species are involved in decreased retinal blood flow, increased vascular permeability and disruption of blood-retinal barrier. The involvement of oxidative stress in the pathology of diabetes from its associated cardiovascular dysfunctions, nephropathy, neuropathy, retinopathy (leading to blindness) and embryopathy or congenital malformations, suggests that potential management of diabetes could benefit from use of dietary biofactors in medicinal and food plants. There is therefore a requirement for research to focus on the molecular mechanisms of action of extracts and/or the biofactors flavonoids, proanthocyanidins, alkaloids, etc. derived from these plants.

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Section: A View On Diabetic Neuropathy and Nephropathymentioning

confidence: 99%

Free Radicals, Antioxidants and Diabetes: Embryopathy, Retinopathy, Neuropathy, Nephropathy and Cardiovascular Complications

et al. 2006

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“…Two of these analyses showed that the higher prescription cost of glargine was more than offset by a lower number of hypoglycaemic events (Table 4). 48,49 Data from Zhang and Menditto 50 are consistent with these reports, and likewise indicate higher prescription costs but greater cost savings when reduced costs are factored into the evaluation for inpatient claims related to hypoglycaemia treatments and total costs for inpatient diabetes care.…”

Section: Studies Of Analogues Versus Human Insulinmentioning

confidence: 61%

Is the use of insulin analogues cost-effective?

Leichter¹

2008

Adv Therapy

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Many patients with diabetes fail to achieve their glycaemic targets despite clear evidence that glycaemic control can prevent or delay the development of costly complications in diabetes. This article describes how insulin analogues (insulins lispro, aspart, glulisine, glargine and detemir) may have a role to play in overcoming barriers to insulin acceptance and improving adherence with therapy, and examines their cost-effectiveness as determined in published studies. Cost-effectiveness studies attempt to assess all the costs and all the benefits of a particular therapy. Pharmacoeconomic models, which calculate the long-term effect of interventions, show that over periods such as 10 or 35 years the higher prescription costs of analogues are offset by a lower incidence of acute hypoglycaemic events and costly, chronic complications such as nephropathy. This results in costs per 'quality-adjusted life year' that fall well within accepted limits for good value for money. Retrospective analyses of managed care databases show that higher prescription costs for analogues are offset by lower hypoglycaemia-related costs and/or inpatient claims. Relative to human insulins, analogues provide a better balance between glycaemic control and tolerability. Patients' fear of hypoglycaemia is allayed; the pen devices used with analogues facilitate insulin injection; and the pharmacokinetic characteristics lead to increased flexibility and convenience. All these factors can help increase adherence with therapy, which may in itself be cost-saving. Taken overall, these results indicate that insulin analogues are a cost-effective therapy.

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“…As in other studies (Bullano, Fisher, Grochulski, Menditto, & Willey, 2006;Zhao, Campbell, Fonseca, & Shi, 2012), hypoglycemia was defined as having an ICD-9-CM code 250.8 (Diabetes with other specified manifestations; applies to diabetic hypoglycemia NOS and hypoglycemic shock NOS), 251.0 (Hypoglycemic coma), 251.1 (Other specified hypoglycemia), and 251.2 (Hypoglycemia, unspecified). The hypoglycemia was categorized as primary if it was the primary cause of admission and secondary if it occurred during the hospital stay.…”

Section: Exposure and Outcomesmentioning

confidence: 99%

The frequency and impact of hypoglycemia among hospitalized patients with diabetes: A population-based study

Gómez-Huelgas

Guijarro-Merino

Zapatero

et al. 2015

Journal of Diabetes and its Complications

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Hypoglycemic events and glycosylated hemoglobin values in patients with type 2 diabetes mellitus newly initiated on insulin glargine or premixed insulin combination products

Cited by 25 publications

References 27 publications

Free Radicals, Antioxidants and Diabetes: Embryopathy, Retinopathy, Neuropathy, Nephropathy and Cardiovascular Complications

Free Radicals, Antioxidants and Diabetes: Embryopathy, Retinopathy, Neuropathy, Nephropathy and Cardiovascular Complications

Is the use of insulin analogues cost-effective?

The frequency and impact of hypoglycemia among hospitalized patients with diabetes: A population-based study

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