Insulin/weight ratio may serve as a predictor of success during insulin pump therapy in type 2 diabetes patients: a proof-of-concept study

Levit, Shmuel; Filippov, Yury Ivanovich; Иванович, Филиппов Юрий; Cohen, Ohad; Weichman, Maria; Мария, Weichman; Azuri, Joseph; Azuri, Joseph; Manisteski, Yossi; Levit, Vyacheslav Moiseevich; Моисеевич, Левит Вячеслав

doi:10.14341/dm2015170-77

Cited by 3 publications

(5 citation statements)

References 18 publications

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“…It should be noted, however, that the U.S. Medicare system offers 80% reimbursement for these devices, excluding the additional yearly cost of insulin, test strips, and pump supplies . The situation seems to be even more complicated by the fact that in T2DM, unlike T1DM, general health and metabolic parameters such as hypertension, dyslipidemia, and increased cardiovascular risks, are no less important than glycemic control …”

Section: Discussionmentioning

confidence: 99%

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Factors associated with withdrawal from insulin pump therapy: A large‐population‐based study

Merzon

Grossman

Vinker

et al. 2020

Diabetes Metabolism Res

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Background: Although, number of diabetic patients received insulin pump (IP) therapy is increasing; there are limited data regarding factors associated with IP withdrawal.Methods: We conducted a cross-sectional study using data from an Israeli health maintenance organization. All patients, 21 or older, with type 1 (T1DM) or type 2 (T2DM) diabetes, who received IP therapy for a 7-year period were identified.Patients who did not purchase IP maintenance supplies for at least six consecutive months were defined as withdrawn (N = 355). Patients who purchased supplies were defined as adherent (N = 352). Results: In both T1DM and T2DM patients, withdrawal from IP therapy was positively associated with duration of diabetes longer than 5 years (odds ratio [OR] = 13.26 [CI, 7.16-23.34; P < .001] and OR = 10.92 [CI, 5.64-21.14; P < .001], respectively), nonadherence to dietician follow-up (OR = 5.78 [CI, 3.65-9.14; P < .001] and OR = 3.41 [CI, 1.99-5.85; P < .001], respectively), and poor glycaemic control prior to IP treatment (OR = 4.04 [CI, 2.18-7.48; P < .001] and OR = 4.59 [CI, 2.71-7.81; P < .001], respectively]. Co-morbid neuro-psychiatric disorders were also risk factors for IP withdrawal: diagnosis of depression (OR = 2.22 [CI, 1.16-4.27; P = .017] and Attention Deficit Hyperactivity Disorder (ADHD) OR = 2.45 [CI, 1.003-5.087; P = .043]) among T1DM patients; and diagnosis of depression (OR = 1.85 [CI, 1.05-5.27; P = .046] and dementia OR = 4.03 [CI, 1.03-19.77; P = .048]) among T2DM patients. Conclusion: In our large real-world population-based study, we found that smoking, obesity, poor glycaemic control, and co-morbid neuro-psychiatric disorders were associated with a high rate of withdrawal from IP therapy. Health care providers ought to familiarize themselves with patient characteristics predictive of nonadherence and should intensify patient follow-up when incorporating this new, costly, and challenging technology. K E Y W O R D S diabetes mellitus, insulin pump, nonadherence

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Section: Discussionmentioning

confidence: 99%

“…According to the Israeli Ministry of Health Directive, ADHD diagnosis is made by psychiatrists, paediatric neurologists, or paediatricians and family physicians with a certified ADHD or neurodevelopmental training. ADHD diagnosis was identified by ICD‐9 codes (314.00‐314.9) …”

Section: Methodsmentioning

confidence: 99%

Factors associated with withdrawal from insulin pump therapy: A large‐population‐based study

Merzon

Grossman

Vinker

et al. 2020

Diabetes Metabolism Res

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“…Normalization of glycemic status (HbA1C ≤ 7%) with a significant reduction of insulin dose (more than 25% of basal TDI) and substitution of Multiple Daily Injections (MDI's) by one insulin injection only was defined as a partial remission of diabetes. Our compliance Score and Hypoglycemia Assessment were successfully used in our previous works: [19,20].…”

Section: Definition Of Remissionmentioning

confidence: 99%

Gravicentric approach to Type 2 Diabetes therapy. The success prediction. A proof-of-concept

et al. 2020

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This study is the proof-of-concept of our "Gravicentric" theory. This concept is based on several fundamental points: obesity as the main foe; rapid reversibility of the disease; as well as a new perspective on the roles different pharmacological classes play in general, and the role of insulin and GLP-1 analogs, in particular. The paper presents and discusses our experience of the implementation of insulin and GLP-1 analogs. The possibility of "insulin weaning"; the therapeutic approach for over-treated patients; and physiological dosing of insulin is also discussed therein. Objectives Primary: To evaluate the long-term efficacy of GLP-1 analogs in insulin-treated Type 2 Diabetes Mellitus (T2DM) patients. Secondary: To analyze which patient would most likely benefit from this combined treatment. Methods In 54 T2DM patients with a mean disease duration of 17.5 years and a mean extent of insulin therapy of 4.5 years, additional GLP-1 analogs therapy was prescribed. Mean duration of GLP-1 treatment was 25.8 months (2.15 years). During the intervention, clinical, biochemical, and anthropometric parameters were analyzed. Compliance, Hypoglycemia and Metabolic Index (MI) assessments were implemented. Results Mean Glycated hemoglobin (HbA1C) decreased from 9.28 1.43 to 8.54 1.4% on GLP-1 analogs, p 0.01. Total Daily dose of Insulin (TDI) showed considerable reduction: 80.6 42.7 U/day before starting GLP-1 vs.41.0 30.7 U/day on GLP-1, p 0.01. These changes were directly linked to weight loss: BMI has dropped from 35.1 4.8 kg/cm2 before, to 32.8 5.0 kg/cm2 on GLP-1 analogs, with patients losing 6.7 kg on average. Moreover, 13 (24%) participants discontinued at least one kind of insulin, while 7 (13%) stopped taking insulin completely, with simultaneous improvement in diabetes control. No clinically significant hypoglycemia was observed. Post-hoc, the participants were categorized according to each patients ability to reduce TDI by more than 20 U/day, and then split into two groups. Group A 34 patients (64.2%) who successfully reduced TDI; Group B 19 patients (35.8%) who failed to do so. The comparison of the two groups showed the following: Significantly larger virtually twice as large baseline TDI in Group A (97.440.4 U/day vs. 52.231.0 U/day), p 0.001. Very effective BMI reduction (BMI 3.3 2.4 kg/cm2 0.9 1.2 kg/cm2, p 0.001) and much better compliance (1.4 1.1 vs. 2.2 1.0, p 0.02) in Group A. A considerable decline of insulin requirements in group A, on GLP-1 therapy (TDI on GLP-1 was -62.4 31.9 U/day) with no TDI reduction in Group B (TDI on GLP-1 was +0.03 14.1 U/day, p 0.001). Thus, in spite of the fact that on GLP1 therapy HbA1C has declined to the same levels in both groups, patients from group A became much leaner and metabolically healthier. We suggest overtreatment as the critical factor of obesity in Group A. Conclusions Adding GLP-1 analogs to insulin in poorly controlled, insulin-treated T2DM patients resulted in an impressive weight (BMI) reduction with significant improvements in glucose control. This provided for a further decline in insulin resistance and insulin requirements. We suggest that the best candidate for successful GLP-1 analogs therapy is an obese, overtreated and compliant T2DM person. Changes in Metabolic Index (MI) rather than surrogate glycemic parameters (HbA1C) are better predictors of a successful T2DM therapy. Neither the duration of diabetes nor the length of insulin therapy in the past is likely to have a critical role in predicting success. These findings are proof-of-concept of our Gravicentric theory in T2DM.

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“…Эта зако-номерность сохраняется и при применении препаратов смешанного инсулина [25], и даже при помповой инсу-линотерапии у пациентов с СД2 [26]. Сравнительно низ-кие дозы инсулина (в среднем до 0,4ЕД/кг массы тела пациента) могут служить объяснением относительно сла-бого влияния инсулинотерапии на сердечно-сосудистые и онкологические исходы в результатах исследования ORIGIN [8].…”

Section: P (Physiological Dosing) инсулин следует применять только вunclassified

“…В его рамках высокие дозы инсулина позволяют паци-енту продолжать, переедая, усваивать и запасать энергию в виде жира, при этом наращивая вес, а прогрессивное увеличение веса заставляет постепенно увеличивать дозу инсулина, требуемую для поддержания целевых показа-телей гликемического контроля. Следует отметить, что при использовании инсулина в физиологичных дозах увеличения веса пациента не происходит, и порочный круг патофизиологических процессов не формиру-ется [25][26][27].…”

Section: H (Harm Should Be Avoided) высокие (сверхфизиологич-ные) доunclassified

Type 2 diabetes therapeutic strategies: why don't we see the «ELEPHANT» in the room?

Levit

Giveon

Philippov³

et al. 2016

Diabetes mellitus

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Insulin/weight ratio may serve as a predictor of success during insulin pump therapy in type 2 diabetes patients: a proof-of-concept study

Cited by 3 publications

References 18 publications

Factors associated with withdrawal from insulin pump therapy: A large‐population‐based study

Factors associated with withdrawal from insulin pump therapy: A large‐population‐based study

Gravicentric approach to Type 2 Diabetes therapy. The success prediction. A proof-of-concept

Type 2 diabetes therapeutic strategies: why don't we see the «ELEPHANT» in the room?

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