The Impact of the Diabetes Control and Complications Trial and Humalog Insulin on Glycohemoglobin Levels and Severe Hypoglycemia in Type 1 Diabetes

Chase, H. Peter; Lockspeiser, Tai M.; B, Peery; Shepherd, M.; MacKenzie, Todd A.; Anderson, James H.; Garg, Satish K.

doi:10.2337/diacare.24.3.430

Cited by 107 publications

(67 citation statements)

References 23 publications

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“…Although the overall reported rate of hypoglycaemia in the present study was similar to that described recently in an Australian population-based report [33], it is likely to be somewhat less, since the present analysis included episodes of moderate hypoglycaemia that were excluded by Bulsara et al Previous studies from the DCCT [9] and others [37] found that the rate of hypoglycaemia increases with improving metabolic control. It is therefore striking that, in the present study, Maori and Pacific youth had both poor One possible mechanism for this disturbing combination would be a mismatch between insulin administration and food intake or exercise.…”

Section: Discussionsupporting

confidence: 81%

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

et al. 2008

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Aims/hypothesis This study was performed to evaluate the influence of ethnicity and socioeconomic status (SES) on metabolic control in a population-based cohort of children with type 1 diabetes mellitus, and to evaluate whether any relationship between ethnicity and HbA 1c is mediated by SES. Methods We performed a retrospective review of all patients under age 16 years with type 1 diabetes (n=555) from 1995 to 2005 in the greater Auckland region, New Zealand. Diabetes care variables and HbA 1c values were collected prospectively, during clinic visits. Results The mean population HbA 1c was 8.3±1.3%. Maori and Pacific patients had poorer metabolic control than their European counterparts (9.1% and 9.3% vs 8.1%, p<0.001) and higher rates of moderate to severe hypoglycaemia (31.1 and 24.8 vs 14.9 events/100 patient-years, p=0.03). In multiple linear regression analysis, both ethnicity and SES were independently associated with HbA 1c (p<0.001). Other factors associated with higher HbA 1c level were longer duration of diabetes, higher insulin dose, lower BMI z score and less frequent blood glucose monitoring (p<0.001).Conclusions/interpretation Both ethnicity and SES independently influenced metabolic control in a large, unselected population of children with type 1 diabetes. Irrespective of SES, Maori and Pacific youth with type 1 diabetes were at greater risk of both moderate to severe hypoglycaemia and long-term complications associated with poor metabolic control.

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Section: Discussionsupporting

confidence: 81%

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

et al. 2008

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“…68 From 1993 to 1996, HbA1c continued to decline significantly, but this trend was again associated with a significant increase in the number of severe hypoglycemic events (P<0.001). Starting in the autumn of 1996, a majority (676) of the patients switched to insulin lispro when it first became available.…”

Section: Hypoglycemia Riskmentioning

confidence: 99%

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Hartman

2008

Clinical Medicine & Research

115

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Despi te 85 years of research since Banting and Best's isolation of insulin-containing extracts, 1 diabetes still remains one of the most significant causes of morbidity and mortality in the world, and its global impact is likely to accelerate over the coming decades. 2,3 Much of the medical and economic consequences of diabetes are attributable to its associated microvascular and macrovascular complications. [4][5][6] Two classic large-scale clinical studies, the Diabetes Control and Complications Trial (DCCT) 6 and the UK Prospective Diabetes Study (UKPDS), 7 demonstrated that intensive blood-glucose control policies can decrease the frequency of complications, arguing that physicians and patients should strive to mimic, as closely as possible, the serum levels of insulin produced by a healthy person. Secretion of insulin by the pancreas, however, is under complex regulation that depends on the intake of nutrients, other gastrointestinal peptides (e.g., incretins), and overall metabolic levels (i.e., exercise versus rest). 8 These physiological variables, which pose real challenges to the accurate metabolic replacement of insulin, are further complicated by the fact that diabetes requires self-management and therefore depends on the psychology, motivation, and understanding of the patient. A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns.The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile.The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure.To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment.The long-act...

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“…This method of HbA 1c analysis has been shown to be accurate in our laboratory. 4 HbA 1c level at the time of study inclusion was used for analyses.…”

Section: Methodsmentioning

confidence: 99%

“…This method of HbA 1c analysis has been shown to be accurate in our laboratory. 4 HbA 1c level at the time of study inclusion was used for analyses.Statistical analyses were performed by using Microsoft (Seattle, WA) Excel 2000 for Windows and analyzed later by using SAS/ STAT, Version 8e (SAS Institute, Inc, Cary, NC) statistical package for Windows. …”

mentioning

confidence: 99%

Missed Insulin Meal Boluses and Elevated Hemoglobin A1c Levels in Children Receiving Insulin Pump Therapy

et al. 2004

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ABSTRACT. Objective. To identify possible causes of suboptimal glycemic control (ascertained by hemoglobin A 1c [HbA 1c ] level) in youths using insulin pump therapy.Methods. Forty-eight youths who were receiving insulin pump therapy for >6 months, and who were using insulin pumps and blood glucose meters with data that could be downloaded at our facility, are included in this cross-sectional study. Possible causes of suboptimal glycemic control were evaluated by using 4 information sources: 1) insulin pump data downloads; 2) glucose meter data downloads; 3) patient/family questionnaire about insulin bolusing habits, eating habits, exercise, and blood glucose testing habits; and 4) a physician questionnaire. Physicians completed the questionnaire during the patient interview after reviewing the downloaded information and discussing these results with the patient/family.Results. In a previous report from a general pediatric diabetes clinic, 39% of children changing to insulin pump therapy showed improvement in HbA 1c levels (a decrease Ն0.5%), although 64% either showed improvement (of at least a 1.0% decrease of HbA 1c levels) or maintained a HbA 1c level Ͻ8%. 3 Unfortunately, 20% showed a worsening of their HbA 1c level from a mean of 7.8% to 8.8%. The clinical impression was that missed insulin boluses were a major reason for worsening glycemic control, although insulin pump data downloads were not available to confirm the impression. The purpose of the current study was to identify possible causes of suboptimal glycemic control in youths using insulin pump therapy. METHODSThe first 48 youths seen at our clinic who were using insulin pumps and glucose meters with data that could be downloaded were included in this study. All participants were receiving insulin pump therapy for at least 6 months before inclusion and had attended pump training classes. All had received training on counting carbohydrates for the calculation of mealtime insulin boluses and agreed to perform at least 4 blood glucose tests per day before initiating insulin pump therapy. In addition, all participants were using Medtronic MiniMed (Northridge, CA) insulin pumps, because this was the only type of pump with data that could be downloaded at our facility at the time. A variety of glucose meters were used in this study, all of which had data that could be downloaded at our facility. Before inclusion, participants were required to sign a consent/assent form and complete a questionnaire approved by the Colorado Multiple Institutional Review Board. Parents of youths Ͻ18 years of age also signed the consent form.A questionnaire was developed to identify possible reasons for suboptimal glycemic control in youths using insulin pumps, including missed mealtime insulin boluses, timing of meal boluses in relation to meals, pump disconnection and bolus for exercise, and number of blood glucose tests performed per day. Participants were asked to answer as accurately and honestly as possible and were told that they would not be criticized for their re...

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The Impact of the Diabetes Control and Complications Trial and Humalog Insulin on Glycohemoglobin Levels and Severe Hypoglycemia in Type 1 Diabetes

Cited by 107 publications

References 23 publications

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence

Missed Insulin Meal Boluses and Elevated Hemoglobin A1c Levels in Children Receiving Insulin Pump Therapy

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