Control of Blood Sugar in Insulin-Dependent Diabetes: Comparison of an Artificial Endocrine Pancreas, Continuous Subcutaneous Insulin Infusion, and Intensified Conventional Insulin Therapy

Rizza, Robert A.; Gerich, John E.; Haymond, Morey W.; Westland, R.; Hall, Larry D.; Clemens, A H

doi:10.1056/nejm198012043032301

Cited by 278 publications

(79 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition, experimental studies in animals have shown that high exogenous insulin leads to increased atherosclerosis [5]. When high endogenous insulin levels are indeed a CVD risk factor one might expect a paradoxically increased risk of CVD in patients treated with exogenous insulin, as this leads to high (pharmacological) circulating insulin levels [6,7]. Such risk elevation may counteract the benefits of tight glucose control.…”

Section: Introductionmentioning

confidence: 99%

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

et al. 2005

View full text Add to dashboard Cite

Background: Since insulin therapy might have an atherogenic effect, we studied the relationship between cumulative insulin dose and atherosclerosis in type 1 diabetes. We have focused on patients with type 1 diabetes instead of type 2 diabetes to minimise the effect of insulin resistance as a potential confounder. Methods: An observational study was performed in 215 subjects with type 1 diabetes treated with multiple insulin injection therapy. Atherosclerosis was assessed by measurement of carotid intima-media thickness (CIMT). Results: The cumulative dose of regular insulin showed a positive and significant relation with CIMT: increase of 21 m in CIMT per S.D. of insulin use (95% CI: 8-35 adjusted for gender and age), which remained unchanged after adjustment for duration of diabetes, HbA1c, BMI, pulse pressure, physical activity and carotid lumen diameter. A similar relation was found for intermediate-acting insulin: 15.5 m per S.D. (2-29), which was no longer present after further adjustment. Conclusions: These findings provide evidence that a high cumulative dose of regular insulin is a risk factor for atherosclerosis.

show abstract

Section: Introductionmentioning

confidence: 99%

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

et al. 2005

View full text Add to dashboard Cite

show abstract

“…The primary goal of treatment of Type I (insulin-dependent) diabetes mellitus, both at onset and after several years duration, is maintenance of near-normoglycaemia [1] to prevent the onset or delay progression or both of long-term complications [2,3]. This goal is feasible if physiological models of insulin replacement are used [4] and patients are educated with the strategy of intensive insulin therapy [5±7].…”

Section: Introductionmentioning

confidence: 99%

Insulin analogues and their potential in the management of diabetes mellitus

Bolli

Marchi

Park³

et al. 1999

Diabetologia

323

211

View full text Add to dashboard Cite

“…A key goal of insulin therapy is replicating physiologic basal insulin release: the release of insulin averages around 1.3 U/h under normoglycemic physiologic conditions [24]. As the first basal analog insulin with a 24-hour glucose-lowering profile with no pronounced peak [25], Gla-100 represented a significant step towards achieving this goal.…”

Section: Pharmacokinetic/pharmacodynamic Profiles Of Novel Basal Analmentioning

confidence: 99%

Hypoglycemia with New Generation Basal Analog Insulins: A Descriptive Critical Review

Thrasher¹

2015

J Diabetes Metab

View full text Add to dashboard Cite

Optimizing the treatment of people with diabetes relies on balancing the benefits of glycemic control with the risk of hypoglycemia. Although insulin is essential for treating patients with type 1 diabetes mellitus, patient and physician concerns regarding an increased risk of hypoglycemia can lead to delays in initiating insulin treatment in patients with type 2 diabetes mellitus. This clinical inertia contributes to reduced glycemic control and poorer outcomes for patients. Advances in insulin agents have reduced the risk of hypoglycemia. In particular, the introduction of insulin glargine, the first basal analog insulin with a 24-hour glucose-lowering profile with no pronounced peak, represented a significant step towards achieving this goal.To further improve patient management, a number of insulin formulations and molecules are in development and are designed to have pharmacokinetic/pharmacodynamic (PK/PD) profiles allowing closer mimicking of normal physiologic insulin release. Here we review these new agents, and discuss their hypoglycemic risk as reported in clinical trials. In addition, the difficulties in making comparative evaluations from studies with different patient populations and definitions of hypoglycemia are discussed. Solutions to improve future clinical trials are suggested. In general, the improved PK/PD profiles of new-generation insulins appear to result in better clinical outcomes in terms of hypoglycemia. What is needed are head-to-head trials using standardized methods and criteria to allow clinicians to compare hypoglycemia rates between insulins, and help them to discuss appropriate choices of therapy with their patients.

show abstract

Control of Blood Sugar in Insulin-Dependent Diabetes: Comparison of an Artificial Endocrine Pancreas, Continuous Subcutaneous Insulin Infusion, and Intensified Conventional Insulin Therapy

Cited by 278 publications

References 27 publications

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

Insulin analogues and their potential in the management of diabetes mellitus

Hypoglycemia with New Generation Basal Analog Insulins: A Descriptive Critical Review

Contact Info

Product

Resources

About