Expert Group Recommendations on the Effective Use of Bolus Insulin in the Management of Type 2 Diabetes Mellitus

Chawla, Rajeev; Mukherjee, J. J.; Chawla, Manoj; Kanungo, Alok Kumar; Shunmugavelu, M; Das, Ashok Kumar

doi:10.3390/medsci9020038

Cited by 4 publications

(4 citation statements)

References 120 publications

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“…The quantity and type of carbohydrates consumed are pivotal factors influencing postprandial glucose levels. The prevalence of high carbohydrate intake within the population may be a contributing factor to elevated postprandial glucose levels [17].…”

Section: Discussionmentioning

confidence: 99%

A retrospective electronic medical record-based study of insulin usage and outcomes in insulin-naive Indian adults with T2DM: The REALITY study

Chawla,

Makkar,

Modi

et al. 2023

Int J Diabetes Dev Ctries

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Objective This retrospective longitudinal study analyzed the demographic profile, insulin usage pattern, and outcomes of insulin-naive adults with type 2 diabetes mellitus (T2DM) who initiated insulin glargine. Methods The study included 1006 insulin naive T2DM individuals aged ≥ 18 years, treated with any insulin type between January 2016 and December 2018, using electronic medical records. Results Majority of participants were men (55.8%) with a mean age of 59.8 ± 11.9 years and average T2DM duration of 12.0 ± 6.6 years. Insulin glargine was the most commonly used insulin (66.9%), followed by insulin aspart (16.4%), insulin degludec (15.1%), human insulin (11.1%), and insulin isophane (9.2%). At baseline, the mean glycated hemoglobin (HbA1c) was 8.9 ± 1.9%, mean fasting plasma glucose (FPG) was 190 ± 59 mg/dL, and mean post-prandial plasma glucose (PPG) was 264 ± 78 mg/dL. In the insulin glargine group, baseline HbA1c was 9.0 ± 1.7%, FPG was 196 ± 62 mg/dL, and PPG was 283 ± 81 mg/dL. Throughout the study, there was an improvement in HbA1c, FPG, and PPG levels in the insulin glargine group. Body weight remained relatively stable, and the number of hypoglycemic events was minimal and non-life-threatening. Conclusion The REALITY study in India demonstrated that initiating basal insulin treatment in insulin-naive individuals with T2DM led to improved glycemic parameters over a 12-month period.

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Section: Discussionmentioning

confidence: 99%

A retrospective electronic medical record-based study of insulin usage and outcomes in insulin-naive Indian adults with T2DM: The REALITY study

Chawla,

Makkar,

Modi

et al. 2023

Int J Diabetes Dev Ctries

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“…Patients should avoid high-fiber foods, fatty foods, and foods that are difficult to digest. Instead, they should focus on low-fat, low-fiber, and easily digestible foods such as broth, plain pasta, and boiled or baked potatoes [49].…”

Section: Glucose Controlmentioning

confidence: 99%

“…The success of glucose control for diabetic gastroparesis can vary depending on several factors, such as the severity, the underlying cause, the effectiveness of the treatment regimen, and the patient's adherence to treatment. Studies have shown that combining dietary modifications, medication, and insulin therapy can effectively improve glucose levels in diabetic gastroparesis [45,49]. It is important to note that a personalized treatment plan tailored to the patient's unique needs and circumstances is essential for achieving optimal glucose control.…”

Section: Glucose Controlmentioning

confidence: 99%

Diabetic Gastroparesis: A Narrative Review of a Neglected Complication

Valko

2023

CRDOJ

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Diabetic gastroparesis is a form of autonomic neuropathy resulting in a complication of diabetes mellitus and characterized by delayed gastric emptying. The prevalence is estimated to be 5% among type 1 diabetics and 1% among type 2 diabetics. It is most commonly seen in people who have had diabetes for 10 years and have already developed other microvascular complications. The pathophysiology of diabetic gastroparesis is complex and not yet fully understood, but it is believed to involve several interrelated factors. One of the main contributing factors is damage to the nerves (diabetic neuropathy) that control the muscles of the stomach and intestines. This can lead to abnormal contractions and motility in the stomach, resulting in delayed gastric emptying and associated symptoms. The cardinal symptoms of gastroparesis include nausea, vomiting, postprandial fullness, early satiety, bloating, upper abdominal pain, and in severe cases, anorexia, and weight loss, with a characteristic cyclic pattern with periodic exacerbations. The diagnosis typically involves a combination of medical history, physical examination, and laboratory tests (i.e., scintigraphy, capsule endoscopy, and/or electrogastrography). The main targets of the management of gastroparesis include symptomatic control, correction of nutritional deficiencies, and maintenance of optimal weight. Pharmacological therapies aim to improve symptoms and include prokinetics, motilin agents, ghrelin agonists, 5HT4 receptor agonists, antiemetics, and neuromodulators. In order to ensure the successful management of diabetic gastroparesis, it is essential to achieve adequate glucose control with dietary and insulin intake modifications. Endoscopic therapies can be an effective alternative when conservative measures have failed to improve symptoms. Overall, diabetic gastroparesis is a debilitating and progressive disease that significantly affects a patient's quality of life and has limited treatments. This narrative review provides an updated overview of the medical approach to this multifaceted condition.

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“…На відміну від ЦД1, у пацієнтів з ЦД2 немає абсолютного інсулінового дефіциту, тому розрахунок дози відповідно до кількості аліментарних вуглеводів (спожитих вуглеводних одиниць) не є можливим. У пацієнтів з ЦД2 зазвичай розпочинають застосування прандіального інсуліну з однієї ін'єкції у невеликій дозі -4-5 ОД [3,30]. Ця доза не залежить від кількості спожитих вуглеводів.…”

Section: результати та обговоренняunclassified

Issues of insulin therapy for type 2 diabetes and ways to solve them

Katerenchuk

2023

Mìžnarodnij endokrinologìčnij žurnal

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The article is a summary of personal experience and literature data from PubMed, Scopus, Web of Science, ClinicalTrials.gov databases. As a result of the analysis, the main problems faced by practical endocrinologists when administering insulin therapy to patients with type 2 diabetes mellitus (T2DM) have been determined. Insulin therapy remains an important component of glucose-lowering therapy in T2DM. A significant increase in the number of oral hypoglycemic agents has allowed delaying the start of insulin therapy but the treatment for T2DM without insulin is not real today. The current problems of insulin therapy are as follows: untimely start, insufficient titration of the dose of basal insulin, excessive use of basal and bolus insulins, the irrationality of the use of premixes and the basis bolus regimen of insulin therapy. There are methods to overcome each of these issues that have proven their effectiveness according to clinical trials and real clinical practice data. The combination of insulin and oral therapy plays an important role, the addition of oral hypoglycemic agents is effective at different stages of insulin therapy. One of the most promising options is the use of fixed combinations of basal insulin with glucagon-like peptide-1 receptor agonists. Fixed combinations can be used as initial therapy and are often the first step when changing other insulin therapy regimens. The use of fixed combinations can be an option for modification (simplification) of complex insulin therapy regimens, including the basal bolus regimen. Authors review current evidence and circumstances in which insulin can be used, consider individualized choices of alternatives and combination regimens, and offer some guidance on personalized targets and approaches to glycemic control in type 2 diabetes. In general, most of the modern problems of insulin therapy have options for successful overcome.

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Expert Group Recommendations on the Effective Use of Bolus Insulin in the Management of Type 2 Diabetes Mellitus

Cited by 4 publications

References 120 publications

A retrospective electronic medical record-based study of insulin usage and outcomes in insulin-naive Indian adults with T2DM: The REALITY study

A retrospective electronic medical record-based study of insulin usage and outcomes in insulin-naive Indian adults with T2DM: The REALITY study

Diabetic Gastroparesis: A Narrative Review of a Neglected Complication

Issues of insulin therapy for type 2 diabetes and ways to solve them

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