Insulin Therapy in Type 2 Diabetes

Wyne, Kathleen; Mora, Pablo

doi:10.1080/07435800701743836

Cited by 6 publications

(5 citation statements)

References 163 publications

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“…Starting insulin therapy with low doses in combination with oral agents is effective in achieving glycaemic targets and maintaining HbA 1c values. 58 59 Furthermore, insulin use can improve insulin resistance 58 and may have cardiovascular benefits. Concerns that insulin therapy would worsen weight gain, obesity, and accelerate coronary artery disease have not been realized.…”

Section: Insulin Therapymentioning

confidence: 99%

“…They have a rapid onset of action (typically 5-15 min), peak activity 2 h after injection, and their effect has almost disappeared after 4-5 h. This matches normal mealtime peaks of plasma insulin more closely than human regular insulin, and in turn results in less immediate post-prandial hyperglycaemia and less late post-prandial hypoglycaemia. 58 New long-acting insulin formulations such as glargine and detemir provide good glycaemic control between meals without the risk of hypoglycaemia. Insulin glargine results from two modifications of human insulin, substitution of glycine at position A21, and addition of two arginine molecules at the C terminal of the B chain.…”

Section: Insulin Therapymentioning

confidence: 99%

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Diabetes mellitus: new drugs for a new epidemic

Nicholson

Hall

2011

British Journal of Anaesthesia

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The prevalence of diabetes mellitus (DM) is increasing rapidly in the 21st century as a result of obesity, an ageing population, lack of exercise, and increased migration of susceptible patients. This costly and chronic disease has been likened recently to the 'Black Death' of the 14th century. Type 2 DM is the more common form and the primary aim of management is to delay the micro- and macrovascular complications by achieving good glycaemic control. This involves changes in lifestyle, such as weight loss and exercise, and drug therapy. Increased knowledge of the pathophysiology of diabetes has contributed to the development of novel treatments: glucagon-like peptide-1 (GLP-1) mimetics, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), and insulin analogues. GLP-1 agonists mimic the effect of this incretin, whereas DPP-4 inhibitors prevent the inactivation of the endogenously released hormone. Both agents offer an effective alternative to the currently available hypoglycaemic drugs but further evaluation is needed to confirm their safety and clinical role. The past decade has seen the rise and fall in the use of the TZDs (glitazones), such that the only glitazone recommended is pioglitazone as a third-line treatment. The association between the use of rosiglitazone and adverse cardiac outcomes is still disputed by some authorities. The advent of new insulin analogues, fast-acting, and basal release formulations, has enabled the adoption of a basal-bolus regimen for the management of blood glucose. This regimen aims to provide a continuous, low basal insulin release between meals with bolus fast-acting insulin to limit hyperglycaemia after meals. Insulin therapy is increasingly used in type 2 DM to enhance glycaemic control. Recently, it has been suggested that the use of the basal-release insulins, particularly insulin glargine may be associated with an increased risk of cancer. Although attention is focused increasingly on newer agents in the treatment of diabetes, metformin and the sulphonylureas are still used in many patients. Metformin, in particular, remains of great value and may have novel anti-cancer properties.

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Section: Insulin Therapymentioning

confidence: 99%

Section: Insulin Therapymentioning

confidence: 99%

Diabetes mellitus: new drugs for a new epidemic

Nicholson

Hall

2011

British Journal of Anaesthesia

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“…Importantly, most patients maintain some endogenous insulin secretions, even in late stages of the disease. Starting insulin therapy with low doses in combination with oral agents is effective in the control of glycemic level and maintaining HbA 1c values [33]. …”

Section: Currently Used Drug Therapymentioning

confidence: 99%

“…Compared to the neutral protamine Hegedorn (NPH) insulin, it is released very slowly from the injection site and its duration of action is prolonged, allowing a relatively constant basal insulin supply without peak for more than 24 hours. A lower incidence of hypoglycemia, especially at night, has been reported with insulin glargine when compared to NPH insulin [33]. …”

Section: Currently Used Drug Therapymentioning

confidence: 99%

“…Although the majority of patients with type 2 diabetes requiring insulin therapy can be successfully treated with basal insulin alone, because of progressive diminution in their insulin secretory capacity, some will require prandial insulin therapy with shorter-acting insulins. Newer fast acting analogues, such as insulin lispro, insulin aspart, or insulin glargine, have a rapid onset of action and 4-5 hours of action duration that is normal meal time peaks of plasma insulin more closely than human regular insulin, therefore, immediate post-prandial hyperglycemia and late post-prandial hypoglycemia is rare [33]. …”

Section: Currently Used Drug Therapymentioning

confidence: 99%

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Current therapeutic agents and anesthetic considerations for diabetes mellitus

2012

Korean J Anesthesiol

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As the incidence of diabetes mellitus (DM) continues to increase worldwide, more diabetic patients will be presented for surgery and anesthesia. This increase of DM is a consequence of the rise in new patients of type 2 DM, and is likely attributable to rapid economic development, improved living standards, aging population, obesity, and lack of exercise. The primary goal of management in DM is to delay, or prevent the macro- and microvascular complications by achieving good glycemic control. More understanding of the pathophysiology of DM has contributed to the advance of new pharmacological approaches. In addition to the conventional therapy for DM, glucagon-like peptide-1 (GLP-1) mimetics, dipeptidyl peptidase-4 (DPP-4) inhibitors, thiazolidinediones (TZDs), and insulin analogues are currently available effective hypoglycemic agents for the management of the patients with DM in the perioperative period and also consider the adverse effects of newly introduced agents that need more clinical observations.

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Long-acting insulin before surgery – which dose?

Hall¹

2012

Journal of Clinical Anesthesia

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Insulin Therapy in Type 2 Diabetes

Cited by 6 publications

References 163 publications

Diabetes mellitus: new drugs for a new epidemic

Diabetes mellitus: new drugs for a new epidemic

Current therapeutic agents and anesthetic considerations for diabetes mellitus

Long-acting insulin before surgery – which dose?

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