المؤلفون: Achong, Naomi, Duncan, Emma, McIntyre, David, Callaway, Leonie

المصدر: Diabetes Care

مصطلحات موضوعية: Australia, Blood Glucose, Diabetes Mellitus, Humans, Peripartum Period, Pregnancy in Diabetics, Prospective Studies, Retrospective Studies, Type 1, adult, aged, article, blood, body mass, continuous infusion, correlation analysis, creatinine, creatinine blood level, delivery, drug withdrawal, female, glucose blood level, human, hypoglycemia, insulin, insulin dependent diabetes mellitus, long acting insulin, major clinical study, metabolism, non insulin dependent diabetes mellitus

الوصف: OBJECTIVE We aimed to 1) describe the peripartum management of type 1 diabetes at an Australian teaching hospital and 2) discuss factors influencing the apparent transient insulin independence postpartum. RESEARCH DESIGN AND METHODS We conducted a retrospective review of women with type 1 diabetes delivering singleton pregnancies from 2005 to 2010. Information was collected regarding demographics, medical history, peripartum management and outcome, and breast-feeding. To detect a difference in time to first postpartum blood glucose level (BGL) >8 mmol/L between women with an early (<4 h) and late (>12 h) requirement for insulin postpartum, with a power of 80% and a type 1 error of 0.05, at least 24 patients were required. RESULTS An intravenous insulin infusion was commenced in almost 95% of women. Univariate analysis showed that increased BMI at term, lower creatinine at term, longer duration from last dose of long- or intermediate-acting insulin, and discontinuation of an insulin infusion postpartum were associated with a shorter time to first requirement of insulin postpartum (P = 0.005, 0.026, 0.026, and <0.001, respectively). There was a correlation between higher doses of insulin commenced postpartum and number of out-of-range BGLs (r[36] = 0.358, P = 0.030) and hypoglycemia (r[36] = 0.434, P = 0.007). Almost 60% had at least one BGL <3.5 mmol/L between delivery and discharge. CONCLUSIONS Changes in the pharmacodynamic profile of insulin may contribute to the transient insulin independence sometimes observed postpartum in type 1 diabetes. A dose of 50–60% of the prepregnancy insulin requirement resulted in the lowest rate of hypoglycemia and glucose excursions. These results require validation in a larger, prospective study.

وصف الملف: application/pdf

العلاقة: https://eprints.qut.edu.au/94204Test/1/364.full.pdf; Achong, Naomi, Duncan, Emma, McIntyre, David, & Callaway, Leonie (2014) Peripartum management of Glycemia in women with Type 1 diabetes. Diabetes Care, 37(2), pp. 364-371.; https://eprints.qut.edu.au/94204Test/; Faculty of Health; Institute of Health and Biomedical Innovation

الإتاحة: https://doi.org/10.2337/dc13-1348Test
https://eprints.qut.edu.au/94204Test/

المؤلفون: Buse, J.B., Garg, S.K., Rosenstock, J., Bailey, T.S., Banks, P., Bode, B.W., Danne, T., Kushner, J.A., Lane, W.S., Lapuerta, P., McGuire, D.K., Peters, A.L., Reed, J., Sawhney, S., Strumph, P.

المصدر: Diabetes Care, 41(9)

مصطلحات موضوعية: Adult, Diabetes Mellitus, Type 1, Glycosides, Hypoglycemia, Diabetic Ketoacidosis, North America, Male, Weight Loss, Female, Insulin Infusion Systems, Aged, Humans, Middle Aged, Glycated Hemoglobin A, Drug Therapy, Combination, Body Weight, Double-Blind Method, Insulin

الوصف: OBJECTIVE: Evaluate the efficacy and safety of the dual sodium-glucose cotransporter 1 (SGLT1) and SGLT2 inhibitor sotagliflozin in combination with optimized insulin in type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: The in Tandem1 trial, a double-blind, 52-week phase 3 trial, randomized North American adults with T1D to placebo (n = 268), sotagliflozin 200 mg (n = 263), or sotagliflozin 400mg(n =262) after6 weeks ofinsulin optimization. The primary end point was HbA1c change from baseline at 24 weeks. HbA1c, weight, and safety were also assessed through 52 weeks. RESULTS: From a mean baseline of 7.57%, placebo-adjusted HbA1c reductions were 0.36% and 0.41% with sotagliflozin 200 and 400 mg, respectively, at 24 weeks and 0.25% and 0.31% at 52 weeks (all P < 0.001). Among patients with a baseline HbA1c ≥7.0%, an HbA1c <7% was achieved by 15.7%, 27.2%, and 40.3% of patients receiving placebo, sotagliflozin 200 mg, and sotagliflozin 400 mg, respectively (P ≤ 0.003 vs. placebo) at 24 weeks. At 52 weeks, mean treatment differences between sotagliflozin 400 mg and placebo were 21.08 mmol/L for fasting plasma glucose, 24.32 kg for weight, and 215.63% for bolus insulin dose and 211.87% for basal insulin dose (all P < 0.001). Diabetes Treatment Satisfaction Questionnaire scores increased significantly by 2.5 points with sotagliflozin versus placebo (P < 0.001) at 24 weeks. Genital mycotic infections and diarrhea occurred more frequently with sotagliflozin. Adjudicated diabetic ketoacidosis (DKA) occurred in 9 (3.4%) and 11 (4.2%) patients receiving sotagliflozin 200 and 400 mg, respectively, and in 1 (0.4%) receiving placebo. Severe hypoglycemia occurred in 17 (6.5%) patients from each sotagliflozin group and 26 (9.7%) patients receiving placebo. CONCLUSIONS: In a 1-year T1D study, sotagliflozin combined with optimized insulin therapy was associated with sustained HbA1c reduction, weight loss, lower insulin dose, fewer episodes of severe hypoglycemia, improved patient-reported outcomes, and more DKA ...

العلاقة: https://doi.org/10.17615/88k1-rx27Test; https://cdr.lib.unc.edu/downloads/wd376281n?file=thumbnailTest; https://cdr.lib.unc.edu/downloads/wd376281nTest

الإتاحة: https://doi.org/10.17615/88k1-rx27Test
https://cdr.lib.unc.edu/downloads/wd376281n?file=thumbnailTest
https://cdr.lib.unc.edu/downloads/wd376281nTest