Insulin Signaling Is Inhibited by Micromolar Concentrations of H2O2 EVIDENCE FOR A ROLE OF H2O2 IN TUMOR NECROSIS FACTOR α-MEDIATED INSULIN RESISTANCE

FlexPen: addressing issues of confidence and convenience in insulin delivery.

Interest in intensified insulin therapy has contributed to the increased popularity of alternative insulin delivery systems, including insulin pen delivery devices. Although there have been several studies of patient-reported outcomes associated with insulin pen use (1–6), there has been no adequate assessment of 1 ) the most advanced devices, pens delivering premixed intermediate-acting and rapid-acting analog insulin; 2 ) the effects of pens for patients previously naive to insulin; 3 ) the effects of pens on general quality of life; and 4 ) what factors contribute to preference for different insulin delivery systems.

Participants were patients with type 2 diabetes who completed a satisfaction substudy after being enrolled by their physicians in a 3-month clinical experience program of NovoLog Mix 70/30 in a prefilled FlexPen insulin pen device that delivered a 70/30 mixture of intermediate-acting and rapid-acting analog insulin (a suspension of protamine-crystallized insulin aspart and soluble insulin aspart). Of 899 patients who originally signed and returned a card indicating consent to participate in the satisfaction substudy, 372 (41%) returned completed questionnaires, for which they were given US$25. The questions included items from validated measures. Diabetes treatment satisfaction was measured by the Diabetes Treatment Satisfaction Questionnaire (change) (DTSQc) (7) and Quality of Life status and change (QLsc) (8). Quality of life was measured by the QLsc. Table 1 describes the measures, including the questions used for each measure, the reliability of each measure, and the …

https://care.diabetesjournals.org/content/diacare/27/10/2495.full.pdf

Quality of life, treatment satisfaction, and treatment preference associated with use of a pen device delivering a premixed 70/30 insulin aspart suspension (aspart protamine suspension/soluble aspart) versus alternative treatment strategies

PREVIEWClinical trials have convincingly demonstrated that improved glycemic control significantly reduces the risk of diabetes-related complications. However, tight control is not always easy for patients to achieve. To help overcome some of the problems linked with tight control, insulin pen devices have been developed to offer easier, safer, more accurate, and more discreet insulin injection. In this article, Dr Bohannon provides information about these insulin pens and discusses which patients are most likely to benefit.

Insulin delivery using pen devices. Simple-to-use tools may help young and old alike.

The principles of managing type 2 diabetes mellitus in the elderly are no different from those in younger patients, but the priorities and therapeutic strategies need to be cautiously individualised. The objectives of treatment are to improve glycaemic control in a stepwise approach that involves nonpharmacological methods including diet and exercise, and pharmacological therapy including mixtures of oral antihyperglycaemic agents alone or in combination with insulin. Although the goals of treatment may be the same for elderly and younger patients, certain aspects of type 2 diabetes in the elderly require special consideration. Treatment decisions are influenced by age and life expectancy, comorbid conditions and severity of the vascular complications. Adherence to dietary therapy, physical activity, and medication regimens may be compromised by comorbid conditions and psychosocial limitations. Drug-induced hypoglycaemia has been the main consideration and the most serious potential complication. In addition, the long term macrovascular and microvascular complications of type 2 diabetes are a source of significant morbidity and mortality. Indeed, vascular and neuropathic complications are already present at the time of diagnosis in a significant number of patients, and the impact of improved diabetes control depends on the age and life expectancy of the patient. Age-related changes in pharmacokinetics and the potential for adverse effects and drug interactions should also be considered when choosing appropriate pharmacological therapy. In general, a conservative and stepwise approach to the treatment of the elderly patient with type 2 diabetes is suggested; treatment may be initiated with monotherapy, followed by early intervention with a combination of oral agents including a sulphonylurea as a foundation insulin secretagogue in addition to a supplemental insulin sensitiser. Insulin therapy is eventually required if significant hyperglycaemia [glycosylated haemoglobin (HbA1c) >8%] persists despite oral combination therapy. Combination therapy with evening insulin and a long-acting sulphonylurea such as glimepiride is an effective strategy to improve hyperglycaemia in the elderly patient with type 2 diabetes in whom polypharmacy with oral agents is unsuccessful. In addition, such a regimen is simple to follow for the patient who may not be able to adhere to a more complicated insulin regimen. Hyperglycaemia in the elderly can be managed well with practical intervention and a straightforward treatment plan to enhance compliance. Optimal glycaemic control should be possible for every patient if treatment is individualised; however, strict glycaemic control may not be achievable in all patients or even desirable in many elderly patients.

I. Nosari

Papers

Safety, efficacy, acceptability of a pre-filled insulin pen in diabetic patients over 60 years old