Comparative effectiveness of basal-bolus versus premix analog insulin on glycemic variability and patient-centered outcomes during insulin intensification in type 1 and type 2 diabetes: a randomized, controlled, crossover trial.
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Patient satisfaction was impacted more positively by improved QoL, reduced glucose variability, and better glycemic control with a basal-bolus regimen than negatively by the burden of additional injections, thereby facilitating insulin intensification and the ability to achieve HbA1c below 7.0%.Abstract:
Context: In patients with diabetes, intraday glucose variability might predict health outcomes independently from glycosylated hemoglobin (HbA1c). Objective: Our objective was to evaluate patient satisfaction (PS), quality of life (QoL), glycemic control, and variability during insulin intensification to HbA1c below 7.0%. Patients, Design, and Setting: Eighty-two type 1 and 306 insulin-treated type 2 diabetes patients (47% male; age 54 ± 11 yr; HbA1c = 7.8 ± 0.7%) participated in this multicenter, randomized, crossover trial at 52 U.S. centers. Interventions: Interventions included insulin glargine plus premeal glulisine (n = 192) vs. twice-daily premix 75/25 or 70/30 analog insulin (n = 196) for 12 wk and crossed to the alternate arm for 12 wk. Main Outcome Measures: Main outcome measures included PS and QoL questionnaires, 3-d continuous glucose monitoring (CGM), and HbA1c every 4–8 wk. Results: Mean ± se HbA1c change was −0.39 ± 0.09% for glargine-glulisine and −0.05 ± 0.09% for premix (P < 0.0001). Th...read more
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Journal ArticleDOI
Type 2 diabetes mellitus.
Ralph A. DeFronzo,Ele Ferrannini,Leif Groop,Robert R. Henry,William H. Herman,Jens J. Holst,Frank B. Hu,C. Ronald Kahn,Itamar Raz,Gerald I. Shulman,Donald C. Simonson,Marcia A. Testa,Ram Weiss +12 more
TL;DR: The greatest need is for agents that enhance insulin sensitivity, halt the progressive pancreatic β-cell failure that is characteristic of T2DM and prevent or reverse the microvascular complications.
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Recommendations for standardizing glucose reporting and analysis to optimize clinical decision making in diabetes: the Ambulatory Glucose Profile (AGP).
Richard M. Bergenstal,Andrew J. Ahmann,Timothy L. Bailey,Roy W. Beck,Joan Bissen,Bruce A. Buckingham,Larry C. Deeb,Robert H. Dolin,Satish K. Garg,Robin Goland,Irl B. Hirsch,David C. Klonoff,Davida F. Kruger,Glenn Matfin,Roger S. Mazze,Beth A. Olson,Christopher G. Parkin,Anne L. Peters,Margaret A. Powers,Henry Rodriguez,Phil Southerland,Ellie Strock,William V. Tamborlane,David M. Wesley +23 more
TL;DR: Recommendations from the expert panel regarding the need to standardize glucose profile summary metrics and the value of a uniform glucose report to aid clinicians, researchers, and patients are presented.
Journal ArticleDOI
Recommendations for Standardizing Glucose Reporting and Analysis to Optimize Clinical Decision Making in Diabetes: The Ambulatory Glucose Profile:
Richard M. Bergenstal,Andrew J. Ahmann,Timothy L. Bailey,Roy W. Beck,Joan Bissen,Bruce A. Buckingham,Larry C. Deeb,Robert H. Dolin,Satish K. Garg,Robin Goland,Irl B. Hirsch,David C. Klonoff,Davida F. Kruger,Glenn Matfin,Roger S. Mazze,Beth A. Olson,Christopher G. Parkin,Anne L. Peters,Margaret A. Powers,Henry Rodriguez,Phil Southerland,Ellie Strock,William V. Tamborlane,David M. Wesley +23 more
TL;DR: Recommendations from the expert panel regarding the need to standardize glucose Profile summary metrics and the value of a uniform glucose report to aid clinicians, researchers, and patients are presented.
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Glycemic Variability and Diabetes Complications: Does It Matter? Simply Put, There Are Better Glycemic Markers!
TL;DR: There is universal agreement that HbA1c is the current gold standard for the primary clinical target, but there is no consensus as to whether other proposed glycemic metrics hold promise to provide additional clinical data or whether there should be additional targets beyond Hb a1c.
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Clinical and Patient-Centered Outcomes in Obese Patients With Type 2 Diabetes 3 Years After Randomization to Roux-en-Y Gastric Bypass Surgery Versus Intensive Lifestyle Management: The SLIMM-T2D Study.
TL;DR: Three years after randomization to RYGB versus IMWM, surgery produced greater weight loss, lower HbA1c, reduced cardiovascular risk, and improvements in obesity-related quality of life in obese patients with type 2 diabetes.
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