More evidence needed on the benefits of CGM in children with type 1 and adults with type 2

SMBG

Previous systematic reviews and meta-analyses have failed to turn up clear evidence on the benefits and harms of continuous glucose monitoring (CGM) in children with type 1 diabetes and insulin-using patients with type 2 diabetes. This systematic review set out to update this state of affairs in the light of recent studies. In children with [read the full story…]

Welsh NHS recommends saxagliptin as an option in type 2 diabetes

The All Wales Medicines Strategy Group has published a recommendation regarding saxagliptin, the DPP-4 inhibitor (Onglyza®) Saxagliptin is recommended as an option for use within NHS Wales for the treatment of adult patients aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control in combination with insulin (with or without metformin) [read the full story…]

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Review: biphasic insulin was better than basal insulin in type 2 diabetes

Adjusting the dose

We report on a critical appraisal by the Centre for Reviews and Dissemination (CRD) of a systematic review of insulin regimens in type 2 diabetes. Clinical question: In type 2 diabetes inadequately controlled with oral agents, does biphasic insulin, compared with basal insulin, lead to better glycaemic control? The review defined the proportion of patients [read the full story…]

Lack of clear evidence for metformin in type 2 diabetes on insulin therapy

A pill

Metformin is widely used as a first line treatment for type 2 diabetes and it is usually continued when treatment is intensified, such as with other oral agents or by insulin therapy. This systematic review looked at whether metformin is actually beneficial to patients who are using insulin. Clinical question: In people with type 2 [read the full story…]

What people with type 2 diabetes think about starting insulin therapy

Picture of a syringe

Clinical question In type 2 diabetes starting insulin or poorly controlled on oral therapy, what psychological barriers do people experience around initiating insulin therapy? Making the transition to insulin therapy in type 2 diabetes can be very difficult.  This review set out to identify the psychological barriers people experience when faced with the challenge. The [read the full story…]

5mm needles may be as good as 8mm for obese patients with type 1 diabetes or type 2 on insulin

Picture of a syringe

Clinical question: In obese people (BMI ≥30kg/m2) with diabetes who inject insulin, are 5mm needles, as compared to 8mm, effective at maintaining glycaemic control and acceptable to patients? Methods: Randomised crossover trial with six months duration, N=130.    Glycaemic control was measured by HbA1c, fructosamine and 1,5-anhydroglucitol.  Patient preferences were measured with a visual analog pain [read the full story…]

Insulin glargine may be cost-effective compared with basal insulin.

Picture of a syringe

Insuline glargine has several clinical and quality of life benefits compared with human basal insulin (NPH).  However, it is also more costly.  Do these benefits justify the additional cost? A new economic evaluation addresses this question.  The authors searched the literature for published evaluations.  They found seven good quality studies that addressed the issue, though [read the full story…]

Proportion of type 2 diabetics achieving good glycemic control by insulin regimen

Picture of a syringe

This review collated data from over 80 studies of different insulin regimens to determine what proportion of people with type 2 diabetes patients achieve a glycosylated haemoglobin target of HbA1c of 7% or lower: Basal insulin:  37.2% (31.5-43.1%) Biphasic insulin: 35.3% (28.9-42.1%) Prandial insulin: 37.5% (27.7-47.9%) Basal-bolus insulin: 51.2% (41.4-61.1%) Note that there may be [read the full story…]

Guidance for intensification of insulin therapy in type 2 diabetes.

Adjusting the dose

The Indian Journal of Endocrinology has recently publised a consensus statement on the intensification of insulin therapy in type 2 diabetes. The guidelines cover making the switch from a premix analog biphasic insulin aspart (BIAsp) 30 to a mid-/high-ratio premix regimen in patients who are failing to achieve good glycaemic control. The guidelines were produced [read the full story…]

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Quality of life in people hospitalised with type 2 diabetes

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A survey has reported quality of life of data from a cohort of hospitalis patients with type 2 diabetes on either oral antidiabetic agents or insulin regimens. The study used a questionnaire-based instrument – WHOWOL-BREF – to measure quality of life.  The participants had at least 5 years duration of diagnosis and had been hospitalised [read the full story…]