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Hematopoietic Stem Cell Transplantation as Treatment for Type 1 Diabetes
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Júlio C. Voltarelli, Richard K. Burt, Norma Kenyon, Dixon B. Kaufman, Elizabeth C. Squiers
Diabetics on insulin often suffer from negative psychological and social implications.36 IIT is complicated by a higher incidence of hypoglycemic reactions (approximately 3 times higher than conventional insulin treatment) that may result in seizures and/or death.37 The incremental cost per year of life gained by intensive insulin therapy has been estimated at $28,661 US dollars.38 In America, only 20-30% of type 1 diabetics are on IIT,39 approximately 10% on an insulin pump, and 20% on multiple injections. Therefore, in clinical practice, therapy associated with higher mortality, i.e., conventional insulin therapy, remains the standard of care for approximately 70% of type 1 diabetics in America. The access to medical care, education, and motivation for IIT is influenced by socioeconomic status. This results in a disproportionate percentage of conventional insulin therapy in lower socioeconomic groups. Finally, patients in developing countries, in which most of the world’s population reside, due to limited medical resources, are even less likely to initiate or remain on IIT.
Rheology of Diabetes Mellitus
Published in Gordon D. O. Lowe, Clinical Blood Rheology, 2019
So much for overall comparisons of diabetic and nondiabetic groups: what of the relationship between filtration on the one hand and the presence of microangiopathy or impaired metabolic control on the other? Some11,17,33–36 found filtration to be more impaired in diabetics with varying complications than in complication-free individuals, but Schmid-Schönbein and Volger15 and Lowe et al.39 were unable to observe a correlation between filtration and diabetic microangiopathy. Impaired metabolic control was associated with a further deterioration in filtration,11,15,18,29–32,34,40 although Ritchie38 was unable to confirm this. Improvement in metabolic control in diabetic patients by conventional insulin therapy (with or without fluid replacement), or by treatment with the artificial pancreas, was noted by several authors to be accompanied by a reversal of filtration towards normal nondiabetic levels. Interestingly, Juhan et al.29–31 have demonstrated that this was mediated by a direct effect of insulin on the red cell and was independent of prevailing levels of blood glucose.
Insulin Therapy
Published in Jack L. Leahy, Nathaniel G. Clark, William T. Cefalu, Medical Management of Diabetes Mellitus, 2000
When the goal of therapy is limited to abating symptoms of hyperglycemia, restoring a positive nutritional state, and improving overall sense of well-being, then a conventional insulin program suffices. Conventional insulin therapy is considered a once- or twice-daily regimen of insulin. It is simple to use, but does not mimic normal physiological insulin secretion. Thus, a general rule of thumb is that once- or twice-daily intermediate insulin is most appropriate for patients in whom achieving optimal glycemic control is not of paramount importance. However, in some type 2 patients with diabetes especially those who are obese, endogenous insulin secretion may be adequate to allow this type of insulin program to achieve excellent glycemic control. On the other hand, in established type 1 diabetes or any diabetic patient who lacks adequate endogenous insulin production (a common example is nonobese, elderly patients), glycemic control is typically poor, with large glucose variations throughout the day and a tendency for midafternoon and nocturnal hypoglycemia when the insulins are given prebreakfast and presupper.
Special diet in type 1 diabetes: do gender and BMI-SDS differ?
Published in Child and Adolescent Obesity, 2021
Alena Gerlinde Thiele, Nicole Prinz, Monika Flury, Melanie Hess, Daniela Klose, Thomas Meissner, Klemens Raile, Ilona Weis, Sabine Wenzel, Sascha Tittel, Thomas Kapellen, Reinhard Holl
At the time of the first documentation of the special diet (± 6 months) we analyzed the following parameters (for controls: most recent treatment year was considered): age, body mass index-standard deviation score (BMI-SDS), height-SDS, duration and age at onset of T1D, glycated hemoglobin (HbA1c), total daily insulin dosage (IU per kg body weight per day), and insulin therapy regime (conventional insulin therapy [CT, ≤3 injection time-points per day], intensified conventional insulin therapy [ICT, ≥4 injection time-points per day], or continuous subcutaneous insulin infusion [CSII] by an insulin pump), microalbuminuria, and physical activity (at least one time per week for 45 to 60 minutes). Height- and BMI-SDS were calculated for patients under 18 years of age using national reference data from the German Health Interview and Examination Survey for children and adolescents (KiGGS) (Neuhauser et al. 2013). Further, migration background, defined by either the patient or at least one of the parents born outside of one of the participating countries (Germany, Austria, Switzerland, and Luxembourg), was analyzed.
Comparison of intensive versus conventional insulin therapy in traumatic brain injury: a meta-analysis of randomized controlled trials
Published in Brain Injury, 2018
Rafael A. Núñez-Patiño, Andres Zorrilla-Vaca, Lucia Rivera-Lara
Current guidelines (American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. http://www.diabetes.org/. Accessed June 11, 2017) propose that glycaemic control infusions should aim to maintain BG levels less than 200 mg/dL in neurocritically ill patients with hyperglycaemia (31). In contrast, guidelines for the provision and assessment of nutrition support in critically ill patients recommend maintaining BG between 110 and 150 mg/dL when nutrition support therapy is provided (32). Guidelines for the use of insulin infusions in ICU patients recommend controlling BG to between 150 and 180 mg/dL (33). The impact of IIT versus conventional insulin therapy (CIT) in patients with TBI remains unclear, and no general consensus regarding the overall difference between IIT and CIT has been established. Therefore we performed a meta-analysis of RCTs comparing IIT and CIT in patients with TBI.
Closed-loop insulin delivery systems in children and adolescents with type 1 diabetes
Published in Expert Opinion on Drug Delivery, 2020
In a three-way comparison between dual-hormone closed-loop, single-hormone closed-loop and conventional insulin pump therapy, one study demonstrated a significant improvement of overnight time spent in range with dual-hormone compared to single-hormone closed-loop (p = 0.032) [70]. Both studies showed an increase in time in range with either closed-loop system use compared to conventional insulin therapy [70,71]. Dual-hormone closed-loop therapy reduced the need for rescue carbohydrates, however, did not eliminate the need for them in any of the published studies.