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Latest & greatest articles for type 1 diabetes
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on type 1 diabetes or other clinical topics then use Trip today.
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A randomized, multicentre trial evaluating the efficacy and safety of fast-acting insulin aspart in continuous subcutaneous insulin infusion in adults with type1diabetes (onset 5) To evaluate the efficacy and safety of fast-acting insulin aspart (faster aspart) vs insulin aspart (IAsp) used in continuous subcutaneous insulin infusion (CSII) in participants with type1diabetes (T1D).This was a double-blind, treat-to-target, randomized, 16-week trial investigating CSII treatment with faster (...) % confidence interval [CI] 0.14; 1.87) or 0.09% (95% CI 0.01; 0.17; P < 0.001) for non-inferiority (0.4% margin; P < 0.02 for statistical significance in favour of IAsp). Faster aspart was superior to IAsp in change from baseline in 1-hour postprandial glucose (PPG) increment after a meal test (ETD -0.91 mmol/L [95% CI -1.43; -0.39] or -16.4 mg/dL [95% CI -25.7; -7.0]; P = 0.001), with statistically significant reductions also at 30 minutes and 2 hours. The improvement in PPG was reflected in the change
Comparative effectiveness and harms of long-acting insulins for type1 and type 2 diabetes: A systematic review and meta-analysis To review evidence comparing benefits and harms of long-acting insulins in patients with type1 and 2 diabetes.MEDLINE and two Cochrane databases were searched during February 2018. Two authors selected studies meeting inclusion criteria and assessed their quality. Comparative studies of adult or paediatric patients with diabetes treated with insulin degludec (...) , detemir or glargine were included. Meta-analysis was used to combine results of similar studies, and the I2 statistic calculated to assess statistical heterogeneity.Of 2534 citations reviewed, 70 studies met the inclusion criteria. No statistically significant differences in HbA1c were seen between any two insulins or formulations. Hypoglycaemia was less probable with degludec than with glargine, including nocturnal hypoglycaemia in type1 (rate ratio 0.68, 95% CI 0.56-0.81) and type 2 diabetes (rate
The effects of incretin-based therapies on beta-cell function and insulin resistance in type 2 diabetes: A systematic review and network meta-analysis combining 360 trials To evaluate the comparative effects of incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase-4 inhibitors (DPP-4Is), on β-cell function and insulin resistance in patients with type 2 diabetes mellitus (T2DM).Medline, Embase, the Cochrane Library
Effect of Resveratrol on Blood Lipid Levels in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis Few studies have considered the effect of resveratrol on blood lipid levels, and the results of these studies are inconsistent. In this study, the first meta-analysis on the effect of resveratrol on blood lipid levels in patients with type 2 diabetes was conducted.This study used keywords such as type 2 diabetes, total cholesterol, triglyceride (TG), high-density lipoprotein, low (...) -density lipoprotein, and resveratrol and their abbreviations, free words, and related words to search PubMed, Cochrane Library, and Embase. The Cochrane risk of bias tool was used to evaluate the risk of bias, and Review Manager 5.3 and Stata 13.0 were used for data merging and statistical analysis.Ten randomized controlled trials involving a total of 363 patients with type 2 diabetes were included in the analysis. The results show that longer resveratrol intervention time (≥6 months) can reduce TG
with type 2 diabetes mellitus and high cardiovascular risk to canagliflozin or placebo. Its primary outcome was a composite of major adverse cardiovascular events. The main outcome of interest for this report was fatal or nonfatal stroke. Additional exploratory outcomes were stroke subtypes and other vascular outcomes defined according to standard criteria. Results- There were 1 958 (19%) participants with prior stroke or transient ischemic attack at baseline. These individuals were older, more (...) Canagliflozin and Stroke in Type 2 Diabetes Mellitus Background and Purpose- This study reports the detailed effects of canagliflozin on stroke, stroke subtypes, and vascular outcomes in participants with and without cerebrovascular disease (stroke or transient ischemic attack) at baseline from the CANVAS (Canagliflozin Cardiovascular Assessment Study) Program. Methods- The CANVAS Program, comprising 2 similarly designed and conducted clinical trials, randomly assigned 10 142 participants
A whey/guar "preload" improves postprandial glycaemia and glycated haemoglobin levels in type 2 diabetes: A 12-week, single-blind, randomized, placebo-controlled trial To evaluate the effects of 12 weeks of treatment with a whey/guar preload on gastric emptying, postprandial glycaemia and glycated haemoglobin (HbA1c) levels in people with type 2 diabetes (T2DM).A total of 79 people with T2DM, managed on diet or metformin (HbA1c 49 ± 0.7 mmol/mol [6.6 ± 0.1%]), were randomized, in single-blind (...) fashion, to receive 150 mL flavoured preloads, containing either 17 g whey protein plus 5 g guar (n = 37) or flavoured placebo (n = 42), 15 minutes before two meals, each day for 12 weeks. Blood glucose and gastric emptying (breath test) were measured before and after a mashed potato meal at baseline (without preload), and after the preload at the beginning (week 1) and end (week 12) of treatment. HbA1c levels, energy intake, weight and body composition were also evaluated.Gastric emptying was slower
Pegbelfermin (BMS-986036), PEGylated FGF21, in Patients with Obesity and Type 2 Diabetes: Results from a Randomized Phase 2 Study Obesity and type 2 diabetes mellitus (T2DM) are risk factors for nonalcoholic fatty liver disease, including nonalcoholic steatohepatitis. This study assessed pegbelfermin (BMS-986036), recombinant PEGylated human fibroblast growth factor 21 (FGF21), in patients with obesity and T2DM predisposed to fatty liver.In this randomized, double-blind, placebo-controlled (...) study, patients with T2DM and BMI of 30 to 50 kg/m2 received subcutaneous pegbelfermin (1, 5, or 20 mg daily or 20 mg weekly; n = 96) or placebo (n = 24) for 12 weeks. Primary end points were safety, tolerability, and change in HbA1c. Additional end points included insulin sensitivity, lipids, adiponectin, and disease progression biomarkers.There were no significant effects of pegbelfermin versus placebo on HbA1c. Pegbelfermin 20 mg/d significantly improved high-density lipoprotein cholesterol (P
Implementation of a Health Plan Program for Switching From Analogue to Human Insulin and Glycemic Control Among Medicare Beneficiaries With Type 2 Diabetes. Prices for newer analogue insulin products have increased. Lower-cost human insulin may be effective for many patients with type 2 diabetes.To evaluate the association between implementation of a health plan-based intervention of switching patients from analogue to human insulin and glycemic control.A retrospective cohort study using (...) hemoglobin A1c (HbA1c) levels estimated over three 12-month periods: preintervention (baseline) in 2014, intervention in 2015, and postintervention in 2016. Secondary outcomes included rates of serious hypoglycemia or hyperglycemia using ICD-9-CM and ICD-10-CM diagnostic codes.Over 3 years, 14 635 members (mean [SD] age: 72.5 [9.8] years; 51% women; 93% with type 2 diabetes) filled 221 866 insulin prescriptions. The mean HbA1c was 8.46% (95% CI, 8.40%-8.52%) at baseline and decreased at a rate of -0.02
Fewer large babies are born to pregnant woman with type1diabetes if their glucose was monitored continuously Fewer large babies are born to pregnant woman with type1diabetes if their glucose was monitored continuously Discover Portal Discover Portal Fewer large babies are born to pregnant woman with type1diabetes if their glucose was monitored continuously Published on 12 December 2017 doi: Pregnant women with type1diabetes who used a continuous glucose monitoring system were half (...) , only improved slightly. This may be unsurprising because HbA1c results are less reliable in pregnancy and women found it hard to stick to the continuous monitoring protocol. Strict control of blood glucose levels during pregnancy reduces the risk for women with type1diabetes, and their babies are less likely to be large or need treatment for low blood glucose. Continuous monitoring provides many readings but requires the user to deliver insulin accordingly. Motivated women may find continuous
.,Stefanetti, R.,Trenell, M.,Welsh, P.,Kean, S.,Ford, I.,McConnachie, A.,Sattar, N.,Taylor, R. Lancet , 2017 BACKGROUND: Type 2 diabetes is a chronic disorder that requires lifelong treatment. We aimed to assess whether intensive weight management within routine primary care would achieve remission of type 2 diabetes. METHODS: We did this open-label, cluster-randomised trial (DiRECT) at 49 primary care practices in Scotland and the Tyneside region of England. Practices were randomly assigned (1:1), via (...) Type 2 diabetes can be reversed with a low-calorie diet Type 2 diabetes can be reversed with a low-calorie diet Discover Portal Discover Portal Type 2 diabetes can be reversed with a low-calorie diet Published on 13 February 2018 doi: Nearly half of people given a formula replacement diet of 830 calories per day for three to five months, followed by food reintroduction, went into remission from type 2 diabetes. They were supported to achieve and maintain weight reduction by primary care nurses
Type 2 diabetes is becoming more common in children Type 2 diabetes is becoming more common in children Discover Portal Discover Portal Type 2 diabetes is becoming more common in children Published on 25 July 2017 doi: The number of children being diagnosed with both type1 and type 2 diabetes is rising, but new cases of type 2 diabetes, the form associated with being overweight, has risen five-fold in about five years. New analysis in this NIHR-supported study suggest that type 2 diabetes now (...) weight. Having type 2 diabetes brings an increased risk of other complications and healthcare problems for individuals and is associated with extra resource use and costs for society. NICE has produced guidance about preventing type 2 diabetes, but it appears that more needs to be done to promote healthier lifestyles to children and their families. Share your views on the research. Why was this study needed? The number of children and young people in England and Wales with both diabetestype1 and 2
Insulin pumps not much better than multiple injections for intensive control of type1diabetes Insulin pumps not much better than multiple injections for intensive control of type1diabetes Discover Portal Discover Portal Insulin pumps not much better than multiple injections for intensive control of type1diabetes Published on 11 July 2017 doi: People with type1diabetes offered insulin pumps did not achieve better blood glucose control compared with those using multiple daily injections (...) treatment might actually have been a reflection of the training given to them. Currently just 10% of adults with type1diabetes access these training courses. These results support NICE guidelines around the restricted use of insulin pumps and suggest that training improves self-management of the condition. Efforts should therefore be made to encourage training uptake. Share your views on the research. Why was this study needed? People with type1diabetes require lifelong treatment with insulin. Doses
have found that this may be improved with continuous insulin pumps. Larger studies will be required to confirm if this is the case and to assess the safety of the technique for advanced type 2 diabetes as it is currently only recommended for type1diabetes. This treatment option is more expensive than multiple daily injections so cost-effectiveness will also need to be looked at. Nevertheless, these are promising results for people with poorly controlled type 2 diabetes. Share your views (...) for advanced stages of the disease, but approximately one in every four people on insulin injections has a very poor control of blood sugar levels. Evidence on insulin pumps in type 2 diabetes is sparse compared to the evidence in type1diabetes. This study aimed to assess blood sugar control using continuous subcutaneous insulin infusions in type 2 diabetes in order to inform the development of patient-centred treatment approaches. What did this study do? This meta-analysis included five randomised
(OR, 0.12 [95% CI, 0.08 to 0.18]; RD, -22% [-27% to -18%]). When added to metformin and sulfonylurea, GLP-1 receptor agonists were associated with the lowest odds of hypoglycemia (OR, 0.60 [95% CI, 0.39 to 0.94]; RD, -10% [95% CI, -18% to -2%]). CONCLUSIONS AND RELEVANCE: Among adults with type 2 diabetes, there were no significant differences in the associations between any of 9 available classes of glucose-lowering drugs (alone or in combination) and the risk of cardiovascular or all-cause mortality (...) Nine different drug classes reviewed for type 2 diabetes Nine different drug classes reviewed for type 2 diabetes Discover Portal Discover Portal Nine different drug classes reviewed for type 2 diabetes Published on 17 January 2017 doi: Metformin worked best at keeping blood sugar levels under control and remains a good first choice as single therapy. Overall, the nine classes of blood sugar-lowering drugs had similar effect on risk of death from cardiovascular causes and overall mortality
Flu vaccine reduces deaths for people with type 2 diabetes Flu vaccine reduces deaths for people with type 2 diabetes Discover Portal Discover Portal Flu vaccine reduces deaths for people with type 2 diabetes Published on 18 October 2016 doi: Flu vaccination helps prevent some deaths, serious strokes, heart failure and pneumonia in people with type 2 diabetes. Vaccination is linked to less hospital admissions for these reasons, but there is no link to rates of admissions for heart attack (...) . The results come from a reliable population-based study that looked back at the general practice and hospital records of almost 125,000 adults with type 2 diabetes in England. Outcome rates were compared between those who had and hadn’t received the flu vaccine over seven successive flu seasons. The researchers carefully adjusted for things like the seasonal change in flu numbers. The findings strongly support current recommendations that people with chronic medical conditions such as diabetes receive
at the timing of use of sulfonylureas – as first-line treatment, second-line treatment, unspecified, or specifically as add-on therapy to metformin. Statistical analysis found that the overall sample size was large enough to conclude that the number of people harmed by sulfonylureas is likely to be less than 1 in 200. What does current guidance say on this issue? NICE’s 2015 guidance on type 2 diabetes recommends a sulfonylurea as an initial treatment option if the standard first-choice drug metformin (...) Sulfonylureas can be considered safe for those with type 2 diabetes Sulfonylureas can be considered safe for those with type 2 diabetes Discover Portal Discover Portal Sulfonylureas can be considered safe for those with type 2 diabetes Published on 20 July 2016 doi: This large review finds that sulfonylurea drugs are not associated with an increased risk of death, heart attack or stroke when compared with placebo, diet control or other diabetes drugs. Sulfonylureas are commonly used
for non-critical care. Those using the system spent about six hours longer in the target range, and this could hasten their recovery and reduce staff workload. The number of hospitalised patients with type 2 diabetes is increasing. Glucose control often worsens during illness. Closed-loop pumps have been shown to improve blood glucose control in type1diabetes and in critical care settings. This two-centre study included 136 patients with type 2 diabetes on general hospital wards. Patients using (...) (hypoglycaemia) can delay recovery and increase the risk of complications. However, illness, medication and changes in routine, such as mealtimes, can make it difficult to maintain blood glucose targets. A Canadian review of 20 studies showed that a newer closed-loop insulin pump, also known as an artificial pancreas, increased the time that patients with type1diabetes spent in the target blood glucose range, and decreased the risk of severe hypoglycaemia. This study aimed to see if it could benefit
The benefits and harms of aspirin for people with type 2 diabetes are finely balanced Aspirin benefits and harms balanced in type 2 diabetes Discover Portal Discover Portal The benefits and harms of aspirin for people with type 2 diabetes are finely balanced Published on 4 December 2018 doi: Daily aspirin reduced the risk of serious vascular events among people with diabetes, while increasing the risk of major bleeding to a similar extent. Aspirin prevented one person in every 100 from having (...) be prescribed to people with diabetes who do not have existing cardiovascular disease. Share your views on the research. Why was this study needed? Cardiovascular disease is the leading cause of death in the UK. It accounted for 152,465 deaths in 2016, of which 66,076 deaths were from coronary heart disease and 37,771 from stroke. Around 4 million people in the UK have diabetes, mostly type 2. Adults with diabetes are two to three times more likely to develop cardiovascular disease, and nearly twice
control. This is not enough to be clinically important or outweigh the costs and personal inconvenience of long-term self-testing. Self-monitoring is a well-established strategy for type1diabetes and for people with type 2 who need insulin. The benefit for all people with type 2 is debatable. This review pooled 24 randomised controlled trials comparing self-monitoring with any control strategy for people not taking insulin. Self-monitoring gave a 0.3 percentage point reduction in glycated (...) . . Cochrane Database of Syst Rev. 2012;(1):CD005060. Why was this study needed? There are around 3.7 million people living with diabetes in the UK. Around 90% of those affected have type 2 diabetes. Management of type 2 diabetes usually begins with lifestyle changes, followed by the addition of oral blood-glucose-lowering medications, progressing to additional drugs and insulin if needed. Blood glucose is monitored by measuring HbA1c every three to six months. The aim is to keep HbA1c ideally below 6.5
Motivational interviewing may encourage healthy eating in people with type 2 diabetes Motivational interviewing may encourage healthy eating in people with type 2 diabetes Discover Portal Discover Portal Motivational interviewing may encourage healthy eating in people with type 2 diabetes Published on 15 March 2016 doi: A motivational communication approach may help people with type 2 diabetes eat more healthily, but may be no better than usual care for changing other behaviours or improving (...) doesn’t support the wide adoption of motivational interviewing, as described in this review because it is not known yet why many studies showed no effect. Next steps could be to identify which components of the interventions worked, how intensive they need to be and what the impact of prior skill and training in delivery of the intervention was. Share your views on the research. Why was this study needed? Diabetes affects around four million people living in the UK. Around 90% have type 2 diabetes