RESEARCH PAPER
Are we helping or harming our insulin-treated diabetic patients during ambulatory treatment?
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1
Diabetology Ward, Institute of Rural Health, Lublin, Poland
2
Institute of Public Health, Pope John Paul II State School of Higher Education, Biala Podlaska, Poland
3
Department of Functional Research, Institute of Rural Health, Lublin, Poland
Corresponding author
Piotr Dziemidok
Diabetology Ward, Institute of Rural Health, Lublin, Poland
Ann Agric Environ Med. 2013;20(2):346-350
KEYWORDS
ABSTRACT
Introduction:
Correctness of insulin treatment depends on both the experience and skills of the doctor and knowledge and behaviour of the patient.
Objective:
Evaluation the adequacy of insulin doses administered to diabetes patients in ambulatory conditions.
Material and Methods:
The treatment of 59 patients hospitalized in the Diabetology Ward was evaluated at admission, discharge and 3 months after hospitalization.
Results:
The mean daily doses of insulin significantly differed at times of evaluation and were: 53.90, 39.31 and 43.34 units, respectively (p≈0.000001). A significant reduction of body weight, 90.86 vs. 88.25 kg (p≈0.000001), was obtained only during hospitalization, and was maintained 3 months after discharge (87.86 kg). Significant differences were also noted in the body mass index (33.44 vs. 32.48 vs. 32.37 kg/m2, p≈0.000001). The change in waist circumference was not statistically significant (107.87 vs. 104.89 cm; p≈0.06). A decrease in the number of hypoglycaemia episodes was observed, but were statistically insignificant (25 vs. 23; p≈0.7). Three months after hospitalization an insignificant decrease of HbA1c level was noted (8.41% vs. 8.03%; p≈0.07).
Conclusions:
During treatment in the Diabetology Ward the procedure of choice was more frequently a reduction than an increase in insulin doses. This management led to the reduction of the patients’ body weight, improvement of glycaemia, without any significant effect on the diabetes control determined by the HbA1c level.
REFERENCES (31)
1.
DeWitt DE, Hirsh B. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus. JAMA. 2007; 289(17): 2254–2264.
2.
Orłowska-Kunikowska E. Rola insuliny w leczeniu cukrzycy typu 2. Chor. Serca Naczyń. 2006; 3(1): 13–17.
3.
DCCT Research Group. The effects of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. N Engl J Med. 1993; 329: 977–986.
4.
UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998; 352: 837–853.
5.
Wake N, Hisashige A, Katayama T, et al. Cost-effectiveness of intensive insulin therapy for type 2 diabetes: a 10-year follow-up of the Kumamoto study. Diabetes Res Clin Pract. 2000; 48: 201–210.
6.
The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of Intensive Glucose Lowering in Type 2 Diabetes. N Engl J Med. 2008; 358: 2545–2559.
7.
Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009; 360: 129–139.
8.
Hemkens LG, Grouven U, Bender R, et al. Risk of malignancies in patients with diabetes treated with human insulin or insulin analogues: a cohort study. Diabetologia. 2009; 52: 1732–1744.
9.
DCCT Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complication trial. Am J Med. 1993; 90: 450–459.
10.
Schwartz AV, Vittinghoff E, Sellmeyer DE, Feingold KR, de Renkeneire N, Strotmeyer ES, et al. Diabetes-related complications, glycemic control and falls in alder adults. Diabetes Care. 2008; 31(3): 391–396.
11.
Leow MK, Wyckoff J. Under-recognised paradox of neuropathy from rapid glycaemic control. Postgrad Med J. 2005; 81: 103–107.
12.
Wilson DE. Excessive insulin therapy: biochemical effects and clinical repercussions. Current concepts of counterregulation in type I diabetes. Ann Intern Med. 1983; 98(2): 219–227.
13.
Cryer PE, Gerich JE. Glucose counterregulation, hypoglycemia, and intensive insulin therapy in diabetes mellitus. N Engl J Med. 1985; 313(4): 232–241.
14.
Somogyi M, Kirstein M. Insulin as a cause of extreme hyperglycemia and instability. Weekly Bulletin of the St Louis Medical Society. 1938; 32: 498–510.
15.
Matyka KA, Crowne EC, Havel PJ, et al. Counterregulation during spontaneous nocturnal hypoglycemia in prepubertal children with type 1 diabetes. Diabetes Care. 1999; 22: 1144–1150.
16.
Guillod L, Comte-Perret S, Monbaron D, et al. Nocturnal hypo-glycaemias in type 1 diabetic patients: what can we learn with continuous glucose monitoring? Diabetes Metab. 2007; 33: 360–365.
17.
DCCT Research Group. Influence of intensive diabetes treatment on body weight and composition of adults with type 1 in Diabetes Control and Complications Trial. Diabetes Care. 2001; 24: 1711–1721.
18.
Colhoun HM. Use of insulin glargine and cancer incidence in Scotland: a study from the Scottish Diabetes Research Network Epidemiology Group. Diabetologia. 2009; 52: 1755–1765.
19.
Rosenstock J, Fonseca V, McGill JB, et al. Similar risk of malignancy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: findings from a 5 year randomised, open-label study. Diabetologia. 2009; 52: 1971–1973.
20.
Smith U, Gale EA. Does diabetes therapy influence the risk of cancer? Diabetologia. 2009; 52: 1699–1708.
21.
Draznin B. Mitogenic action of insulin: friend, foe or ‘frenemy’? Diabetologia. 2010; 53(2): 229–233.
22.
Evans JM, Donnelly LA, Emslie-Smith AM, et al. Metformin and reduced risk of cancer in diabetic patients. BMJ. 2005; 330: 1304–1305.
23.
Dunkan BB, Smith MI. Metformin, cancer, alphabet soup, and the role of epidemiology in etiologic research. Diabetes Care. 2009; 32: 1748–1750.
24.
Chantelau E, Kohner EM. Why some cases of retinopathy worsen when diabetic control improves. BMJ. 1997; 315: 1105–1106.
25.
DCCT/EDIC Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002; 287: 2563–2569.
26.
Holman RR, Sanjoy KP, Bethel A, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008; 359: 1577–1589.
27.
Linn T, Ortac K, Laube H, et al. Intensive therapy in adult insulin-dependent diabetes mellitus is associated with improved insulin sensitivity and reserve. Metabolism. 1996; 45: 1508–1513.
28.
Li Y, Xu W, Liao Z, et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of beta-cell function. Diabetes Care. 2004; 27(11): 2597–2602.
29.
Rodier M, Colette C, Gouzes C, et al. Effects of insulin therapy upon plasma lipid fatty acids and platelet aggregation in NIDDM with secondary failure to oral antidiabetic agents. Diabetes Res Clin Pract. 1995; 28: 19–28.
30.
Malmberg K. Prospective randomised study of insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. BMJ. 1997; 314: 1512–1515.
31.
Gray A, Raikou M, McGuire A, et al. Cost effectivenes of an intensive blood glucoce control policy in patients with type 2 diabetes. BMJ. 2000; 320: 1373–1378.