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Abstracts from the Association of British Clinical Diabetologists (ABCD) meetings
| Content Provider | Semantic Scholar |
|---|---|
| Author | Hanna, Fwf Scarpello, J. H. B. Harlow, Ja Jones, Patsy Peters, W. A. Ryder, R. E. J. Cull, Michelle Ramtoola, Shenaz Ritchie, C. Singhal, Paras Baynes, Chris Semple, Curtis Basu, Abhimanyu McIlwaine, Werner Patel, Vandhana Varadhan, Lakshminarayanan Levy, Dalia Birch, Carsten |
| Copyright Year | 2006 |
| Abstract | s from the Autumn 2006 meeting (P1): The effect of a ‘Treat to Target’ approach with insulin glargine in patients with persistent poor glycaemic control on traditional treatment with twice daily insulin mixtures REJ Ryder, J Cutler, ML Cull and AP Mills City Hospital, Birmingham. E-mail: bob.ryder@swbh.nhs.uk Background and aims: In type 2 diabetes a ‘Treat to Target’ (T2T) approach, with once daily long acting insulin at bedtime and continuing oral hypoglycaemic agents, has been shown to be remarkably effective in clinical trials involving patients with inadequate glycaemic control despite maximum oral hypoglycaemic agents. The aim was to see if a similar T2T approach could be as successful in unselected patients in an inner city area who were already established on traditional twice daily insulin mixtures and yet remained poorly controlled (HbA1c >8% for at least 1 year). Material and methods: This audit is of 85 such patients (mean [±SD] age 59 [±9] years; 54% female, 46% male; 53% South-Asian, 24% Caucasian, 23% Afro-Caribbean) were offered a T2T protocol involving a self-applied 2IU increase in the dose of insulin glargine every 3 days if the fasting glucose on self-testing was >5.4mmol/L on each of those days. Patients were on the maximum tolerated dose of metformin. If fasting glucose reached the target but HbA1c remained above 7%, a prandial oral glucose regulator was added and, if this failed, patients were offered prandial fast acting insulin analogue with a dose increasing algorithm. Patients reaching 200 units of insulin daily without glycaemic control were offered the addition of a glitazone. There were sufficient data to make an analysis based on 81/85 patients. Results: A snapshot was taken at a median (range) of 2 (0.6–3.3) years into the ongoing rolling programme. Mean (±SD) HbA1c had fallen from 9.92 (±1.34)% to latest value of 8.86 (±1.77)% (p<10-5). The lowest HbA1c achieved in response to the protocol was at 1.1 (0.2–2.7) years and was ≤6.5% in 16%, ≤7% in 30%, ≤7.5% in 32% and ≤7.9% in 46%. Only 28% failed to show significant improvement in HbA1c (HbA1c fall ≥1%). However, in many the improvement was not sustained. Latest HbA1c at the time of the snapshot was ≤6.5% in 4%, ≤7% in 12%, ≤7.5% in 17% and ≤7.9% in 26%. In 52% the HbA1c was not significantly better than baseline. Conclusion: These data suggest that a T2T approach, based initially on once daily long acting insulin analogue, significantly improved glycaemic control in nearly three-quarters of patients who were poorly controlled on standard approaches using twice daily insulin mixtures, the improvement being sustained in nearly half. With 30% achieving HbA1c ≤7%, the T2T approach described above is worth considering in patients who are poorly controlled on twice daily insulin mixtures. (P2): Application of a ‘Treat to Target’ approach with once daily long acting insulin at bedtime in the ‘real world’ of unselected patients in an inner city area REJ Ryder, J Cutler, ML Cull and AP Mills City Hospital, Birmingham. E-mail: bob.ryder@swbh.nhs.uk Background and aims: In patients with type 2 diabetes and inadequate glycaemic control despite maximum oral hypoglycaemic agents, a ‘Treat to Target’ (T2T) approach, with once daily long acting insulin at bedtime and continuing oral hypoglycaemic agents, has been shown to be remarkably effective in clinical trials. The aim was to see to what extent this approach could be as successful in the ‘real world’ of unselected patients in an inner city area. Material and methods: This audit is of 132 such patients (mean [±SD] age 57 [±11] years; 60% male, 40% female; 50% SouthAsian, 36% Caucasian, 14% Afro-Caribbean) who between 2002 and 2004 were offered a T2T protocol involving a self-applied 2IU increase in the dose of insulin isophane every 3 days if the fasting glucose on self-testing was >5.4mmol/L on each of those days. Patients were on the maximum tolerated dose of metformin. Those experiencing nocturnal or fasting hypoglycaemia were switched to insulin glargine. If fasting glucose reached the target but HbA1c remained above 7%, a prandial oral glucose regulator was added and, if this failed, patients were offered prandial fast acting insulin analogue with a dose increasing algorithm. Patients reaching 200 units of insulin daily without glycaemic control were offered the addition of a glitazone. There were sufficient data to make an analysis based on 128/132 patients. Results: A snapshot was taken at a median (range) of 2.2 (0.2–3.4) years into the ongoing rolling programme. Mean (±SD) HbA1c had fallen from 10.3 (±1.6)% to latest value of 8.2 (±1.5)% (p<10-26). The lowest HbA1c achieved in response to the protocol was at 1.3 (0.2–3) years and was ≤6.5% in 20%, ≤7% in 41%, ≤7.5% in 55% and ≤7.9% in 60%. Only 5% failed to show significant improvement in HbA1c (HbA1c fall ≥1%). Latest HbA1c at the time of the snapshot was ≤6.5% in 9%, ≤7% in 23%, ≤7.5% in 38% and ≤7.9% in 48%. In only 27% was the HbA1c not significantly better than baseline. Conclusion: Whilst the figures from this audit are less impressive than those from formal clinical trials, 41% achieved HbA1c ≤7%. This shows that even in the ‘real world’ of unselected patients in an inner city area, a T2T approach involving patient driven insulin dose adjustment can be considerably more effective than traditional methods involving twice daily insulin mixtures and insufficiently frequent dose adjustment by health professionals. (P3): Successful treatment of severe hypoglycaemia in type I diabetes with human islet transplantation P Srinivasan1, GC Huang2, M Zhao2, P Muiesan1, W Littlejohn1, M Rela1, S Persaud3, P Jones3, J Karani1, S Ashraf2, N Heaton1 and SA Amiel2 1Institutes of Liver Studies and 2Diabetes Research Group, King’s College London, School of Medicine and King’s College Hospital, London; 3Beta Cell Development & Function Group, King’s College London School of Biomedical & Health Sciences. E-mail: stephanie.amiel@kcl.ac.uk Background: Treating type 1 diabetic patients with severe hypoglycaemia (SH) by islet transplantation has become a realistic option but experience is lacking in the UK and limited by insufficient donors. We sought to improve the quantity and quality of human islets from conventional (heart-beating) donors and controlled non-heart beating donors (NHBD). Methods: We modified techniques of isolation of islets and assessed islets in vitro for viability, morphology, insulin response to glucose challenge and the ability to reverse hyperglycaemia in a diabetic animal model. Since June 2002, 76 isolations have been performed from conventional donors, and 10 from NHBD. Five patients with type 1 diabetes and recurrent SH have been identified, characterised and transplanted. Results: Mean islet IEQ from conventional donors was 410 970±1724 30IEQ/pancreas vs 505 000±84 230/pancreas from NHBD (p=0.011). Islets from both groups were highly viable with 88.56±7.02 and 91.3±3.2% viability (p=NS). Islets from both Abstracts from the Association of British Clinical Diabetologists (ABCD) meetings ABCD Abstracts.qxp 19/2/07 3:57 pm Page 1 |
| File Format | PDF HTM / HTML |
| DOI | 10.1002/pdi.1171 |
| Alternate Webpage(s) | https://abcd.care/sites/abcd.care/files/site_uploads/Abstracts/AbstractsAutumn2006/Abstracts_Autumn2006.pdf |
| Alternate Webpage(s) | https://abcd.care/sites/abcd.care/files/site_uploads/Abstracts/AbstractsAutumn2005/Abstracts_Autumn2005.pdf |
| Alternate Webpage(s) | https://doi.org/10.1002/pdi.1171 |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Synopsis |
