			Home About us Contact

Postprandial Glucose Levels (postprandial + glucose_level)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Insulin therapy in type 2 diabetes: what is the evidence?

DIABETES OBESITY & METABOLISM, Issue 5 2009
Mariëlle J. P. Van Avendonk
Aim:, To systematically review the literature regarding insulin use in patients with type 2 diabetes mellitus Methods:, A Medline and Embase search was performed to identify randomized controlled trials (RCT) published in English between 1 January 2000 and 1 April 2008, involving insulin therapy in adults with type 2 diabetes mellitus. The RCTs must comprise at least glycaemic control (glycosylated haemoglobin (HbA1c), postprandial plasma glucose and /or fasting blood glucose (FBG)) and hypoglycaemic events as outcome measurements. Results:, The Pubmed search resulted in 943 hits; the Embase search gave 692 hits. A total of 116 RCTs were selected by title or abstract. Eventually 78 trials met the inclusion criteria. The studies were very diverse and of different quality. They comprised all possible insulin regimens with and without combination with oral medication. Continuing metformin and/or sulphonylurea after start of therapy with basal long-acting insulin results in better glycaemic control with less insulin requirements, less weight gain and less hypoglycaemic events. Long-acting insulin analogues in combination with oral medication are associated with similar glycaemic control but fewer hypoglycaemic episodes compared with NPH insulin. Most of the trials demonstrated better glycaemic control with premix insulin therapy than with a long-acting insulin once daily, but premix insulin causes more hypoglycaemic episodes. Analogue premix provides similar HbA1c, but lower postprandial glucose levels compared with human premix, without increase in hypoglycaemic events or weight gain. Drawing conclusions from the limited number of studies concerning basal,bolus regimen seems not possible. Some studies showed that rapid-acting insulin analogues frequently result in a better HbA1c or postprandial glucose without increase of hypoglycaemia than regular human insulin. Conclusion:, A once-daily basal insulin regimen added to oral medication is an ideal starting point. All next steps, from one to two or even more injections per day should be taken very carefully and in thorough deliberation with the patient, who has to comply with such a regimen for many years. [source]

Aging per se does not influence postprandial glucose levels in type 2 diabetes

GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2005
Yumiko Magata
Background: It is well known that postprandial glucose increases with aging in non-diabetic subjects. The question we addressed is whether elderly type 2 diabetic patients with definite fasting hyperglycemia (, 126 mg/dL) also display increased postprandial hyperglycemia relative to their younger counterparts. Methods: Diurnal plasma glucose profiles were measured in 162 overt type 2 diabetic patients treated by diet alone (diet group) or with sulfonylureas as monotherapy (SU group). Plasma glucose concentrations were measured at 08.00 hours (before breakfast), 10.00, 12.00 (before lunch), 14.00, 18.00 (before dinner), 20.00, 24.00, 03.00, 06.00 and 08.00 hours the next morning. The postprandial glucose area under the curve (AUC) from 08.00 to 24.00 hours was calculated above the baseline level equal to the 08.00-hours plasma glucose value, and the relationships with clinical variables, including age, were assessed. Results: There were no differences in diurnal plasma glucose profiles between the middle-aged (< 65 years) and elderly (, 65 years) groups either the diet group or the SU group. Univariate analysis showed that the postprandial glucose area under the curve was related to the 08:00-hours plasma glucose value (R = 0.583, P < 0.001) in the diet alone group and to the duration of diabetes (R = 0.220, P < 0.05), SU dose (R = 0.330, P = 0.001) and urine CPR (R = ,0.229, P < 0.05) in the SU group. In multivariate analysis, postprandial glucose area under the curve was only related to 08.00 hours plasma glucose value in the diet group (R2 of the model = 0.340, P < 0.001) and to the SU dose in SU group (R2 of the model = 0.145, P < 0.001). Conclusion: These results suggest that aging, per se, does not influence postprandial glucose levels in overt type 2 diabetic patients. [source]

Use of the DirecNet Applied Treatment Algorithm (DATA) for diabetes management with a real-time continuous glucose monitor (the FreeStyle Navigator)

PEDIATRIC DIABETES, Issue 2 2008
Diabetes Research In Children Network (DirecNet) Study Group
Background:, There are no published guidelines for use of real-time continuous glucose monitoring data by a patient; we therefore developed the DirecNet Applied Treatment Algorithm (DATA). The DATA provides algorithms for making diabetes management decisions using glucose values: (i) in real time which include the direction and rate of change of glucose levels, and (ii) retrospectively based on downloaded sensor data. Objective:, To evaluate the use and effectiveness of the DATA in children with diabetes using a real-time continuous glucose sensor (the FreeStyle Navigator). Subjects:, Thirty children and adolescents (mean ± standard deviation age = 11.2 ± 4.1 yr) receiving insulin pump therapy. Methods:, Subjects were instructed on use of the DATA and were asked to download their Navigator weekly to review glucose patterns. An Algorithm Satisfaction Questionnaire was completed at 3, 7, and 13 wk. Results:, At 13 wk, all of the subjects and all but one parent thought that the DATA gave good, clear directions for insulin dosing, and thought the guidelines improved their postprandial glucose levels. In responding to alarms, 86% of patients used the DATA at least 50% of the time at 3 wk, and 59% reported doing so at 13 wk. Similar results were seen in using the DATA to adjust premeal bolus doses of insulin. Conclusions:, These results show the feasibility of implementing the DATA when real-time continuous glucose monitoring is initiated and support its use in future clinical trials of real-time continuous glucose monitoring. [source]