The Impact of the Diabetes Control and Complications Trial and Humalog Insulin on Glycohemoglobin Levels and Severe Hypoglycemia in Type 1 Diabetes

Diabetes Care - Tập 24 Số 3 - Trang 430-434 - 2001
H. Peter Chase1, Tai M. Lockspeiser1, Brooke Peery1, Mark D. Shepherd1, Todd A. MacKenzie1, James H. Anderson2, Satish K. Garg1
1Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver, Colorado
2Eli Lilly and Company, Indianapolis, Indiana

Tóm tắt

OBJECTIVE—This study was performed to determine the effects of the Diabetes Control and Complications Trial (DCCT) report in 1993 and the introduction of Lispro (Humalog) insulin in 1996 on glycemic control and on the number of severe hypoglycemic episodes in type 1 diabetic patients of various ages. RESEARCH DESIGN AND METHODS—Diabetes care parameters and HbA1c data from 884 subjects with type 1 diabetes were entered into our database at the time of clinic visits from 1993 through 1998. In addition, a questionnaire was sent to all patients to validate the number of insulin injections per day, the incidence of severe hypoglycemic episodes (as defined by the DCCT), and the use of Humalog insulin. Data were divided into four age-groups: <5, 5–12, 13–18, and >18 years of age. RESULTS—Longitudinal HbA1c levels declined significantly after the DCCT report in 1993–1996 (P < 0.001), but the number of severe hypoglycemic events increased (P < 0.001). A second decline in HbA1c levels was observed after the introduction of Humalog insulin in 1996 (P < 0.001). However, severe hypoglycemic episodes did not change (P = 0.26). CONCLUSIONS—Administration of Humalog resulted in an additional reduction in HbA1c levels beyond the reduction in HbA1c values after the DCCT report. In contrast to the increase in severe hypoglycemic events after the DCCT results, the number of severe hypoglycemic episodes did not increase after the introduction of Humalog, despite a further decrease in HbA1c values.

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Tài liệu tham khảo

Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986, 1993

American Diabetes Association: Implications of the Diabetes Control and Complications Trial (Position Statement). Dia-betes 42:1555–1558, 1993

Tuttleman M, Lipsett L, Harris MI: Attitudes and behaviors of primary care physicians regarding tight control of blood glucose in IDDM patients. Diabetes Care 16:765–772, 1993

Chase HP: Understanding Insulin-Dependent Diabetes . 9th ed. Denver, CO, FGI Print Management, 1999

Diabetes Control and Complications Trial Research Group: Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. J Pediatr 125:177–188, 1994

Diabetes Control and Complications Trial Research Group: Adverse events and their association with treatment regimens in the Diabetes Control and Complications Trial. Diabetes Care 18:1415–1427, 1995

Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M: Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective six year study. Diabetes Res Clin Pract 28:103–117, 1995

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. Lancet 352:837–853, 1998

Geffner ME: Reviewing the Diabetes Control and Complications Trial: one member of the “control panel” speaks. J Pediatr 125:228–229, 1994

Garg SK, Carmain JA, Braddy KC, et al: Pre-meal insulin analog insulin Lispro versus Humulin® R insulin treatment in young subjects with type 1 diabetes. Diabet Med 13:47–52, 1996

Schernthaner G, Wein W, Sandholzer K, Equiluz-Bruck S, Bates PC, Birkett MA: Postprandial insulin Lispro: a new therapeutic option for type 1 diabetic patients. Diabetes Care 21:571–573, 1998

Pampanelli S, Torlone E, Ialli C, Del Sindaco P, Ciofetta M, Lepore M, Bartocci L, Brunetti P, Bolli GB: Improved postprandial metabolic control after subcutaneous injection of a short-acting insulin analog in IDDM of short duration with residual pancreatic β-cell function. Diabetes Care 18:1452–1459, 1995

Garg SK, Anderson JH, Perry SV, Mackenzie T, Keith P, Jennings MK, Hansen MM, Chase HP: Long-term efficacy of Humalog® in subjects with type 1 diabetes mellitus. Diabet Med 16:384–387, 1999

Holleman F, Schmitt H, Rottiers R, Rees A, Symanowski S, Anderson JH: Reduced frequency of severe hypoglycemia and coma in well-controlled IDDM patients with insulin Lispro. Diabetes Care 20:1827–1832, 1997

Zinman B, Tildesley H, Chiasson JL, Tsui E, Strack T: Insulin Lispro in CSII: results of a double-blind crossover study. Diabetes 46:440–443, 1997

Renner R, Pfutzner A, Trautmann M, Harzer O, Sauter K, Landgraf R: Use of insulin lispro in continuous subcutaneous insulin infusion treatment: results of a multicenter trial. German Humalog-CSII Study Group. Diabetes Care 22:784–788, 1999

Garg SK, Anderson JH, Gerard LA, Mackenzie TA, Gottlieb PA, Jennings MK, Chase HP: Impact of insulin-lispro on HbA1c values in insulin pump users. Diabetes, Obesity and Metabolism 1:1–5, 2000

Melki V, Renard E, Lassmann-Vague V, Boivin S, Guerci B, Hanaire-Broutin H, Bringer J, Belicar P, Jeandidier N, Meyer L, Blin P, Augendre-Ferrante B, Tauber JP: Improvement of HbA1c and blood glucose stability in IDDM patients treated with Lispro insulin analog in external pumps. Diabetes Care 21:977–982, 1998

Chase HP, Garg SK: At the controls with Lispro. Diabetes Forecast 32–39, 1997

Rutledge KS, Chase HP, Klingensmith GJ, Walravens PA, Slover RH, Garg SK: Effectiveness of postprandial Humalog in toddlers with diabetes. Pediatrics 100:968–972, 1997

Ryan CM, Atchison J, Puczynski S, Puczynski M, Arslanian S, Becker D: Mild hypoglycemia associated with deterioration of mental efficiency in children with insulin-dependent diabetes mellitus. J Pediatr 117:32–38, 1990

Rovet JF, Ehrlich RM, Hoppe M: Intellectual deficits associated with early onset of insulin-dependent diabetes mellitus in children. Diabetes Care 10:510–515, 1987

Caprio S, Plewe G, Diamond MP, Simonson DC, Boulware SD, Sherwin RS, Tamborlane WV: Increased insulin secretion in puberty: a compensatory response to reductions in insulin sensitivity. J Pediatr 114:963–967, 1989

Amiel SA, Sherwin RS, Simonson DC, Lauritano AA, Tamborlane WV: Impaired insulin action in puberty: a contributing factor to poor glycemic control in adolescents with diabetes. N Engl J Med 315:215–219, 1986

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Diabetes Care

Tập 24 Số 3

430-434

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