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[PMID]:29241887
[Au] Autor:Dawoud D; Fenu E; Higgins B; Wonderling D; Amiel SA
[Ad] Endereço:National Guideline Centre, Royal College of Physicians, London, UK; Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt. Electronic address: dalia.dawoud@rcplondon.ac.uk.
[Ti] Título:Basal Insulin Regimens for Adults with Type 1 Diabetes Mellitus: A Cost-Utility Analysis.
[So] Source:Value Health;20(10):1279-1287, 2017 12.
[Is] ISSN:1524-4733
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To assess the cost-effectiveness of basal insulin regimens for adults with type 1 diabetes mellitus in England. METHODS: A cost-utility analysis was conducted in accordance with the National Institute for Health and Care Excellence reference case. The UK National Health Service and personal and social services perspective was used and a 3.5% discount rate was applied for both costs and outcomes. Relative effectiveness estimates were based on a systematic review of published trials and a Bayesian network meta-analysis. The IMS CORE Diabetes Model was used, in which net monetary benefit (NMB) was calculated using a threshold of £20,000 per quality-adjusted life-year (QALY) gained. A wide range of sensitivity analyses were conducted. RESULTS: Insulin detemir (twice daily) [iDet (bid)] had the highest mean QALY gain (11.09 QALYs) and NMB (£181,456) per patient over the model time horizon. Compared with the lowest cost strategy (insulin neutral protamine Hagedorn once daily), it had an incremental cost-effectiveness ratio of £7844/QALY gained. Insulin glargine (od) [iGlarg (od)] and iDet (od) were ranked as second and third, with NMBs of £180,893 and £180,423, respectively. iDet (bid) remained the most cost-effective treatment in all the sensitivity analyses performed except when high doses were assumed (>30% increment compared with other regimens), where iGlarg (od) ranked first. CONCLUSIONS: iDet (bid) is the most cost-effective regimen, providing the highest QALY gain and NMB. iGlarg (od) and iDet (od) are possible options for those for whom the iDet (bid) regimen is not acceptable or does not achieve required glycemic control.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 1/tratamento farmacológico
Hipoglicemiantes/administração & dosagem
Insulina Detemir/administração & dosagem
Insulina Glargina/administração & dosagem
Insulina Isófana/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Teorema de Bayes
Glicemia/efeitos dos fármacos
Simulação por Computador
Análise Custo-Benefício
Diabetes Mellitus Tipo 1/economia
Inglaterra
Feminino
Seres Humanos
Hipoglicemiantes/economia
Insulina Detemir/economia
Insulina Glargina/economia
Insulina Isófana/economia
Masculino
Meia-Idade
Modelos Econômicos
Anos de Vida Ajustados por Qualidade de Vida
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Hypoglycemic Agents); 2ZM8CX04RZ (Insulin Glargine); 4FT78T86XV (Insulin Detemir); 53027-39-7 (Insulin, Isophane)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180202
[Lr] Data última revisão:
180202
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:28953430
[Au] Autor:Wu JW; Azoulay L; Majdan A; Boivin JF; Pollak M; Suissa S
[Ad] Endereço:Jennifer W. Wu, Laurent Azoulay, Jean-François Boivin, and Samy Suissa, McGill University; Jewish General Hospital; Michael Pollak, McGill University; and Agnieszka Majdan, Jewish General Hospital, Montreal, Quebec, Canada.
[Ti] Título:Long-Term Use of Long-Acting Insulin Analogs and Breast Cancer Incidence in Women With Type 2 Diabetes.
[So] Source:J Clin Oncol;35(32):3647-3653, 2017 Nov 10.
[Is] ISSN:1527-7755
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Purpose The association between long-acting insulin analogs and increased breast cancer risk is uncertain, particularly with the short follow-up in previous studies. We assessed this risk long term in women with type 2 diabetes. Methods A population-based cohort of women 40 years or older, all of whom were treated with long-acting (glargine, detemir) or neutral protamine Hagedorn (NPH) insulin between 2002 and 2012, was formed using the United Kingdom's Clinical Practice Research Datalink. Women were followed until February 2015 or breast cancer diagnosis. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% CIs of incident breast cancer, comparing long-acting insulin analogs with NPH overall, as well as by duration and cumulative dose. Results The cohort included 22,395 women who received insulin treatment, with 321 incident breast cancer events occurring during up to 12 years of follow-up (incidence rate 3.3 per 1,000 person-years). Compared with NPH insulin, insulin glargine was associated with an increased risk of breast cancer (HR, 1.44; 95% CI, 1.11 to 1.85), mainly increasing 5 years after glargine initiation (HR, 2.23; 95% CI, 1.32 to 3.77) and after > 30 prescriptions (HR, 2.29; 95% CI, 1.26 to 4.16). The risk was particularly elevated among prior insulin users (HR, 1.53; 95% CI, 1.10 to 2.12) but not for new users, which included fewer patients and for which one cannot rule out an HR of 1.81. The risk associated with insulin detemir was not significantly elevated (HR, 1.17; 95% CI, 0.77 to 1.77). Conclusion Long-term use of insulin glargine is associated with an increased risk of breast cancer in women with type 2 diabetes. The risk associated with insulin detemir remains uncertain because there are fewer users of this insulin.
[Mh] Termos MeSH primário: Neoplasias da Mama/epidemiologia
Diabetes Mellitus Tipo 2/complicações
Diabetes Mellitus Tipo 2/tratamento farmacológico
Hipoglicemiantes/uso terapêutico
[Mh] Termos MeSH secundário: Idoso
Canadá
Feminino
Seres Humanos
Hipoglicemiantes/efeitos adversos
Incidência
Insulina Detemir/uso terapêutico
Insulina Glargina/uso terapêutico
Insulina Isófana/uso terapêutico
Meia-Idade
Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hypoglycemic Agents); 2ZM8CX04RZ (Insulin Glargine); 4FT78T86XV (Insulin Detemir); 53027-39-7 (Insulin, Isophane)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170928
[St] Status:MEDLINE
[do] DOI:10.1200/JCO.2017.73.4491


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[PMID]:28234565
[Au] Autor:Takahashi H; Nishimura R; Onda Y; Ando K; Tsujino D; Utsunomiya K
[Ad] Endereço:a Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine , Jikei University School of Medicine , Tokyo , Japan.
[Ti] Título:Comparison of glycemic variability in Japanese patients with type 1 diabetes receiving insulin degludec versus insulin detemir using continuous glucose monitoring: a randomized, cross-over, pilot study.
[So] Source:Expert Opin Pharmacother;18(4):335-342, 2017 Mar.
[Is] ISSN:1744-7666
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To use continuous glucose monitoring (CGM) to compare glycemic variability in patients with type 1 diabetes (T1D) treated with insulin degludec (IDeg) versus insulin detemir (IDet). METHODS: Ten patients with T1D were randomly assigned to receive once-daily IDeg, followed by twice-daily IDet, or vice versa. Glucose variability was evaluated by CGM after >4 weeks of the first insulin and again after crossover to the second insulin. RESULTS: The total daily insulin dose (U/kg/day) and the total daily basal insulin dose (U/kg/day) were significantly lower during treatment with IDeg than with IDet [median (interquartile range): 0.55 (0.54-0.73) vs. 0.64 (0.54-0.83); P = 0.028, 0.24 (0.19-0.36) vs. 0.30 (0.19-0.39); P = 0.027]. The 24-hour mean glucose levels were not significantly different. However, their standard deviation (SD) was significantly smaller during treatments with IDeg than those with IDet [59.5 (39.5-71.0) vs. 72.8 (61.8-92.8); P = 0.008]. Their mean fasting glucose levels and the mean postprandial peak levels after breakfast and after dinner were significantly lower with IDeg. CONCLUSIONS: A CGM-based comparison demonstrated that once-daily IDeg showed fewer glycemic fluctuations than twice-daily IDet. IDeg appears to stabilize blood glucose levels better during both daytime and nighttime (particularly, before and after breakfast) with a lower insulin dosage.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 1/tratamento farmacológico
Hipoglicemiantes/uso terapêutico
Insulina Detemir/uso terapêutico
Insulina de Ação Prolongada/uso terapêutico
[Mh] Termos MeSH secundário: Glicemia/efeitos dos fármacos
Estudos Cross-Over
Feminino
Seres Humanos
Masculino
Meia-Idade
Projetos Piloto
Período Pós-Prandial
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Hypoglycemic Agents); 0 (Insulin, Long-Acting); 4FT78T86XV (Insulin Detemir); 54Q18076QB (insulin degludec)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170310
[Lr] Data última revisão:
170310
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170225
[St] Status:MEDLINE
[do] DOI:10.1080/14656566.2017.1293652


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[PMID]:28156005
[Au] Autor:O'Neill SM; Kenny LC; Khashan AS; West HM; Smyth RM; Kearney PM
[Ad] Endereço:Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, 5th Floor, Cork University Maternity Hospital, Wilton, Cork, Munster, Ireland.
[Ti] Título:Different insulin types and regimens for pregnant women with pre-existing diabetes.
[So] Source:Cochrane Database Syst Rev;2:CD011880, 2017 02 03.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Insulin requirements may change during pregnancy, and the optimal treatment for pre-existing diabetes is unclear. There are several insulin regimens (e.g. via syringe, pen) and types of insulin (e.g. fast-acting insulin, human insulin). OBJECTIVES: To assess the effects of different insulin types and different insulin regimens in pregnant women with pre-existing type 1 or type 2 diabetes. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 October 2016), ClinicalTrials.gov (17 October 2016), the WHO International Clinical Trials Registry Platform (ICTRP; 17 October 2016), and the reference lists of retrieved studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that compared different insulin types and regimens in pregnant women with pre-existing diabetes.We had planned to include cluster-RCTs, but none were identified. We excluded quasi-randomised controlled trials and cross-over trials. We included studies published in abstract form and contacted the authors for further details when applicable. Conference abstracts were superseded by full publications. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias, and checked for accuracy. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS: The findings in this review were based on very low-quality evidence, from single, small sample sized trial estimates, with wide confidence intervals (CI), some of which crossed the line of no effect; many of the prespecified outcomes were not reported. Therefore, they should be interpreted with caution. We included five trials that included 554 women and babies (four open-label, multi-centre, two-arm trials; one single centre, four-arm RCT). All five trials were at a high or unclear risk of bias due to lack of blinding, unclear methods of randomisation, and selective reporting of outcomes. Pooling of data from the trials was not possible, as each trial looked at a different comparison.1. One trial (N = 33 women) compared Lispro insulin with regular insulin and provided very low-quality evidence for the outcomes. There were seven episodes of pre-eclampsia in the Lispro group and nine in the regular insulin group, with no clear difference between the two groups (risk ratio (RR) 0.68, 95% CI 0.35 to 1.30). There were five caesarean sections in the Lispro group and nine in the regular insulin group, with no clear difference between the two groups (RR 0.59, 95% CI 0.25 to 1.39). There were no cases of fetal anomaly in the Lispro group and one in the regular insulin group, with no clear difference between the groups (RR 0.35, 95% CI 0.02 to 8.08). Macrosomia, perinatal deaths, episodes of birth trauma including shoulder dystocia, nerve palsy, and fracture, and the composite outcome measure of neonatal morbidity were not reported.2. One trial (N = 42 women) compared human insulin to animal insulin, and provided very low-quality evidence for the outcomes. There were no cases of macrosomia in the human insulin group and two in the animal insulin group, with no clear difference between the groups (RR 0.22, 95% CI 0.01 to 4.30). Perinatal death, pre-eclampsia, caesarean section, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy and fracture and the composite outcome measure of neonatal morbidity were not reported.3. One trial (N = 93 women) compared pre-mixed insulin (70 NPH/30 REG) to self-mixed, split-dose insulin and provided very low-quality evidence to support the outcomes. Two cases of macrosomia were reported in the pre-mixed insulin group and four in the self-mixed insulin group, with no clear difference between the two groups (RR 0.49, 95% CI 0.09 to 2.54). There were seven cases of caesarean section (for cephalo-pelvic disproportion) in the pre-mixed insulin group and 12 in the self-mixed insulin group, with no clear difference between groups (RR 0.57, 95% CI 0.25 to 1.32). Perinatal death, pre-eclampsia, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy, or fracture and the composite outcome measure of neonatal morbidity were not reported.4. In the same trial (N = 93 women), insulin injected with a Novolin pen was compared to insulin injected with a conventional needle (syringe), which provided very low-quality evidence to support the outcomes. There was one case of macrosomia in the pen group and five in the needle group, with no clear difference between the different insulin regimens (RR 0.21, 95% CI 0.03 to 1.76). There were five deliveries by caesarean section in the pen group compared with 14 in the needle group; women were less likely to deliver via caesarean section when insulin was injected with a pen compared to a conventional needle (RR 0.38, 95% CI 0.15 to 0.97). Perinatal death, pre-eclampsia, fetal anomaly, birth trauma including shoulder dystocia, nerve palsy, or fracture, and the composite outcome measure of neonatal morbidity were not reported.5. One trial (N = 223 women) comparing insulin Aspart with human insulin reported none of the review's primary outcomes: macrosomia, perinatal death, pre-eclampsia, caesarean section, fetal anomaly, birth trauma including shoulder dystocia. nerve palsy, or fracture, or the composite outcome measure of neonatal morbidity.6. One trial (N = 162 women) compared insulin Detemir with NPH insulin, and supported the outcomes with very low-quality evidence. There were three cases of major fetal anomalies in the insulin Detemir group and one in the NPH insulin group, with no clear difference between the groups (RR 3.15, 95% CI 0.33 to 29.67). Macrosomia, perinatal death, pre-eclampsia, caesarean section, birth trauma including shoulder dystocia, nerve palsy, or fracture and the composite outcome of neonatal morbidity were not reported. AUTHORS' CONCLUSIONS: With limited evidence and no meta-analyses, as each trial looked at a different comparison, no firm conclusions could be made about different insulin types and regimens in pregnant women with pre-existing type 1 or 2 diabetes. Further research is warranted to determine who has an increased risk of adverse pregnancy outcome. This would include larger trials, incorporating adequate randomisation and blinding, and key outcomes that include macrosomia, pregnancy loss, pre-eclampsia, caesarean section, fetal anomalies, and birth trauma.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 1/tratamento farmacológico
Diabetes Mellitus Tipo 2/tratamento farmacológico
Hipoglicemiantes/uso terapêutico
Insulina/uso terapêutico
Complicações na Gravidez/tratamento farmacológico
Gravidez em Diabéticas/tratamento farmacológico
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Hipoglicemiantes/administração & dosagem
Insulina/administração & dosagem
Insulina Aspart/uso terapêutico
Insulina Detemir/uso terapêutico
Insulina Lispro/uso terapêutico
Gravidez
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Hypoglycemic Agents); 0 (Insulin); 0 (Insulin Lispro); 4FT78T86XV (Insulin Detemir); D933668QVX (Insulin Aspart)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170619
[Lr] Data última revisão:
170619
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170204
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD011880.pub2


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[PMID]:28042719
[Au] Autor:Strandberg AY; Khanfir H; Mäkimattila S; Saukkonen T; Strandberg TE; Hoti F
[Ad] Endereço:a University of Helsinki, Helsinki, Finland, and Aava Medical Centre , Kerava , Finland.
[Ti] Título:Insulins NPH, glargine, and detemir, and risk of severe hypoglycemia among working-age adults.
[So] Source:Ann Med;49(4):357-364, 2017 Jun.
[Is] ISSN:1365-2060
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The longer acting basal insulin analogs glargine and detemir have shown a lower incidence of hypoglycemia compared to insulin NPH in clinical studies. We evaluated the real-life risk of severe hypoglycemia among new users of insulins in the working-age population in Finland. METHODS: All persons aged 18-65 years with diabetes mellitus who were newly prescribed with insulins NPH, glargine, or detemir during 2006-2009, were identified from national registers. Risk of severe hypoglycemia requiring hospital care was compared between insulin types. RESULTS: A total of 16,985 persons initiated basal insulin treatment (5586, 7499, and 3900 patients started NPH, glargine, and detemir, respectively) during follow-up. Five hundred and thirty-six persons were hospitalized because of severe hypoglycemia. Absolute rate (per 1000 patient-years) was 20.6 (95% CI 17.9, 23.8), 17.8 (15.6, 20.3), and 12.4 (9.9, 15.5) for NPH, glargine, and detemir initiators, respectively. With NPH as reference, the adjusted hazard ratio (HR) was 0.92 (95% CI 0.74, 1.15, p = 0.47) for glargine, and 0.70 (0.51, 0.94, p= 0.018) for detemir. The HR for detemir compared to glargine was 0.76 (0.58, 0.99, p = 0.040). CONCLUSIONS: Initiating insulin treatment with detemir, but not with glargine, was associated with a significantly lower risk of severe hypoglycemia compared to NPH, among working-age adults. KEY MESSAGES The comparative safety of modern basal insulins regarding hypoglycemia among the working-age population is unclear. Large reductions in the incidence of severe hypoglycemia were seen among real-life patients who started insulin detemir, as compared to patients who initiated glargine or especially NPH insulin. Given the large amount of patients using insulin, these findings may have considerable clinical consequences at the population level.
[Mh] Termos MeSH primário: Diabetes Mellitus/tratamento farmacológico
Hipoglicemia/epidemiologia
Insulina Detemir/efeitos adversos
Insulina Glargina/efeitos adversos
Insulina Isófana/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Feminino
Hospitalização/estatística & dados numéricos
Seres Humanos
Hipoglicemia/induzido quimicamente
Insulina Detemir/uso terapêutico
Insulina Glargina/uso terapêutico
Insulina Isófana/uso terapêutico
Estudos Longitudinais
Masculino
Meia-Idade
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
2ZM8CX04RZ (Insulin Glargine); 4FT78T86XV (Insulin Detemir); 53027-39-7 (Insulin, Isophane)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170103
[St] Status:MEDLINE
[do] DOI:10.1080/07853890.2016.1278302


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[PMID]:27879196
[Au] Autor:Rathmann W; Czech M; Franek E; Kostev K
[Ti] Título:Treatment persistence in the use of basal insulins in Poland and Germany
.
[So] Source:Int J Clin Pharmacol Ther;55(2):119-125, 2017 Feb.
[Is] ISSN:0946-1965
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:AIMS: To compare short-term basal insulin therapy persistence and its predictors in Poland and Germany. METHODS: Persistence was defined as proportions of patients remaining on the initial basal insulin (analogs: Poland: n = 6,889, Germany: n = 454,067; neutral protamine Hagedorn (NPH) insulins: Poland: n = 50,761, Germany: n = 226,064) over 2 years based on nationwide prescription databases (LRx; IMS Health) in Poland and Germany from 2013 to 2015. Persistence was evaluated by Kaplan-Meier curves (log-rank tests). Risk of discontinuation of initial basal insulin was investigated using Cox regression models adjusting for age, sex, comedication with other glucose-lowering agents and baseline or comedication with antihypertensives, lipid-lowering drugs, antidepressants, and antiepileptics. RESULTS: In Poland, 2-year persistence was 83.0% in analog insulin and 73.3% in NPH users (p < 0.001). In Germany, persistence was also higher in patients with analog insulins (92.6% vs. 79.0%; p < 0.001). Analog insulin users were less likely to discontinue basal insulin compared with NPH users (adjusted hazard ratio (95%CI): Poland: 0.73 (0.67 - 0.79); Germany: 0.27 (0.27 - 0.28)). Higher age (> 75 vs. ≤ 60 years: Poland: 1.24 (1.16 - 1.33), Germany: 1.09 (1.07 - 1.11)) and GLP-1 receptor agonist use (Poland: 2.76 (1.38 - 5.53), Germany: 1.21 (1.16 - 1.26)) were related to higher risk of discontinuation. Male sex, metformin, sulfonylurea, thiazolidinedione, and short-acting insulin prescriptions as well as antihypertensive, anti-epileptic, and lipid-lowering drug use were associated with lower risk of discontinuation in both countries (all p < 0.05). CONCLUSIONS: This real-world study shows that both in Poland and Germany treatment persistence of newly-prescribed basal insulin is influenced by type of insulin (analog vs. NPH) and by glucose-lowering and other comedications.
.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/tratamento farmacológico
Hipoglicemiantes/uso terapêutico
Insulina de Ação Prolongada/uso terapêutico
Adesão à Medicação
[Mh] Termos MeSH secundário: Idoso
Biomarcadores/sangue
Glicemia/efeitos dos fármacos
Glicemia/metabolismo
Distribuição de Qui-Quadrado
Comorbidade
Bases de Dados Factuais
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/diagnóstico
Diabetes Mellitus Tipo 2/epidemiologia
Prescrições de Medicamentos
Feminino
Alemanha/epidemiologia
Seres Humanos
Hipoglicemiantes/efeitos adversos
Insulina Detemir/uso terapêutico
Insulina Glargina/uso terapêutico
Insulina Isófana/uso terapêutico
Insulina de Ação Prolongada/efeitos adversos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Análise Multivariada
Polônia/epidemiologia
Polimedicação
Modelos de Riscos Proporcionais
Fatores de Risco
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Biomarkers); 0 (Blood Glucose); 0 (Hypoglycemic Agents); 0 (Insulin, Long-Acting); 2ZM8CX04RZ (Insulin Glargine); 4FT78T86XV (Insulin Detemir); 53027-39-7 (Insulin, Isophane)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170626
[Lr] Data última revisão:
170626
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161124
[St] Status:MEDLINE
[do] DOI:10.5414/CP202772


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[PMID]:27854036
[Au] Autor:Fatima S; Sen P; Sneha P; Priyadoss CG
[Ad] Endereço:Genes and Proteins Lab, Department of Biotechnology, Jamia Millia Islamia, New Delhi, 110025, India. sfatima1@jmi.ac.in.
[Ti] Título:Hydrophobic Interaction Between Domain I of Albumin and B Chain of Detemir May Support Myristate-Dependent Detemir-Albumin Binding.
[So] Source:Appl Biochem Biotechnol;182(1):82-96, 2017 May.
[Is] ISSN:1559-0291
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The bindings of detemir [LysB29(Nε-tetradecanoyl)des(B30)-insulin] with two highly homologous albumins, HSA (human serum albumin) and BSA (bovine serum albumin), were investigated through CD, spectrofluorophotometry, and molecular docking analysis. The absence of any tryptophanyl residue in detemir makes albumin binding study possible by exclusive tryptophanyl spectral quenching at 340 nm (λem = 296 nm). The interactions found to be static (Kq > 10 M s ) with Stern-Volmer constants ≈10 M . The observed ΔG that was negative in all cases concludes the reactions were spontaneous. Domains I and III of an albumin unfold with 5.0 M urea at pH 7.4, although domain II remains intact. Significant decreases in ΔH and ΔS were due to unfolding explicit that detemir binding may involve domains I and III of albumins. Temperature-dependent changes in binding were higher in HSA than BSA but after unfolding such changes were very less, further indicating the role of domains I and III in detemir binding. Pro28 and Tyr26 of insulin were found to be interacting with Arg114 and Val116 of HSA domain I, while myristate segment of detemir binds to Lys519 of domain III. Interactions seem to be predominantly hydrophobic and entropy driven. Although detemir binds to albumin through myristate, the peptide part shows involvement in binding.
[Mh] Termos MeSH primário: Insulina Detemir/química
Ácido Mirístico/química
Soroalbumina Bovina/química
Albumina Sérica/química
[Mh] Termos MeSH secundário: Sequência de Aminoácidos
Animais
Sítios de Ligação
Bovinos
Seres Humanos
Interações Hidrofóbicas e Hidrofílicas
Cinética
Simulação de Acoplamento Molecular
Ligação Proteica
Domínios e Motivos de Interação entre Proteínas
Desdobramento de Proteína
Termodinâmica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Serum Albumin); 0I3V7S25AW (Myristic Acid); 27432CM55Q (Serum Albumin, Bovine); 4FT78T86XV (Insulin Detemir)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161118
[St] Status:MEDLINE
[do] DOI:10.1007/s12010-016-2312-4


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[PMID]:27717130
[Au] Autor:Singh S; Wright EE; Kwan AY; Thompson JC; Syed IA; Korol EE; Waser NA; Yu MB; Juneja R
[Ad] Endereço:Johns Hopkins University School of Medicine, Baltimore, Maryland.
[Ti] Título:Glucagon-like peptide-1 receptor agonists compared with basal insulins for the treatment of type 2 diabetes mellitus: a systematic review and meta-analysis.
[So] Source:Diabetes Obes Metab;19(2):228-238, 2017 Feb.
[Is] ISSN:1463-1326
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Since 2005, several glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been approved to treat people with type 2 diabetes. These agents are considered for use at the same point in the treatment paradigm as basal insulins. A comprehensive comparison of these drug classes, therefore, can help inform treatment decisions. This systematic review and meta-analysis assessed the clinical efficacy and safety of GLP-1 RAs compared with basal insulins. MATERIALS AND METHODS: MEDLINE, EMBASE, CENTRAL and PubMed databases were searched. Randomized clinical trials (RCTs) of ≥16 weeks' duration comparing GLP-1 RAs vs basal insulins in adults with type 2 diabetes inadequately controlled with oral antihyperglycemic drugs were included. Data on the change from baseline to 26 weeks (±10 weeks) of treatment in hemoglobin A1c (HbA1c) and weight, as well as the proportion of patients experiencing hypoglycaemia, were extracted. Fixed-effect pairwise meta-analyses were conducted where data were available from ≥2 studies. RESULTS: Fifteen RCTs were identified and 11 were meta-analysed. The once-weekly GLP-1 RAs, exenatide long acting release (LAR) and dulaglutide, led to greater, statistically significant mean HbA1c reductions vs basal insulins (exenatide: -0.31% [95% confidence interval -0.42, -0.19], dulaglutide: -0.39% [-0.49, -0.29]) whilst once-daily liraglutide and twice-daily exenatide did not (liraglutide: 0.06% [-0.06, 0.18], exenatide: 0.01% [-0.11, 0.13]). Mean weight reduction was seen with all GLP-1 RAs while mean weight gain was seen with basal insulins. Interpretation of the analysis of hypoglycaemia was limited by inconsistent definitions and reporting. Because of the limited number of available studies sensitivity analyses to explore heterogeneity could not be conducted. CONCLUSIONS: Although weight reduction is seen with all GLP-1 RA's, only the once-weekly agents, exenatide LAR and dulaglutide, demonstrate significant HbA1c reductions when compared to basal insulins.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/tratamento farmacológico
Hipoglicemiantes/uso terapêutico
Incretinas/administração & dosagem
Insulina/uso terapêutico
[Mh] Termos MeSH secundário: Glicemia/metabolismo
Diabetes Mellitus Tipo 2/metabolismo
Receptor do Peptídeo Semelhante ao Glucagon 1/agonistas
Peptídeos Semelhantes ao Glucagon/administração & dosagem
Peptídeos Semelhantes ao Glucagon/análogos & derivados
Hemoglobina A Glicada/metabolismo
Seres Humanos
Hipoglicemia/induzido quimicamente
Fragmentos Fc das Imunoglobulinas/administração & dosagem
Insulina Detemir/uso terapêutico
Insulina Glargina/uso terapêutico
Insulina de Ação Prolongada/uso terapêutico
Liraglutida/administração & dosagem
Peptídeos/administração & dosagem
Proteínas Recombinantes de Fusão/administração & dosagem
Peçonhas/administração & dosagem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Blood Glucose); 0 (Glucagon-Like Peptide-1 Receptor); 0 (Glycated Hemoglobin A); 0 (Hypoglycemic Agents); 0 (Immunoglobulin Fc Fragments); 0 (Incretins); 0 (Insulin); 0 (Insulin, Long-Acting); 0 (Peptides); 0 (Recombinant Fusion Proteins); 0 (Venoms); 0 (hemoglobin A1c protein, human); 2ZM8CX04RZ (Insulin Glargine); 4FT78T86XV (Insulin Detemir); 54Q18076QB (insulin degludec); 62340-29-8 (Glucagon-Like Peptides); 839I73S42A (Liraglutide); 9P1872D4OL (exenatide); WTT295HSY5 (dulaglutide)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161008
[St] Status:MEDLINE
[do] DOI:10.1111/dom.12805


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[PMID]:27593206
[Au] Autor:Heise T; Mathieu C
[Ad] Endereço:Profil GmbH, Neuss, Germany.
[Ti] Título:Impact of the mode of protraction of basal insulin therapies on their pharmacokinetic and pharmacodynamic properties and resulting clinical outcomes.
[So] Source:Diabetes Obes Metab;19(1):3-12, 2017 Jan.
[Is] ISSN:1463-1326
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Manufacturers of insulin products for diabetes therapy have long sought ways to modify the absorption rate of exogenously administered insulins in an effort to better reproduce the naturally occurring pharmacokinetics of endogenous insulin secretion. Several mechanisms of protraction have been used in pursuit of a basal insulin, for which a low injection frequency would provide tolerable and reproducible glucose control; these mechanisms have met with varying degrees of success. Before the advent of recombinant DNA technology, development focused on modifications to the formulation that increased insulin self-association, such as supplementation with zinc or the development of preformed precipitates using protamine. Indeed, NPH insulin remains widely used today despite a frequent need for a twice-daily dosing and a relatively high incidence of hypoglycaemia. The early insulin analogues used post-injection precipitation (insulin glargine U100) or dimerization and albumin binding (insulin detemir) as methods of increasing therapeutic duration. These products approached a 24-hour glucose-lowering effect with decreased variability in insulin action. Newer basal insulin analogues have used up-concentration in addition to precipitation (insulin glargine U300), and multihexamer formation in addition to albumin binding (insulin degludec), to further increase duration of action and/or decrease the day-to-day variability of the glucose-lowering profile. Clinically, the major advantage of these recent analogues has been a reduction in hypoglycaemia with similar glycated haemoglobin control when compared with earlier products. Future therapies may bring clinical benefits through hepato-preferential insulin receptor binding or very long durations of action, perhaps enabling once-weekly administration and the potential for further clinical benefits.
[Mh] Termos MeSH primário: Diabetes Mellitus/tratamento farmacológico
Hipoglicemiantes/farmacologia
Insulina/farmacologia
[Mh] Termos MeSH secundário: Química Farmacêutica
Diabetes Mellitus/metabolismo
Seres Humanos
Hipoglicemia/induzido quimicamente
Hipoglicemiantes/efeitos adversos
Insulina/análogos & derivados
Insulina Detemir/efeitos adversos
Insulina Detemir/farmacologia
Insulina Glargina/efeitos adversos
Insulina Glargina/farmacologia
Insulina Isófana/efeitos adversos
Insulina Isófana/farmacologia
Insulina Lenta/farmacologia
Insulina de Ação Prolongada/efeitos adversos
Insulina de Ação Prolongada/farmacologia
Proteínas Recombinantes/farmacologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Hypoglycemic Agents); 0 (Insulin); 0 (Insulin, Long-Acting); 0 (Recombinant Proteins); 117442-98-5 (NovoSol Basal insulin); 2ZM8CX04RZ (Insulin Glargine); 4FT78T86XV (Insulin Detemir); 53027-39-7 (Insulin, Isophane); 54Q18076QB (insulin degludec); 8049-62-5 (Insulin, Lente)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171107
[Lr] Data última revisão:
171107
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160906
[St] Status:MEDLINE
[do] DOI:10.1111/dom.12782


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[PMID]:27130075
[Au] Autor:Cichosz SL; Lundby-Christensen L; Johansen MD; Tarnow L; Almdal TP; Hejlesen OK; Group TC
[Ad] Endereço:Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
[Ti] Título:Prediction of excessive weight gain in insulin treated patients with type 2 diabetes.
[So] Source:J Diabetes;9(4):325-331, 2017 Apr.
[Is] ISSN:1753-0407
[Cp] País de publicação:Australia
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Weight gain is an ongoing challenge when initiating insulin therapy in patients with type 2 diabetes mellitus (T2DM). However, if prediction of insulin-associated weight gain was possible on an individual level, targeted initiatives could be implemented to reduce weight gain. The aim of the present study was to identify predictors of weight gain in insulin-treated patients with T2DM. METHODS: In all, 412 individuals with T2DM were, in addition to metformin or placebo, randomized into 18-month treatment groups with three different insulin analog treatment regimens (biphasic, aspart, detemir). Participants with excessive weight gain were defined as the group with weight gain in the 4th quartile (>6.2 kg).We developed a pattern classification method to predict individuals prone to excessive weight gain. RESULTS: Over the 18-month treatment period, median weight gain among all 412 patients was 2.4 kg (95% prediction interval [PI] -5.6, 12.4 kg), whereas median weight gain for those in the upper 4th quartile (n = 103) was 8.9 kg (95% PI 6.3, 15.2 kg). No clinical baseline data were strong predictors of excessive weight gain. However, the weight gain during the first 3 months of the trial and the subsequent dose of insulin yielded a useful predictor for weight gain at the 18-month follow-up. Combining these two predictors into a prediction model with other clinical available information produced a receiver operating characteristic area under the curve of 0.80. CONCLUSIONS: We have developed a prediction model that could help identify a substantial proportion of individuals with T2DM prone to large weight gain during insulin therapy.
[Mh] Termos MeSH primário: Insulinas Bifásicas/uso terapêutico
Diabetes Mellitus Tipo 2/tratamento farmacológico
Insulina Aspart/uso terapêutico
Insulina Detemir/uso terapêutico
Ganho de Peso/efeitos dos fármacos
[Mh] Termos MeSH secundário: Idoso
Insulinas Bifásicas/efeitos adversos
Glicemia/metabolismo
Distribuição de Qui-Quadrado
Diabetes Mellitus Tipo 2/sangue
Diabetes Mellitus Tipo 2/fisiopatologia
Quimioterapia Combinada
Feminino
Seguimentos
Hemoglobina A Glicada/metabolismo
Seres Humanos
Hipoglicemiantes/efeitos adversos
Hipoglicemiantes/uso terapêutico
Insulina Aspart/efeitos adversos
Insulina Detemir/efeitos adversos
Modelos Logísticos
Masculino
Metformina/uso terapêutico
Meia-Idade
Prognóstico
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Biphasic Insulins); 0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (Hypoglycemic Agents); 4FT78T86XV (Insulin Detemir); 9100L32L2N (Metformin); D933668QVX (Insulin Aspart)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160501
[St] Status:MEDLINE
[do] DOI:10.1111/1753-0407.12418



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