Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impa...Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impact of this transition in subjects with Type 1 DM is recently reported. Objective: To examine the impact of this transition on various parameters of diabetes management in Type 2 DM. Subjects and Methods: A retrospective review of the records of subjects with Type 2 DM was conducted until 8/2007 in whom the transition had occurred. Only those subjects with adequate glycemic control while receiving insulin glargine [GI] and completing at least 3 months of therapy with insulin detemir [DI] are included in this report. Ten subjects with Type 2 DM, duration 7 ± 2 years with age, 55 ± 3 years who were switched from GI to DI (Group 1) fulfilled the criteria for inclusion. Subjects were switched from GI in Q AM to DI Q HS in the same daily dose. Glycemic control (HbA1c), body weight, daily insulin dose (Units) and severe hypoglycemic events during the last 2 weeks of the period, pre switch and again at the end of 3 months post switch were assessed. Records of 8 subjects matched for age, duration of DM, glycemic control while receiving GI for additional 3 months (Group 2) during the same period were examined for comparison. All subjects were followed in the outpatient clinic at intervals of 3 months. Results Glycemic control remained stable on continuing GI AM;HbA1c;7.1 ± 0.3 to 7.1 ± 0.3%, while it worsened on switching to DI Q HS;HbA1c, 7.1 ± 0.3 to 8.1 ± 0.5 [P < 0.01]. A mild weight loss was noted in subjects on transition. No severe hypoglycemic events were reported in any subject in either group. Conclusion Abrupt transition from insulin glargine to insulin detemir in subjects with Type 2 DM is likely to result in lapse of glycemic control which may cause decreased quality of life. Furthermore, use of insulin detemir may result in increased costs due to need of the higher daily dose as well as additional equipment required for probable twice daily administration to achieve adequate glycemic control. Therefore, insulin glargine and detemir appear to be far from being bioequivalent.展开更多
Objective: Octreotide three times daily is re-ported to reduce daily insulin by 50% in patients with Type 1 DM. Therefore, we assessed the impact of long acting Octreotide (Sandostatin LAR) monthly Intramuscular admin...Objective: Octreotide three times daily is re-ported to reduce daily insulin by 50% in patients with Type 1 DM. Therefore, we assessed the impact of long acting Octreotide (Sandostatin LAR) monthly Intramuscular administration in a subject with Type 1 DM. Methods: A 32-year-old man with Type 1 DM of 16 years participated after obtaining informed consent. He had no microvascular or macrovascular complications. He continued the present insulin regimen for four weeks. IM Sandostatin LAR 20 mg was initiated and increased at four weeks to 30 mg. He was followed every four weeks for six months. Insulin regimen was adjusted every two weeks based on blood glucose before meals, bedtime and on onset of hypoglycemic symptoms. He continued other medications, previous diet and activity Assessment of HbA1c, serum electrolytes, urea nitrogen, creatinine, TSH, free T4, liver enzymes, complete blood cell counts, vitamin B12, lipids and insulin regimen were performed at the initiation and end of the study. Results: HbA1c declined from 9 to 8% with reduction in daily insulin dose from 55 to 43 units, with a major reduction in insulin Glargine, 50 to 40 units. Body weight remained unaltered. Other laboratory tests including gallbladder examina-tion remained unchanged Conclusion: Monthly Sandostatin LAR administration may improve glycemic control with less insulin in Type 1 DM.展开更多
Background: Low free T4 and normal/low TSH concentrations are often noted in clinical practice and denote presence of “Euthyroid Sick Syndrome” or Central Hypothyroidism. However, accurate diagnosis is difficult eve...Background: Low free T4 and normal/low TSH concentrations are often noted in clinical practice and denote presence of “Euthyroid Sick Syndrome” or Central Hypothyroidism. However, accurate diagnosis is difficult even with determination of free T3 being low/normal in both. Repeated determination of these tests may help differentiate between these disorders. Objective: Evaluation of reverse T3 to differentiate between “Euthyroid Sick Syndrome” and Central Hypothyroidism. Subjects and Methods: Free T3 and Reverse T3 were determined as “add on” tests using previously drawn blood samples of 78 consecutive adults showing low free T4, 0.80 ± 0.02 and low/normal TSH, 1.29 ± 0.40 [normal ranges, 0.89 - 1.70 mcg/dl;0.45 - 4.67 uU/ml]. Free T4, free T3, TSH and reverse T3 levels were also determined in age-matched 35 healthy volunteers and reassessed in study group. Statistical analyses for comparisons were conducted between groups. All data are reported as Mean ± SEM. Results: Reverse T3 established two distinct groups: 1) subnormal concentrations, 8.31 ± 0.52 [range, 11 - 14 ng/dl];2) supernormal levels;32 ± 4 [normal Range 12 - 26]. Free T3 concentrations were subnormal or normal, 1.6 - 2.9 [normal range, 2.3 - 4.2 ng/ml] in individuals amongst both groups. On reassessment after 3 - 6 weeks, free T4, free T3, TSH and reverse T3 normalized in group with normal or elevated reverse T3 indicating recovery from “Euthyroid Sick Syndrome” whereas free T4 and reverse T3 remained subnormal in the other group suggesting presence of Central Hypothyroidism. Conclusion: Reverse T3 is a reliable laboratory test differentiating between Central Hypothyroidism and “Euthyroid Sick Syndrome” in subjects with low free T4 and low/normal TSH levels.展开更多
文摘Background: Iowa Care (Iowa Medicaid in State of Iowa, USA), switched insulin glargine to detemir in subjects with Diabetes Mellitus (DM) without the knowledge or approval of healthcare providers beginning 8/2006.Impact of this transition in subjects with Type 1 DM is recently reported. Objective: To examine the impact of this transition on various parameters of diabetes management in Type 2 DM. Subjects and Methods: A retrospective review of the records of subjects with Type 2 DM was conducted until 8/2007 in whom the transition had occurred. Only those subjects with adequate glycemic control while receiving insulin glargine [GI] and completing at least 3 months of therapy with insulin detemir [DI] are included in this report. Ten subjects with Type 2 DM, duration 7 ± 2 years with age, 55 ± 3 years who were switched from GI to DI (Group 1) fulfilled the criteria for inclusion. Subjects were switched from GI in Q AM to DI Q HS in the same daily dose. Glycemic control (HbA1c), body weight, daily insulin dose (Units) and severe hypoglycemic events during the last 2 weeks of the period, pre switch and again at the end of 3 months post switch were assessed. Records of 8 subjects matched for age, duration of DM, glycemic control while receiving GI for additional 3 months (Group 2) during the same period were examined for comparison. All subjects were followed in the outpatient clinic at intervals of 3 months. Results Glycemic control remained stable on continuing GI AM;HbA1c;7.1 ± 0.3 to 7.1 ± 0.3%, while it worsened on switching to DI Q HS;HbA1c, 7.1 ± 0.3 to 8.1 ± 0.5 [P < 0.01]. A mild weight loss was noted in subjects on transition. No severe hypoglycemic events were reported in any subject in either group. Conclusion Abrupt transition from insulin glargine to insulin detemir in subjects with Type 2 DM is likely to result in lapse of glycemic control which may cause decreased quality of life. Furthermore, use of insulin detemir may result in increased costs due to need of the higher daily dose as well as additional equipment required for probable twice daily administration to achieve adequate glycemic control. Therefore, insulin glargine and detemir appear to be far from being bioequivalent.
文摘Objective: Octreotide three times daily is re-ported to reduce daily insulin by 50% in patients with Type 1 DM. Therefore, we assessed the impact of long acting Octreotide (Sandostatin LAR) monthly Intramuscular administration in a subject with Type 1 DM. Methods: A 32-year-old man with Type 1 DM of 16 years participated after obtaining informed consent. He had no microvascular or macrovascular complications. He continued the present insulin regimen for four weeks. IM Sandostatin LAR 20 mg was initiated and increased at four weeks to 30 mg. He was followed every four weeks for six months. Insulin regimen was adjusted every two weeks based on blood glucose before meals, bedtime and on onset of hypoglycemic symptoms. He continued other medications, previous diet and activity Assessment of HbA1c, serum electrolytes, urea nitrogen, creatinine, TSH, free T4, liver enzymes, complete blood cell counts, vitamin B12, lipids and insulin regimen were performed at the initiation and end of the study. Results: HbA1c declined from 9 to 8% with reduction in daily insulin dose from 55 to 43 units, with a major reduction in insulin Glargine, 50 to 40 units. Body weight remained unaltered. Other laboratory tests including gallbladder examina-tion remained unchanged Conclusion: Monthly Sandostatin LAR administration may improve glycemic control with less insulin in Type 1 DM.
文摘Background: Low free T4 and normal/low TSH concentrations are often noted in clinical practice and denote presence of “Euthyroid Sick Syndrome” or Central Hypothyroidism. However, accurate diagnosis is difficult even with determination of free T3 being low/normal in both. Repeated determination of these tests may help differentiate between these disorders. Objective: Evaluation of reverse T3 to differentiate between “Euthyroid Sick Syndrome” and Central Hypothyroidism. Subjects and Methods: Free T3 and Reverse T3 were determined as “add on” tests using previously drawn blood samples of 78 consecutive adults showing low free T4, 0.80 ± 0.02 and low/normal TSH, 1.29 ± 0.40 [normal ranges, 0.89 - 1.70 mcg/dl;0.45 - 4.67 uU/ml]. Free T4, free T3, TSH and reverse T3 levels were also determined in age-matched 35 healthy volunteers and reassessed in study group. Statistical analyses for comparisons were conducted between groups. All data are reported as Mean ± SEM. Results: Reverse T3 established two distinct groups: 1) subnormal concentrations, 8.31 ± 0.52 [range, 11 - 14 ng/dl];2) supernormal levels;32 ± 4 [normal Range 12 - 26]. Free T3 concentrations were subnormal or normal, 1.6 - 2.9 [normal range, 2.3 - 4.2 ng/ml] in individuals amongst both groups. On reassessment after 3 - 6 weeks, free T4, free T3, TSH and reverse T3 normalized in group with normal or elevated reverse T3 indicating recovery from “Euthyroid Sick Syndrome” whereas free T4 and reverse T3 remained subnormal in the other group suggesting presence of Central Hypothyroidism. Conclusion: Reverse T3 is a reliable laboratory test differentiating between Central Hypothyroidism and “Euthyroid Sick Syndrome” in subjects with low free T4 and low/normal TSH levels.
