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- March 13, 2010 |
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"Starting insulin in Type 2 Diabetes"Dr. Pat Phillips (biography)
English - 2009-03-23 - 48 minutes
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Summary :
Dr Phillips talks about initiation of insulin therapy in type 2 diabetic patients using the KISS (Keep Insulin Safe and Simple) principle.
The use of insulin sooner rather than later in type 2 diabetes is supported by findings from the United Kingdom Prospective Diabetes Study (UKPDS). As the study showed, there was an increasing loss of glycaemic control with time regardless of the type of treatment (intensive or conventional) used. A substudy of the UKPDS did however show that it was possible to maintain the HbA1c below 7 percent by doing stepwise addition of oral agents then insulin when the HbA1c level was going to surpass the target. In this way the progressive nature of the disease is matched with progressive treatment. Therapeutic inertia is however evident; and patients often have reasons to hesitate starting insulin therapy earlier, as well as fears about insulin use.
The UKPDS also showed the risk of hypoglycemia to be increasing with increasing glycaemic control. Compared to type1 patients however, the risk of hypoglycemia is less in type 2 patients. Prof. Phillips explains how the endogenous insulin production in these patients is suppressed when excess exogenous insulin is administered.
The components of the blood glucose profile can be described as the fasting, day-time increment and prandial increment levels. Prof. Phillips goes on to describe how these components should be treated separately, with the fasting and day-time increment (tea-time blood glucose) components being corrected first. The audience is taken through the KISS algorithm, and the types of insulin for starting therapy in type 2 patients are also discussed.
Copyright © 2009 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to:
- Explain the progressive nature of type 2 diabetes
- Demonstrate the rationale for and safety of earlier use of insulin in type 2 diabetes
- Implement the KISS (Keep Insulin Safe and Simple) method for commencement of insulin therapy in type 2 patients
Bibliographic references :
Robert C. Turner, FRCP; Carole A. Cull, PhD; Valeria Frighi, MD; Rury R. Holman, FRCP; for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49) JAMA. 1999;281:2005-2012.
Brown JB, Nichols GA, Perry A.The Burden of Treatment Failure in Type 2 Diabetes
Diabetes Care 27:1535-1540, 2004.
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 (UKPDS 33) Lancet 352; 837-53.1998
Irl B. Hirsch, MD, Richard M. Bergenstal, MD, Christopher G. Parkin, MS, Eugene Wright, Jr., MD and John B. Buse, MD, PhD A Real-World Approach to Insulin Therapy in Primary Care Practice Clinical Diabetes 23:78-86, 2005.
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