Premixed insulin for type 2 diabetes,diabetes treatment option quote,diabetes cure pill,drugs used in type 2 diabetes mellitus - Plans On 2016

A wide range of sources have been used to create an equally wide range of types of insulin (rapid acting, fast acting, premixed, intermediate acting and long acting). It is a challenge for diabetologists to assess the conflicting guidelines and decide which one to follow. While this obvious difference remains a subject of much debate and discussion, the issue has not yet been systematically explored. There are alternate explanations to describe the ethnic differences noted in insulin usage.
Logistic factors such as availability of the product often guided the changing trends in type of insulin used in the country.
Theories of learning could also help explain certain aspects of the behavior related to choice of type of insulin among the endocrinologists. Generalization is a concept from classical conditioning that helps explain pairing of conditioned response with stimulus having close resemblance to the conditioned stimulus. Another concept that could help understand this observation is that of cognitive dissonance. Ethnicity may play a key role in determining choice of insulin therapy among different populations.
Strategies for insulin therapy in type 2 diabetes - medscape, Normalizing blood glucose and mimicking normal insulin secretion in patients with type 2 diabetes may prevent the onset and delay the progression of diabetic. Early and aggressive initiation of insulin therapy for, Early and aggressive initiation of insulin therapy for type 2 diabetes: what is the evidence?. Insulin therapy in type 2 diabetes – nice cks, 2016-03-01 last revised in july 2016 back to top summary: insulin therapy in type 2 diabetes. Outpatient insulin therapy in type 1 and type 2 diabetes, Review from jama — outpatient insulin therapy in type 1 and type 2 diabetes mellitus — scientific review — contextnewer insulin therapies, including the concept. New developments in insulin therapy for type 2 diabetes, Exogenous insulin is well established as the primary and lifesaving therapy for type 1 diabetes. The rapid early rise of insulin secretion in response to a meal is critical, because it ensures the prompt inhibition of endogenous glucose production by the liver disposal of the mealtime carbohydrate load, thus limiting postprandial glucose excursions. Touch Pad Question Currently, roughly ____ of my patients with type 2 diabetes are taking some form of insulin. Those at high risk of hypoglycemia and with multiple diabetic complications should be advised against prolonged fasting. The fasting period of Ramadan among Muslims requires special attention for diabetic patients in particular.
I±-Glucosidase inhibitors are used successfully in the Middle Eastern population during Ramadan.
Vildagliptin has been compared with different sulfonylurea agents, with and without metformin combination, during Ramadan. Type 2 diabetes is associated with a progressive decline in insulin secretion and I?-cell loss with increased duration of diabetes.
Many patients soon after a clinical diagnosis of diabetes need to be treated with insulin injections. Premixed insulin is a commonly prescribed formulation for the outpatient management of patients with type 2 diabetes.
Muslim countries, premixed insulins are among the most frequently prescribed formulations in patients with type 2 diabetes. A number of dietary interventions have been shown to be effective in the management of patients with type 2 diabetes.
Daily consumption of dates is a deeply rooted tradition among Muslims, especially during the Ramadan. These are long night prayers, which are not obligatory but highly recommended, that last for 1a€“2a€…h.
In Pakistan, patients with diabetes fast for an average of 20a€“25a€…days during the month of Ramadan. While some of these insulins are no longer in clinical use, others are being used extensively across the world. Insulin has gone through various modifications, with the currently available range of insulin having a little resemblance to the brown crystalline powder produced in 1921. While premixed insulin is the most frequently prescribed and used insulin in Asia, basal insulin is more extensively used in USA.

This is especially true with regard to choosing appropriate insulin for initiation of therapy. A multicentre study performed in 4 continents compared once daily premixed aspart insulin with once daily glargine insulin. There is no published literature exploring the reasons behind this variation in response across different ethnicity to the best of our knowledge.
At times, patients on prandial insulin had to be shifted to premixed insulin as insulin shortages hit the country.19 At other times, such decisions were guided by convenience as well. Consequently closely resembling stimuli tend to induce same response in spite of a lack of repeated pairing of the relatively novel stimulus. Cognitive dissonance is a state of discomfort caused by holding conflicting ideas simultaneously. Introduction of the concept of ethnopharmacy to diabetology can help systematically study this interesting aspect of diabetes care.
Premix Insulin: Initiation and Continuation Guidelines for Management of Diabetes in Primary Care. Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes.
An observational non-interventional study of people with diabetes beginning or changed to insulin analogue therapy in non-Western countries: the A1chieve study.
Initiating insulin therapy in type 2 Diabetes: a comparison of biphasic and basal insulin analogs. Twice daily biphasic insulin aspart improves postprandial glycaemic control more effectively than twice daily NPH insulin, with low risk of hypoglycaemia, in patients with type 2 diabetes. Risk for nocturnal hypoglycaemia with biphasic insulin aspart 30 compared with biphasic human insulin 30 in adults with type 2 diabetes mellitus: A meta-analysis. Initiating insulin therapy with, or switching existing insulin therapy to, biphasic insulin aspart 30a?„70 (NovoMix_ 30) in routine care: safety and effectiveness in patients with type 2 diabetes in the IMPROVETM observational study. Once-daily initiation with biphasic insulin aspart 30 versus insulin glargine in patients with type 2 diabetes inadequately controlled with oral drugs: an open-label, multinational RCT.
Initiation with once-daily BIAsp 30 results in superior outcome compared to insulin glargine in Asians with type 2 diabetes inadequately controlled by oral anti-diabetic drugs. Because of this variation, time periods indicated here should be considered general guidelines only.
TableA 1 lists the benefits and concerns of commonly used oral antidiabetic agents during Ramadan.
The total insulin dose frequently needs to be adjusted during Ramadan in patients with type 1 or type 2 diabetes. Box 2 lists the common sources of 15a€…g of carbohydrates that are usually sufficient to correct mild-to-moderate hypoglycemic events. There is no data on the safety and efficacy of SGLT-2 inhibitors during the fasting period of Ramadan.
Premixed insulin is the most frequently prescribed and used insulin in Asia; basal insulin is more extensively used in USA. A wide range of sources (bovine, porcine, bovine-porcine, human, analogue) have been used to create an equally wide range of types of insulin (rapid acting, fast acting, premixed, intermediate acting and long acting).
A lot of controversy continues to exist regarding the ideal insulin for initiation and intensification. Some unique regional and cultural concerns existing in developing nations are summarized in Figure 1. Evidence is available in support of both premixed and basal insulin, though clinical trials have shown that the use of premixed insulin twice-daily provides superior glycaemic control versus basal insulin.9-10 Biphasic insulin aspart 30 is a premixed insulin analogue that contains 30% rapid-acting insulin aspart and 70% protaminated insulin aspart. Insulin usage in America and Europe dates back to the 1920a€™s when it was a treatment for type 1 diabetes, rather than type 2 diabetes. Though this may be termed improvisation, it actually led to innovation, when it was noted that both type 1 and type 2 patients responded well to premixed insulin. Thus in a western outpatient department (OPD), when the conditioned stimulus of a patient of type 1 diabetes (which formed a large proportion of early diabetes clinics) was replaced by an unconditioned stimulus of uncontrolled type 2 diabetes, the response of the physician was the same basal insulin, with or without bolus insulin. Physicians, much like other fellow human beings, tend to rationalize their previous behavior and thoughts in order to avoid cognitive dissonance. Various bio-psycho-behavioral concepts can also be used to understand and explain these observations across different regions of the world with regards to choice of type of insulin in treatment of diabetes.

As compared with basal insulin alone, premixed regimens tend to lower HbA1c to a larger degree while providing enhanced convenience. The position statement of the American Diabetes Association (ADA) and European Association for Study of Diabetes (EASD) recommend beginning therapy with basal insulin. The recently reported baseline results of A1cheiveA®, the largest global observational study in diabetes, reinforce this opinion.
Its safety and efficacy has been demonstrated in numerous randomized clinical trials, meta-analyses and observational studies.8-15 Traditionally, however, premixed insulin has always been thought of as twice daily insulin.
Successive generations of endocrinologists were trained to use insulin, in a prandial, and later, basal-bolus regimen in patients with type 1 diabetes with absolute insulin deficiency. The use of premixed insulin was associated with less number of infections and monitoring thus cutting down costs dramatically. On the other hand, the Indian physician was conditioned to the stimulus in form of type 2 diabetes (as type 1 formed a minuscule proportion of his practice).
Hence it is possible that a physician who has learnt to use basal bolus insulin in type 1 diabetes continues to use the same regimen in type 2 diabetes. There is a need to systematically study these possible hypotheses in order to have a clear understanding on these issues.
20-40% " title="Touch Pad Question Currently, roughly ____ of my patients with type 2 diabetes are taking some form of insulin.
In an interesting observation, they state that a€?a more convenient but less adaptable method involves a€?premixeda€™ insulin, consisting of a fixed combination of intermediate insulin with regular insulin or a rapid analoguea€?. Sparingly available insulin was initially used sparingly in type 2 diabetics, who were considered for insulin therapy only during life threatening complications. This a€?innovative improvisationa€™ led to effective results, which strengthened the popularity of premixed insulin as the insulin of choice in the country.
Consequent to the initial response of use of premixed insulin the same response was generalized to other diabetes types. This may be done subconsciously in order to avoid discrediting his earlier effort of using a particular type of insulin that was deemed to be effective.
It must be mentioned here that use of a specific insulin type was strengthened by a positive reinforcement in form of clinical response, i.e.
The same could be used to explain another interesting observation of prescription of premixed insulin to people with type 1 diabetes in certain centers in India in spite of the obvious differences between these two conditions.
Besides, ethnicity may play a key role in determining choice of insulin therapy among different populations.
The Indian National Premixed guidelines go a step further and recommend use of premixed insulin as a preferred mode of initiating and intensifying therapy.4 Similar views are echoed in national guidelines from Bangladesh. This occurs because subconsciously, the treating physician achieves cognitive concordance by prescribing the same type of insulin to all people with diabetes.
Here, the authors discuss the various factors, pharmacological as well as psychological, that have made premixed insulins the preferred insulin for type 2 diabetes in India and the many parts of Asia.
Looking at the available data, postprandial plasma glucose (PPG) peaks are the major factor leading to cardiovascular disease (CVD) and mortality. Had a satisfactory therapeutic response not occurred, generalization or use of premixed insulin would not have continued.
One should endeavor, however, to emphasize the subtle (and not so subtle) differences between the various forms of diabetes, to ensure optimal therapy of diverse patients. The authors utilize well known theories of psychology, namely generalization, cognitive dissonance and concordance to provide a rational explanation for the preference for premixed insulin that Indian people with diabetes, and their physicians, have. The association between mortality and PPG is much stronger than the one between mortality and fasting plasma glucose (FPG).5 Any treatment that targets PPG is superior when we compare it with outcomes to therapy which targets FPG.
This can be done successfully during postgraduate training and through continuing medical education programmes.

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