Simulation-Based Evaluation of Dose-Titration Algorithms for Rapid-Acting Insulin in Subjects with Type 2 Diabetes Mellitus Inadequately Controlled on Basal Insulin and Oral Antihyperglycemic Medications
| Autor: | Jenny Y. Chien, Xiaosu Ma, Jennal Johnson, James Malone, Vikram Sinha |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
endocrine system diseases Endocrinology Diabetes and Metabolism medicine.medical_treatment Insulin Glargine 030209 endocrinology & metabolism Type 2 diabetes 030226 pharmacology & pharmacy 03 medical and health sciences 0302 clinical medicine Endocrinology Internal medicine Diabetes mellitus medicine Humans Hypoglycemic Agents Insulin lispro Computer Simulation Dosing Glycemic Glycated Hemoglobin Insulin Lispro Dose-Response Relationship Drug business.industry Insulin digestive oral and skin physiology nutritional and metabolic diseases Type 2 Diabetes Mellitus Models Theoretical medicine.disease Metformin Medical Laboratory Technology Diabetes Mellitus Type 2 business Algorithm Algorithms hormones hormone substitutes and hormone antagonists medicine.drug |
| Zdroj: | Diabetes Technology & Therapeutics. 19:483-490 |
| ISSN: | 1557-8593 1520-9156 |
| Popis: | The purpose of this prospective, model-based simulation approach was to evaluate the impact of various rapid-acting mealtime insulin dose-titration algorithms on glycemic control (hemoglobin A1c [HbA1c]).Seven stepwise, glucose-driven insulin dose-titration algorithms were evaluated with a model-based simulation approach by using insulin lispro. Pre-meal blood glucose readings were used to adjust insulin lispro doses. Two control dosing algorithms were included for comparison: no insulin lispro (basal insulin+metformin only) or insulin lispro with fixed doses without titration.Of the seven dosing algorithms assessed, daily adjustment of insulin lispro dose, when glucose targets were met at pre-breakfast, pre-lunch, and pre-dinner, sequentially, demonstrated greater HbA1c reduction at 24 weeks, compared with the other dosing algorithms. Hypoglycemic rates were comparable among the dosing algorithms except for higher rates with the insulin lispro fixed-dose scenario (no titration), as expected. The inferior HbA1c response for the "basal plus metformin only" arm supports the additional glycemic benefit with prandial insulin lispro.Our model-based simulations support a simplified dosing algorithm that does not include carbohydrate counting, but that includes glucose targets for daily dose adjustment to maintain glycemic control with a low risk of hypoglycemia. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|