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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Related Experiment Video

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Improving IV Insulin Administration in a Community Hospital
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Positioning time in range in diabetes management.

Andrew Advani1

  • 1Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute, St Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada. andrew.advani@unityhealth.to.

Diabetologia
|November 9, 2019
PubMed
Summary
This summary is machine-generated.

Continuous glucose monitoring (CGM) provides new diabetes metrics like time in range (TIR). While TIR is valuable, it should be considered alongside time below range (TBR) for a complete picture of glucose control.

Keywords:
CGMDiabetes complicationsHbA1cHyperglycaemiaHypoglycaemiaReviewTime below rangeTime in range

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Area of Science:

  • Endocrinology and Metabolism
  • Diabetes Technology
  • Clinical Research

Background:

  • Continuous glucose monitoring (CGM) offers advanced glucose control indicators beyond traditional lab tests.
  • Time in Range (TIR) is an intuitive metric representing the percentage of time glucose levels remain within a target range.
  • TIR is increasingly discussed between patients and healthcare providers, with standardized targets emerging.

Purpose of the Study:

  • To review the current understanding of TIR's association with diabetes complications and HbA1c.
  • To highlight the limitations of TIR as a standalone metric, particularly concerning hypoglycemia.
  • To discuss the importance of incorporating Time Below Range (TBR) and Time Above Range (TAR) for comprehensive glucose management.

Main Methods:

  • Review of existing literature linking TIR to diabetes complications and HbA1c.
  • Analysis of the role of TBR and TAR in interpreting glucose control data from CGM.
  • Summary of recent consensus recommendations for setting 'time in ranges' goals.

Main Results:

  • Emerging evidence suggests a link between TIR and reduced risk of diabetes complications.
  • TIR shows an inverse association with HbA1c levels.
  • TIR alone is insufficient for assessing hypoglycemia risk due to skewed glucose distributions.

Conclusions:

  • Recommended targets for most people with type 1 or type 2 diabetes include TIR >70%, TBR (<3.9 mmol/l) <4%, and TBR (<3.0 mmol/l) <1%.
  • Less stringent targets are advised for specific populations like older adults, high-risk individuals, and those under 25.
  • Individualized glycaemic targets are crucial, especially when utilizing personal CGM data.