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Related Concept Videos

Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

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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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Diabetes Mellitus: Overview and Type I Subtype01:22

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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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Insulin: Dosing Regimen and Adverse Effects01:16

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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.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Diabetes Mellitus: Type 2 and Gestational01:22

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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Insulin Formulations: Types and Delivery01:27

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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: Symptoms, Diagnosis, and Complications01:15

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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Recent developments in adjunct therapies for type 1 diabetes.

Joseph G Timmons1, Lucy Littlejohn1, James G Boyle1

  • 1School of Cardiovascular & Metabolic Health, BHF Glasgow Cardiovascular Research Centre (GCRC), 126 University Avenue, University of Glasgow, G12 8TA Glasgow, UK.

Expert Opinion on Investigational Drugs
|January 19, 2023
PubMed
Summary
This summary is machine-generated.

Adjunct therapies, like SGLT2 inhibitors and GLP-1 RAs, are being explored to improve type 1 diabetes (T1D) management. Research reviews their efficacy and safety alongside continuous glucose monitoring for better glycemic control.

Keywords:
Adjunct therapyGLP-1 receptor agonistsSGLT-2 inhibitorstype 1 diabetes

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Area of Science:

  • Endocrinology and Metabolism
  • Pharmacology
  • Diabetes Research

Background:

  • Despite advances in insulin therapy, continuous glucose monitoring (CGM), and automated insulin delivery, achieving optimal long-term glycemic control remains a challenge for most individuals with type 1 diabetes (T1D).
  • Adjunct therapies, used alongside insulin, represent a promising strategy to enhance treatment outcomes in T1D.
  • The ideal adjunct agent should improve glycemic control, aid in weight management, reduce insulin needs, and offer cardiorenal protection without increasing hypoglycemia risk.

Approach:

  • This review examines recent clinical trials investigating adjunct agents in T1D.
  • The efficacy and safety of various adjunct therapies, including pramlintide, SGLT2 inhibitors, metformin, GLP-1 receptor agonists, and DPP-4 inhibitors, are discussed.
  • The analysis considers these agents both as monotherapy and in combination, within the context of standard CGM use.

Key Points:

  • Sodium glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA), known for cardiorenal benefits in type 2 diabetes (T2D), are under investigation for T1D.
  • Pramlintide, an amylin analogue, is approved in the USA, while certain SGLT2 inhibitors have had brief approvals in Europe and the UK for T1D.
  • The potential benefits of T2D adjunct agents for T1D patients are a critical area of ongoing research.

Conclusions:

  • Emerging evidence suggests that adjunct therapies hold potential for improving glycemic control and mitigating complications in T1D.
  • Further research is essential to fully understand the long-term efficacy, safety, and cardiorenal benefits of these agents in the T1D population.
  • Integrating adjunct therapies with advanced monitoring technologies like CGM may pave the way for more personalized and effective T1D management.