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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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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: Management and Pharmacotherapy01:15

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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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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Web-Based, Algorithm-Guided Insulin Titration in Insulin-Treated Type 2 Diabetes: Pre-Post Intervention Study.

Nishanth Thiagarajan1, Hong Chang Tan1, Suresh Rama Chandran1

  • 1Department of Endocrinology, Singapore General Hospital, 20 College Road, Academia, Singapore, 169856, Singapore, 65 88900691.

JMIR Formative Research
|February 9, 2025
PubMed
Summary
This summary is machine-generated.

This study shows that a web-based diabetes management platform with algorithm-guided insulin titration significantly improved glycemic control in type 2 diabetes patients. High adherence and mild hypoglycemia episodes indicate its feasibility for routine care.

Keywords:
appdiabetesinsulininterventionmobilemonitoringtechnology

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Area of Science:

  • Endocrinology
  • Digital Health
  • Metabolic Diseases

Background:

  • Self-monitoring of blood glucose (SMBG) via web platforms shows promise for type 2 diabetes (T2D) management.
  • Effectiveness of algorithm-guided insulin titration in Asian populations using these platforms is understudied.

Purpose of the Study:

  • To evaluate the efficacy and safety of the ALRT telehealth solution for improving glycemic control in insulin-treated T2D patients.
  • The ALRT solution integrates SMBG with algorithm-driven insulin dose adjustments.

Main Methods:

  • A 24-week, pre-post intervention study with 25 adults with T2D on twice-daily premixed insulin.
  • Participants used a mobile app for SMBG data upload, receiving algorithm-generated insulin titration recommendations reviewed by physicians.
  • Primary outcome: change in hemoglobin A1c (HbA1c); Secondary outcomes: fasting plasma glucose, insulin dose, hypoglycemia, and SMBG adherence.

Main Results:

  • Significant HbA1c reduction from 8.6% to 7.4% (P<.001).
  • Fasting plasma glucose decreased significantly (P<.001).
  • High SMBG adherence (97.3%); mild hypoglycemia episodes increased but no severe events occurred.

Conclusions:

  • Web-based glucose monitoring with algorithm-guided dosing significantly improves glycemic control in insulin-treated T2D.
  • High adherence suggests feasibility for routine care, with predominantly mild hypoglycemia.
  • The intervention shows promise for T2D management, especially in resource-constrained settings.