Hanna Kwiendacz

Efficacy, Safety, and Quality of Treatment Satisfaction of Premixed Human and Analogue Insulin Regimens in a Large Cohort of Type 2 Diabetic Patients: PROGENS BENEFIT Observational Study

Diabetes is a lifelong course disease, so insulin treatment has to be effective and safe, and patients should be satisfied with it. We aimed to compare efficacy, safety, and quality of treatment satisfaction of human and premixed analogue insulin among 3264 patients (53.58% women) with type 2 diabetes mellitus (T2DM) in a real-life environment. 2493 patients (62.77%) had been assigned to group I where before the inclusion into the study the treatment regimen has been changed from analogue to human premixed insulin and 771 patients (37.23%) to group II where the treatment with insulin analogue remained unchanged. At the end of the study, there was a reduction of HbA1c observed in both of the groups; however, Δ HbA1c was significantly higher in group 1 (−0.599 versus −0.406; P < 0.001 at visit 3 versus visit 1). The number of hypoglycemic episodes during the study observation was insignificantly reduced in both groups. Diabetes treatment satisfaction measured with DTSQ increased at the end of the study and was significantly better in group I compared to group II (P < 0.001). This observational study proved that both human and premixed analogue insulin are effective and safe, and patients are satisfied with the treatment.

Human insulin – is there still a place for it in everyday practice?

Type 2 diabetes is a progressive disease where in case of unsuccessful behavioral modifications and metformin monotherapy treatment needs to be intensified by adding some other oral agents and/or GLP-1 agonists and/ /or basal insulin. After some years of treatment with increasing defect of beta cells, there is a necessity to start or intensify insulin therapy with prandial insulin, premixed insulin, basal-bolus regimen or multiple injections of insulin. Patient’s treatment should be individualized but there are no direct recommendations which type of insulin to choose — human or analogue one. This article summarizes clinical situations in which one could consider using human insulin. When selecting a suitable insulin, the type of dietary habits, especially eating snacks, the presence of gastroparesis and economic issues should be taken into account. It turnes out that for patients with type 2 diabetes both human and analogue insulins are equally safe and efficient in terms of risk of severe hypoglycaemia. Undoubtedly, analogue insulin has uncontestable advantages, but in some clinical cases human insulin seems to be a better option.

Is it necessary to be afraid of vitamin B12 deficiency during metformin treatment

Metformin, a biguanide derivative, is the most frequently used antihyperglycaemic agent in the world. Various adverse effects can occur during the drug therapy. One of them is vitamin B12 deficiency, which may be either asymptomatic (biochemical) or may lead to neurological and/or haematological disorders. Causal diagnosis of these disorders is hampered due to the fact that nervous system symptoms are similar to neurological complications developing over the course of diabetes mellitus. It is estimated that 5.8 to 33% of metformin treated patients have a low (below the reference level) serum vitamin B12 concentration. The interrelation between vitamin B12 deficiency and metformin usage has been known for decades and over that time many studies have been carried out to assess the issue. Unfortunately, these studies were mainly observational, retrospective and performed on nonhomogeneous groups of patients. Recently a meta-analysis of studies concerning only diabetic patients was performed and it demonstrated the existence of a relationship between metformin treatment and vitamin B12 deficiency. Nevertheless, further well-designed, large-scale, randomized studies performed on a homogenous group of patients and employing homogenous criteria for diagnosing vitamin B12 deficiency are necessary in order to decide whether serum vitamin B12 concentration should be routinely checked among metformin treated patients.

Alprostadil in cream — a new option of treating erectile dysfunctions in diabetic patients

Diabetes mellitus is a risk factor for many urological complications, with the most frequent one in men, erectile dysfunction, occurring in patients with diabetes three times more often than in men with normal glucose tolerance. Diabetes contributes to erectile dysfunction through endothelial dysfunction, neuropathy, structural and functional dysfunction of cavernous bodies’ smooth muscles and hormonal disorders. Alprostadil is a synthetic form of Prostaglandin E1, which directly affects arterial smooth muscles and causes vasodilatation. Besides being administrated deeply into the urethra and via injections into cavernous bodies, it might be used as a cream, which is rapidly and almost entirely absorbed into corpus spongiosum and cavernous bodies. It might be used as a first-line treatment for patients who have contraindications for PDE5 inhibitors or prefer topical application of the drug and as a second-line treatment in case of intolerance or no response to PDE5i, also for more complicated clinical cases, often occurring in diabetes. Alprostadil is administrated into the external urethral meatus 5–30 minutes before sexual intercourse; a complete erection appears in 10–12 minutes and lasts 1–2 hours. Due to lack of systemic effects, alprostadil in cream is safe and well tolerated, moreover, it does not interact with intake of food and alcohol. The advanced and effective therapy of erectile dysfunctions, which is alprostadil, helps to improve the quality of life in patients with diabetes.

Pentraxin 3 and atherosclerosis among type 2 diabetic patients

Abstract Type 2 diabetes is contemporarily a major social and epidemiological problem and among others is a strong risk factor for cardiovascular diseases. Pentraxin 3, a potential early biomarker of atherosclerosis, is an acute-phase reactant produced by the peripheral tissues where the inflammation takes place. In this study we examined a group of patients with type 2 diabetes with and without cardiovascular complications compared to persons with normal glucose tolerance (patients with cardiovascular complications and healthy volunteers). Plasma pentraxin 3 concentration as well as some basic biochemical blood analysis were performed. Moreover, transcranial and carotid Doppler ultrasound examination as well as transthoracic echocardiography were performed. It turned out that there was an association of plasma pentraxin 3 concentration and carotid atherosclerosis found in the control group of patients with cardiovascular complications but with normal glucose tolerance. In the group of patients with type 2 diabetes and cardiovascular complications we have found an association of plasma pentraxin 3 concentration with diastolic left ventricular dysfunction. Additionally, in the group of patients with type 2 diabetes without cardiovascular disease plasma pentraxin 3 concentration was associated with elevated urinary albumin creatinine ratio. Further studies, on a larger group of patients, are required to confirm these observations.