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Bad Heilbrunn, Germany

MacGilchrist C.,Glasgow Caledonian University | Paul L.,Glasgow Caledonian University | Paul L.,University of Glasgow | Ellis B.M.,Glasgow Caledonian University | And 3 more authors.
Diabetic Medicine | Year: 2010

Background Older people with diabetes mellitus (DM) may be at high risk of falling because of general risk factors for falls as well as disease-specific factors. Aims To determine the prevalence of falls and to investigate lower-limb factors for falls in older people with DM. Methods Sixty patients with DM over 55 years of age were recruited. 'Fallers' were those who self-reported at least one fall in the previous year. In addition to diabetes status and demographic information, the following were assessed: neuropathy symptom score (NSS), neuropathy disability score (NDS), foot deformity score (FDS), Tinetti performance-oriented assessment of mobility (POMA), ankle muscle strength and gait parameters. Data from 'fallers' and 'non-fallers' were compared and logistic regression analysis performed to identify variables predictive of falls. Results Thirty-five per cent (n = 21) of participants had fallen in the preceding year. Compared with 'non-fallers', there was a greater incidence of peripheral neuropathy among 'fallers' (86% of 'fallers' and 56% of 'non-fallers'), higher vibration perception threshold (P = 0.04), slower gait velocity (P < 0.001), lower muscle strength for dorsiflexion, plantarflexion, inversion and eversion (all P < 0.001) and higher incidence of bony prominences and prominent metatarsal heads (both P < 0.001). There was a strong and significant correlation between dorsiflexion muscle strength and gait velocity. Logistic regression analysis determined that walking velocity, strength of ankle dorsiflexors and NSS accurately predicted 75% of 'fallers'. Conclusions Simple clinical measures of gait velocity and ankle muscle strength may be used to identify people with DM at risk of falling, allowing preventative strategies to be implemented. © 2010 Diabetes UK. Source

Heise T.,Profil Institute For Stoffwechselforschung | Tack C.J.,Radboud University Nijmegen | Cuddihy R.,International Diabetes Center | Davidson J.,University of Texas at Dallas | And 6 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - Insulin degludec/insulin aspart (IDegAsp) is a soluble coformulation of the novel basal analog insulin degludec (IDeg: 70%) and insulin aspart (IAsp: 30%). We compared the safety and efficacy of IDegAsp, an alternative formulation (AF) (55%IDeg and 45% IAsp), and insulin glargine (IGlar) in insulin-naïve subjects with type 2 diabetes inadequately controlled with oral antidiabetic drugs. RESEARCH DESIGN AND METHODS - In this 16-week, open-label trial, subjects (mean age 59.1 years, A1C 8.5%, BMI 30.3 kg/m 2) were randomized to once-daily IDegAsp (n = 59), AF (n = 59), or IGlar (n = 60), all in combination with metformin. Insulin was administered before the evening meal and dose-titrated to a fasting plasma glucose (FPG) target of 4.0-6.0 mmol/L. RESULTS - After 16 weeks, mean A1C decreased in all groups to comparable levels (IDegAsp: 7.0%; AF: 7.2%; IGlar: 7.1%). A similar proportion of subjects achieved A1C <7.0% without confirmed hypoglycemia in the last 4 weeks of treatment (IDegAsp: 51%; AF: 47%; IGlar: 50%). Mean 2-h postdinner plasma glucose increase was lower for IDegAsp (0.13 mmol/L) and AF (0.24mmol/L) than IGlar (1.63 mmol/L), whereasmean FPG was similar (IDegAsp: 6.8mmol/L; AF: 7.4 mmol/L; IGlar: 7.0 mmol/L). Hypoglycemia rates were lower for IDegAsp and IGlar than AF (1.2, 0.7, and 2.4 events/patient year). Nocturnal hypoglycemic events occurred rarely for IDegAsp (1 event) and IGlar (3 events) compared with AF (27 events). CONCLUSIONS - In this proof-of-concept trial, once-daily IDegAsp was safe, well tolerated, and provided comparable overall glycemic control to IGlar at similar low rates of hypoglycemia, but better postdinner plasma glucose control. © 2011 by the American Diabetes Association. Source

Liebl A.,Center for Diabetes and Metabolism
Primary care diabetes | Year: 2010

The treatment of type 2 diabetes is shifting from secondary specialist centres to the primary care setting. However, for this shift to be sustainable and successful, primary care physicians (PCPs) must effectively provide aspects of diabetes care traditionally supplied by specialists. In particular, the early and appropriate use of insulin in type 2 diabetes will increasingly become the responsibility of PCPs. This review examines how patients with type 2 diabetes are currently managed across several European countries, and explores the evidence around insulin use in type 2 diabetes and the implications for primary care. 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd.. All rights reserved. Source

Leichter S.B.,Center for Diabetes and Metabolism | Leichter S.B.,Mercer University | Bowman K.,Columbus Research Foundation | Adkins R.A.,Columbus Research Foundation | Jelsovsky Z.,BioStat International
Diabetes Technology and Therapeutics | Year: 2013

Background: Previous studies have provided limited guidance regarding the clinical efficacy and cost-effectiveness of interventions using "telemedicine" models in the management of diabetes mellitus. We conducted a study to determine if routine clinical assessments of diabetes patients could be effectively conducted via computer and telephone interaction with patients and still provide clinical results similar to traditional office care. Subjects and Methods: We enrolled 100 subjects with diabetes in this 12-month, randomized, controlled, non-inferiority study. Subjects were randomized (1:1 ratio) to a control group (CG) or study group (SG). Baseline characteristics were similar. CG subjects participated in quarterly office visits; SG subjects participated in two office visits (months 6 and 12) and two telemedicine interactions (months 3 and 9). Changes in clinical measurements (hemoglobin A1c [HbA1c], blood pressure, lipids, body mass index [BMI], and body weight) and clinician time requirements were assessed. Results: Seventy subjects completed the study (CG, n=37; SG, n=33). No significant between-group differences in HbA1c, blood pressure, lipids, or BMI were seen at 12 months. SG subjects showed significantly greater reductions in mean (SD) body weight compared with CG subjects: -5.2 (1.6) pounds versus -0.7 (1.5) pounds, respectively (P=0.04). Clinician time requirements for SG subjects were reduced by >40%. Conclusions: Our study demonstrated that use of a telemedicine-based treatment protocol in diabetes patients is feasible and efficient and yields similar clinical outcomes compared with traditional, clinic-based protocols. Telemedicine applications of computer software can potentially expand access to care for patients and may reduce costs for patients, providers, and payers. © Mary Ann Liebert, Inc. Source

Liebl A.,Center for Diabetes and Metabolism | Khunti K.,University of Leicester | Orozco-Beltran D.,University Miguel Hernandez | Yale J.-F.,McGill University
Clinical Medicine Insights: Endocrinology and Diabetes | Year: 2015

Type 2 diabetes mellitus (T2D) is a growing healthcare burden primarily due to long-term complications. Strict glycemic control helps in preventing complications, and early introduction of insulin may be more cost-effective than maintaining patients on multiple oral agents. This is an expert opinion review based on English peer-reviewed articles (2000-2012) to discuss the health economic consequences of T2D treatment intensification. T2D costs are driven by inpatient care for treatment of diabetes complications (40%-60% of total cost), with drug therapy for glycemic control representing 18% of the total cost. Insulin therapy provides the most improved glycemic control and reduction of complications, although hypoglycemia and weight gain may occur. Early treatment intensification with insulin analogs in patients with poor glycemic control appears to be cost-effective and improves clinical outcomes. © the authors, publisher and licensee Libertas Academica Limited. Source

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