Lena Christina Giessmann

Publication Details
Article Title: Risk and Relevance of Insulin Pump Therapy in the Aetiology of Ketoacidosis in People with Type 1 Diabetes.

First Author: Lena Christina Giessmann

All Authors: Giessmann LC, Kann PH

Journal Title: Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association

Abstract: The aim of this systematic data analysis was to determine the prevalence of diabetic ketoacidosis (DKA) as well as hypoglycemic and hyperglycemic disorders during insulin pump therapy (CSII) in patients with type 1 diabetes. The main focus was to investigate whether CSII patients have more DKA than the general type 1 diabetes population.This retrospective study with patients who were treated in our treatment center from 2003 to 2016 includes data from 229 patients (52.4% male, 47.6% female, 37.2±16.3 years; DKA: 93, hypoglycemia: 66, hyperglycemia: 70).Intensified insulin therapy was the most common treatment regimen in the study cohort (73.4%), followed by CSII (24%). However, 32.3% of the patients with DKA were on CSII. This number of DKA cases among the insulin pump users in our study cohort was higher than the prevalence reported in a previously published study by Reichel et al. (2013; p<0.05) and in a customer database (p<0.005). Most common causes of DKA in our study cohort were patient errors (43.3%) or insulin resistance induced by an underlying infection (29.8%). Device malfunction caused 13.5% of all DKA cases with an overwhelming majority on insulin pump treatment (93%). Overall, patient errors caused more DKA cases than device malfunctions.Our findings suggest that despite development of more sophisticated insulin pump devices, DKA is still more frequent with CSII than with other kinds of insulin treatment.

Related Articles

Mini Review Article Open Access Colombia Cardiology and Cardiovascular Medicine Volume 1, Issue 4

Diabetic Cardiomyopathy: Cause or Consequence of Diabetes Mellitus?

Research Article Open Access Iraq Archives of Internal Medicine Research Volume 1, Issue 1

Knowledge and Attitude About Sweeteners Among Type 2 Diabetic Patients

Short Communication Open Access Canada Journal of Psychiatry and Psychiatric Disorders Volume 1, Issue 5

The Diathesis-Stress Model: Psychosocial Stressors, Trauma and Diabetes

Research Article Open Access Ireland Archives of Clinical and Medical Case Reports Volume 2, Issue 6

Motivational Interviewing for Poorly Controlled Type 2 Diabetics in a Rural South African Community

Research Article Open Access Kingdom of Saudi Arabia Archives of Clinical and Medical Case Reports Volume 2, Issue 6
Prevalence of Risk Factors for Diabetes Mellitus and Hypertension Among Adult in Tabuk- Kingdom of Saudi Arabia
Case Report Open Access Turkey Archives of Clinical and Medical Case Reports Volume 1, Issue 3

Severe Rhino-orbital Mucormycosis Infection of anIntensive Care Unit Patient: A Case Report

Research Article Open Access Ghana Archives of Clinical and Biomedical Research Volume 1, Issue 4
Prevalence and Risk Factors of Diabetes Mellitus Among the Inhabitants of Kumasi Metropolis
Research Article Open Access Ghana Archives of Clinical and Biomedical Research Volume 1, Issue 5
Prevalence of the Complications of Diabetes in Developing Countries
Research Article Open Access Saudi Arabia Archives of Clinical and Medical Case Reports Volume 2, Issue 5

Evaluate the Effect of Education Interventions in the Prevention of Diabetic Foot Ulcers through Knowledge of the Disease and Self-Care Practices in Saudi Arabia

Review Article Open Access India Archives of Clinical and Biomedical Research Volume 1, Issue 1
Biochemistry and Pathophysiology of Glycation of DNA: Implications in Diabetes
Geriatrics & gerontology international
Obesity and the prevalence of nocturia in Japanese elderly patients with type 2 diabetes mellitus: The Dogo study.

Authors: Furukawa S, Sakai T, Niiya T, Miyaoka H, Miyake T, Yamamoto S, Maruyama K, Tanaka K, Ueda T, Senba H, Torisu M, Minami H, Tanigawa T, Matsuura B, Hiasa Y, Miyake Y

Abstract: Nocturia is common among patients with type 2 diabetes mellitus, but limited evidence regarding the association between body mass index (BMI) and nocturia exists among such patients. The aim of the present study, therefore, was to evaluate the association between BMI and nocturia among Japanese patients with type 2 diabetes mellitus.Study participants were 809 Japanese patients with type 2 diabetes mellitus. Study participants were considered to have nocturia if they answered "two or more" to the question: "How many times do you typically wake up to urinate from sleeping at night until waking in the morning?" We used the following two outcomes: (i) moderate nocturia was defined as ?2 voids per night; and (ii) severe nocturia was defined as ?3 voids per night. Participants were categorized into four groups according to their BMI: (i) BMI <18.5; (ii) 18.5 ? BMI < 25; (iii) 25 ? BMI < 30; and (iv) BMI ?30. Multiple logistical regression analysis for nocturia in relation to BMI was used, with the category of 18.5 ? BMI < 25 as the reference.Obesity (BMI ?30) was independently positively associated with severe nocturia among elderly patients (age ?65 years) with type 2 diabetes mellitus, but not among young and middle-aged patients: the adjusted OR was 2.96 (95% CI 1.10-7.83). BMI was not associated with moderate nocturia in all patients.In Japanese elderly patients with type 2 diabetes mellitus, obesity was independently positively associated with severe nocturia. Geriatr Gerontol Int 2017; 17: 2460-2465.

Clinical research in cardiology supplements
[Diabetes, sport and exercise].

Authors: Fischer H

Abstract: Physical activity is an essential element in the therapy of type 2 Diabetes mellitus. For physicians and therapists, it is of vital importance to motivate each patient to include exercise into routine daily life. Individual therapy plans are, thus, required.

International journal of cardiology
Effect of glucagon-like peptide-1 on major cardiovascular outcomes in patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials.

Authors: Ding S, Du YP, Lin N, Su YY, Yang F, Kong LC, Ge H, Pu J, He B

Abstract: The effect of glucagon-like peptide-1 (GLP-1) treatment in patients with type 2 diabetes mellitus (T2DM) remains controversial. The purpose of this study was to compare the effect of GLP-1 and placebo/conventional antidiabetic agents on cardiovascular risk in T2DM patients. PubMed, EmBase and the Cochrane Library were searched to identify its eligible studies as well as manual searches for the reliability of this study. All eligible trials were performed in T2DM patients who received GLP-1 therapy or placebo/conventional antidiabetic agents. The reported outcomes included major cardiovascular events (MACE), and total mortality. Of 490 identified studies, we included 13 trials reporting data on 11,943 T2DM patients. Overall, the pooled results suggested that GLP-1 therapy has no or little effect on MACE (RR: 0.99; 95% CI: 0.88-1.12; P=0.872) and total mortality (RR: 0.90; 95% CI: 0.70-1.15; P=0.399). Furthermore, sensitivity analysis indicated that GLP-1 was associated with lower incidence of total mortality (RR: 0.28; 95% CI: 0.08-0.93; P=0.037). We concluded that GLP-1 therapy was not associated with MACE and total mortality compared with placebo or antidiabetic agents.

Anales de medicina interna (Madrid, Spain : 1984)
[Cost-effectiveness analysis of the use of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic model of the CARDS study].

Authors: Fernández de Bobadilla J, López de Sa E, Alonso Troncoso I, Moreno Gómez R, Rubio-Terrés C, Soto Alvarez J

Abstract: To perform a cost-effectiveness analysis of the use of Atorvastatin 10 mg in the primary prevention of cardiovascular disease in patients with type 2 diabetes (DM2).A deterministic and retrospective model by a decision analysis based on CARDS study (Collaborative Atorvastatin Diabetes Study) was performed. In the CARDS study, a significant reduction in cardiovascular morbimortality by the use of Atorvastatin 10 mg versus placebo (5.8 vs. 9.0%, p=0.001) in DM2 patients with an additional condition, had previously been demonstrated. In the present cost-effectiveness analysis, effectiveness units were life years gained (LYG) and quality adjusted life years (QALY), obtained from differences in morbimortality and life expectancy in DM2 patients, with and without previous cardiovascular events. Costs of the evaluated alternatives were obtained from the CARDS results.Incremental cost-effectiveness ratio of using Atorvastin 10 mg versus placebo was 5,886 euro per LYG and 8,046 euro per QALY. Sensitivity analyses confirmed the model stability.In the primary prevention of the cardiovascular disease in type 2 diabetic patients, the use of Atorvastatin 10 mg is cost-effective, with a cost per LYG and per QALY below that of other alternatives widely used in the Spanish National Health System, and also below a value considered as a reasonable threshold for our country, which might unofficialy be around 30,000 euro/ QALY.

JAMA internal medicine
Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus.

Authors: Yaffe K, Falvey CM, Hamilton N, Harris TB, Simonsick EM, Strotmeyer ES, Shorr RI, Metti A, Schwartz AV,

Abstract: Hypoglycemia commonly occurs in patients with diabetes mellitus (DM) and may negatively influence cognitive performance. Cognitive impairment in turn can compromise DM management and lead to hypoglycemia.To prospectively evaluate the association between hypoglycemia and dementia in a biracial cohort of older adults with DM.Prospective population-based study.We studied 783 older adults with DM (mean age, 74.0 years; 47.0% of black race/ethnicity; and 47.6% female) who were participating in the prospective population-based Health, Aging, and Body Composition Study beginning in 1997 and who had baseline Modified Mini-Mental State Examination scores of 80 or higher.Dementia diagnosis was determined during the follow-up period from hospital records indicating an admission associated with dementia or the use of prescribed dementia medications. Hypoglycemic events were determined during the follow-up period by hospital records.During the 12-year follow-up period, 61 participants (7.8%) had a reported hypoglycemic event, and 148 (18.9%) developed dementia. Those who experienced a hypoglycemic event had a 2-fold increased risk for developing dementia compared with those who did not have a hypoglycemic event (34.4% vs 17.6%, P?

Preventive cardiology
Effect of fixed-dose ACE-inhibitor/calcium channel blocker combination therapy vs. ACE-inhibitor monotherapy on arterial compliance in hypertensive patients with type 2 diabetes.

Authors: Winer N, Folker A, Murphy JA, Hung E, Bard M, Perkelvald A, Sowers JR, Bakris GL

Abstract: Assessment of vascular compliance may be a useful measurement of the clinical effects of antihypertensive treatment. Both angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers are known to improve vascular elasticity. A study was performed to test the hypothesis that combined therapy with an ACE inhibitor and a calcium channel blocker would have additive benefits on vascular compliance at similar levels of blood pressure (BP), as compared with monotherapy with an ACE inhibitor. This 12-week, double-blind study was a substudy of a larger clinical hypertension study conducted in patients with hypertension and type 2 diabetes. Subjects (N = 20) were randomized to either a fixed-dose combination of amlodipine besylate/benazepril HCl or to enalapril monotherapy. BP, heart rate, large- and small-vessel compliance, systemic vascular resistance, and urinary microalbumin excretion were assessed at baseline and after treatment. Both treatments were similarly effective in lowering BP, reducing systemic vascular resistance, and decreasing urinary microalbumin excretion. Improvement in large-vessel compliance was significantly greater among subjects who received ACE-inhibitor/calcium channel blocker combination therapy (52%) as compared with those who received ACE-inhibitor monotherapy (32%; p < 0.05). No significant change in small-vessel compliance was observed with either treatment. Greater improvement in large-vessel compliance with combination therapy was independent of BP lowering.

Diabetic medicine : a journal of the British Diabetic Association
Provision of structured diabetes information encourages activation amongst people with diabetes as measured by diabetes care process attainment: the WICKED Project.

Authors: Gillani SM, Nevill A, Singh BM

Abstract: People with diabetes have better outcomes if they actively participate in their care. Patient-focused interventions can be effective in activating patients. Yet there is no known trial to evaluate the impact of the provision of individualized diabetes-specific information on patient activation and diabetes care outcomes.In a randomized controlled trial, all people (n = 14 559) with diabetes within the local health economy were recruited and cluster randomized into two groups with the active group mailed a structured personalized report containing information on all nine of their diabetes care processes, whereas the control group received standard care. Differences in their Failed Process Score (FPS) were compared at three months.At three months, the FPS score (1.25 ± 1.87 vs. 1.35 ± 1.97, P < 0.01) and the change in FPS score (0.48 ± 1.55 vs. 0.42 ± 1.49, P < 0.02) were significantly better in those mailed a structured personalized report. A dichotomized FPS score [good attainment (GA) vs. poorer attainment], was significantly better in those mailed (?2 = 10.0, P < 0.05) and using a binary logistic regression analysis adjusting for all demographic factors and the baseline FPS, the relative effect of mailing compared with non-mailing on three-month GA category was OR 1.14 (95% CI 1.04-1.25, P < 0.01).Provision of structured and individualized information to people with diabetes can positively influence the level of patient activation, promote better engagement and open the potential to improve other crucial diabetes outcomes.

Obesity facts
Risk factors for overweight and diabetes mellitus in residential psychiatric patients.

Authors: Mookhoek EJ, de Vries WA, Hovens JE, Brouwers JR, Loonen AJ

Abstract: To investigate the prevalence of and risk factors for overweight and diabetes mellitus in long-stay psychiatric inpatients.Statistical analysis of data collected from medical, laboratory, and pharmacy files.80% of the 256 patients were suffering from schizophrenia or other psychotic disorders. The prevalence of diabetes mellitus was 15%. The prevalence of a disturbed glucose tolerance was 14%. Severe overweight (BMI > 30) was positively associated with the use of clozapine (odds ratio (OR) = 2.7; 95% confidence interval (CI): 1.31-5.75), but negatively with the diagnosis schizophrenia (OR = 0.4; 95% CI: 0.22-0.88). Diabetes mellitus was associated with severe overweight (OR = 3.5; 95% CI: 1.57-7.69). Caucasian patients were at a lower risk for diabetes mellitus (OR = 0.2; 95% CI: 0.08-0.54).In residential psychiatric patients, diabetes mellitus is especially associated with overweight and non-Caucasian origin. In this survey, the use of clozapine was associated with overweight, but not directly with diabetes mellitus. Diabetes mellitus is highly prevalent, which calls for screening for diabetes mellitus at regular intervals.

Experimental diabetes research
Therapeutics of diabetes mellitus: focus on insulin analogues and insulin pumps.

Authors: Valla V

Abstract: Inadequately controlled diabetes accounts for chronic complications and increases mortality. Its therapeutic management aims in normal HbA1C, prandial and postprandial glucose levels. This review discusses diabetes management focusing on the latest insulin analogues, alternative insulin delivery systems and the artificial pancreas.Intensive insulin therapy with multiple daily injections (MDI) allows better imitation of the physiological rhythm of insulin secretion. Longer-acting, basal insulin analogues provide concomitant improvements in safety, efficacy and variability of glycaemic control, followed by low risks of hypoglycaemia. Continuous subcutaneous insulin infusion (CSII) provides long-term glycaemic control especially in type 1 diabetic patients, while reducing hypoglycaemic episodes and glycaemic variability. Continuous subcutaneous glucose monitoring (CGM) systems provide information on postprandial glucose excursions and nocturnal hypo- and/or hyperglycemias. This information enhances treatment options, provides a useful tool for self-monitoring and allows safer achievement of treatment targets. In the absence of a cure-like pancreas or islets transplants, artificial "closed-loop" systems mimicking the pancreatic activity have been also developed.Individualized treatment plans for insulin initiation and administration mode are critical in achieving target glycaemic levels. Progress in these fields is expected to facilitate and improve the quality of life of diabetic patients.

Proteinuria modifies the effects of physical activity on total and cardiovascular disease mortality rates in patients with type 2 diabetes.

Authors: Vepsäläinen T, Soinio M, Lehto S, Juutilainen A, Laakso M, Rönnemaa T

Abstract: Physical activity reduces cardiovascular disease (CVD) and total mortality rates in patients with type 2 diabetes. However, it is not known whether or not the effects of physical activity on mortality rates depend on the presence of proteinuria in type 2 diabetic patients.We prospectively followed up 577 patients with type 2 diabetes who were aged 45 to 64 years and were free of CVD at baseline. Participants were stratified according to the presence of proteinuria (300 mg/l) and the degree of physical activity (0-4 metabolic equivalent tasks [MET] or >4 MET). The Cox proportional hazards model was used to estimate the association of physical activity and proteinuria with risk of mortality.During the 18-year follow-up, 356 patients died, of whom 217 died from CVD. Physically more active patients had significantly reduced total, CVD and CHD mortality rates if they did not have proteinuria. In contrast, physically active proteinuric patients had significantly increased total and CVD mortality rates (HR 1.83, 95% CI 1.00-3.36, p=0.049) in univariate analyses, with HR 2.43 (95% CI 1.09-5.40, p=0.030) in multivariate analyses.Physical activity reduces total and CVD mortality rates in type 2 diabetic patients without proteinuria. However, in proteinuric patients, no protective effect was observed. Larger studies are needed to confirm the latter finding and to define which exercise intensity leads to possible harmful effects.

News & Announcements

Submit your latest research work to our esteemed journals and publish your articles withour any charges in some of our journals

Follow Us