Extensive clinical experience: a simple guide to basal insulin adjustments for long-distance travel.
Ontology highlight
ABSTRACT:
SUBMITTER: Pinsker JE
PROVIDER: S-EPMC7962589 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Long-distance travel across multiple time zones presents unique challenges for patients taking insulin, requiring adjustments in both timing and dosage of basal insulin when several times zones (?5) are traversed. Travel across the International Date Line adds to the confusion, as existing resources and dosing calculators often do not account for the date change. We review recommendations from available guidelines and dosage calculators used for long-distance travel basal insulin adjustments and then present our patient handouts which allow for a safe, specific, single dose adjustment for eastward and westward travel. The included handouts are easy to use and can be freely reproduced for use in diabetes clinics.
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Project description:AimsBasal-bolus therapy is associated with greater treatment burden and lower adherence compared with more simplified regimens. This post hoc analysis studied the difference between insulin degludec/liraglutide (IDegLira) and basal-bolus therapy on number of injections, dose adjustments and patient outcomes in the DUAL VII trial.Materials and methodsDUAL VII was a 26-week, open-label trial in which patients with uncontrolled type 2 diabetes who were using metformin and insulin glargine 100 units/mL (20-50 U) were randomized 1:1 to IDegLira (N = 252) or basal-bolus (insulin glargine U100 + insulin aspart ≤4 times/day) (N = 254). This post hoc analysis reports the observed mean number of injections and cumulative dose adjustments during 26 weeks of treatment. Patient-reported outcomes (Treatment-Related Impact Measure - Diabetes [TRIM-D] and Short Form-36 Health Survey version 2 [SF-36v2]) were collected at scheduled visits and change from baseline scores calculated.ResultsThe clinical benefits (non-inferior HbA1c reductions, weight benefit, less hypoglycaemia) of IDegLira vs basal-bolus therapy were achieved with fewer cumulative dose adjustments (16.6 vs 217.2, respectively) and fewer injections (1 vs ≥3 per day, respectively). Patients treated with IDegLira experienced significant improvements across all TRIM-D domains compared with those undergoing basal-bolus therapy. The SF-36v2 showed improvements in both treatment arms with no significant difference between arms in the physical component summary, but there was a significant improvement in patients treated with IDegLira in the mental component summary (P = .0228).ConclusionsThese findings, combined with the DUAL VII results, suggest that IDegLira, through a more simplified regimen versus basal-bolus therapy, may help improve patient adherence and improve patient outcomes related to diabetes management, treatment burden and mental health, which in turn may assist in the timely achievement of glycaemic control in clinical practice.
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Project description:Gut microbiota and Antimicrobial resistance alteration during international travel in Hong Kong traveler
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Project description:ObjectiveTo evaluate whether LY2605541 results in lower fasting blood glucose (FBG) versus insulin glargine (GL).Research design and methodsThis 12-week, randomized, open-label, Phase 2 study enrolled patients with type 2 diabetes (hemoglobin A(1c) [A1C] ≤ 10.5%), taking metformin and/or sulfonylurea with GL or NPH insulin once daily. Patients converted to morning insulin administration during lead-in were randomized 2:1 from GL (n = 248) or NPH insulin (n = 39) to LY2605541 (n = 195) or GL (n = 95) once daily in the morning.ResultsAt 12 weeks, FBG (mean ± SE) was similar with LY2605541 and GL (118.2 ± 2.0 mg/dL [6.6 ± 0.1 mmol/L] vs. 116.9 ± 2.7 mg/dL [6.5 ± 0.2 mmol/L], P = 0.433) as was A1C (7.0 ± 0.1 vs. 7.2 ± 0.1%, P = 0.279). Intraday blood glucose variability was reduced with LY2605541 (34.4 vs. 39.1 mg/dL [1.9 vs. 2.2 mmol/L], P = 0.031). LY2605541 patients had weight loss (-0.6 ± 0.2 kg, P = 0.007), whereas GL patients gained weight (0.3 ± 0.2 kg, P = 0.662; treatment difference: -0.8 kg, P = 0.001). The incidence and rate of both total hypoglycemia and nocturnal hypoglycemia were comparable between LY2605541 and GL, although, LY2605541 had a 48% reduction in nocturnal hypoglycemia after adjusting for baseline hypoglycemia (P = 0.021). Adverse events were similar across treatments. Alanine aminotransferase and aspartate aminotransferase remained within normal range but were significantly higher with LY2605541 (P ≤ 0.001).ConclusionsIn patients with type 2 diabetes, LY2605541 and GL had comparable glucose control and total hypoglycemia rates, but LY2605541 showed reduced intraday variability, lower nocturnal hypoglycemia, and weight loss relative to GL.
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Project description:Every year billions of butterflies, dragonflies, moths and other insects migrate across continents, and considerable progress has been made in understanding population-level migratory phenomena. However, little is known about destinations and strategies of individual insects. We attached miniaturized radio transmitters (ca 300 mg) to the thoraxes of 14 individual dragonflies (common green darners, Anax junius) and followed them during their autumn migration for up to 12 days, using receiver-equipped Cessna airplanes and ground teams. Green darners exhibited distinct stopover and migration days. On average, they migrated every 2.9+/-0.3 days, and their average net advance was 58+/-11 km in 6.1+/-0.9 days (11.9+/-2.8 km d-1) in a generally southward direction (186+/-52 degrees). They migrated exclusively during the daytime, when wind speeds were less than 25 km h-1, regardless of wind direction, but only after two nights of successively lower temperatures (decrease of 2.1+/-0.6 degrees C in minimum temperature). The migratory patterns and apparent decision rules of green darners are strikingly similar to those proposed for songbirds, and may represent a general migration strategy for long-distance migration of organisms with high self-propelled flight speeds.
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Project description:ObjectiveEvidence in other surgical subspecialties suggests patients traveling farther to undergo surgery have worse outcomes. We sought to determine the impact of travel distance and travel beyond closest center on outcomes after valve surgery.MethodsPatients who underwent valve surgery ±CABG with a Society of Thoracic Surgeons (STS) predicted risk and zip code were extracted from a statewide STS database (2011-016). Patients were stratified by those receiving care greater than or equal to 20 miles from the closest surgical center (Traveler) or at the closest center (Non-Traveler). Multivariate logistic regression assessed the effects of travel distance and traveler status on mortality and major morbidity adjusted for STS predicted risk, median income by zip code, and payer status.ResultsMedian travel distance for all patients (n = 4765) was 19 miles and after risk-adjustment increasing distance was associated with reduced operative mortality (odds ratio [OR], 0.94 [0.89-1.00], P = .049) with no impact on major morbidity. Travelers (445 patients, 9.3%) had lower median income, higher self-pay and reoperative status, but similar urgent/emergent status and STS risk as Non-Travelers. Travelers had lower operative mortality (1.6% vs 4.3%, P = .005) which remained statistically lower after risk-adjustment (OR, 0.32 [0.14-0.75], P = .009). This mortality difference was particularly pronounced in patients with postoperative complications (3.1% vs 7.9%, P = .005).ConclusionsContrary to other surgical subspecialties, farther travel distance and bypassing the nearest surgical center were associated with lower rates of operative mortality and failure to rescue. Either referral patterns or financials reasons may result in Travelers ending up at high performing centers that prevent escalation of complications.
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Project description:In 2011, for the first time, Census in India reported travel distance and mode of travel for the workers. The distance reported is in the form of aggregate counts for each mode of travel in 7 distance bins (0-1?km, 2-5?km, 6-10?km, 11-20?km, 21-30?km, 31-50?km, and >50?km). In this data article, methods are described to model categorical count data as distance-decay functions using continuous probability distributions. The distributions have been developed for 8 categories of modes-walk, cycle, motorised two-wheelers, car, tempo/auto rickshaw/taxi, bus, train, and all modes combined, for the 33 mainland states of India and all states combined. Distance for walk is modelled using exponential distribution, and for all the other modes using lognormal or Weibull distribution. For estimating parameters of the distributions, chi-square minimization has been used in a spreadsheet program. The data presented includes parameters of the 272 (34?×?8) probability distributions as well as descriptive statistics of these distributions.
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