| Metabolic control and risk of hypoglycemia during the first year of intensive insulin treatment in type 2 diabetes. Systematic review and meta-analysis. | |
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MedLine Citation:
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PMID: 22142056 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Background. Intensive insulin treatment is known to improve metabolic control (HbA1c), but is accompanied by the risk of hypoglycemia. Aim. Aim of this study was to analyze clinical correlates of HbA1c, and of overall, nocturnal, and severe hypoglycemia, through direct weighted regressions, as well as the effect of different insulin regimens and insulin analogs, through meta-analysis. Methods. Appropriate methodology (PRISMA statement) was used. 67 randomized studies, published as full papers were analyzed to identify predictors of both HbA1c and hypoglycemia; studies were included in a meta-analysis to study the effect of different insulin regimens or insulin analogs on HbA1c and hypoglycemia during the first year of insulin treatment in type 2 diabetes patients. Results. Final HbA1c, change of HbA1c, hypoglycemia, nocturnal hypoglycemia, and severe hypoglycemia were associated with intensity of treatment. Final HbA1c was higher with basal than with twice-a-day or prandial, and with twice-a-day than with prandial regimen, with opposite figures for hypoglycemia. Within basal regimens, detemir and glargine were similar to NPH on HbA1c, with less hypoglycemia and nocturnal hypoglycemia; within prandial regimens, new analogs were more effective than regular insulin on HbA1c, and induced less hypoglycemia. The effect of glargine on HbA1c and on hypoglycemia vanished with increasing number of insulin injections. Conclusion. Metabolic control and hypoglycemia are associated with intensity of treatment. Basal regimens have a reduced effect on metabolic control, but are associated with lower frequency of hypoglycemia. Newer analogs, short- and long-acting, yield better control and less hypoglycemia than older analogs. |
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Authors:
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A E Pontiroli; L Miele; A Morabito |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-12-5 |
Journal Detail:
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Title: Diabetes, obesity & metabolism Volume: - ISSN: 1463-1326 ISO Abbreviation: - Publication Date: 2011 Dec |
Date Detail:
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Created Date: 2011-12-6 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883645 Medline TA: Diabetes Obes Metab Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
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© 2011 Blackwell Publishing Ltd. |
Affiliation:
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Cattedra di Medicina Interna e Cattedra di Biometria, Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, and Ospedale San Paolo, Milano, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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