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FEATURE ARTICLE:Diabetes In Control Newsletter - 
http://www.diabetesincontrol.com </redirect?http://www.diabetesincontrol.com>

The Newsletter for Professionals in Diabetes Care

January 24, 2001, Issue 36

Glucose Monitoring in the 21st Century

Part 2

Continuous Glucose Sensing
By Clifford Hague

Clifford Hague had been involved in the development of insulin pumps and
glucose sensors for nearly 20 years. Past vice president of marketing and
business development of MiniMed Inc., and former vice president of
clinical research and marketing at VIA Medical, he has written numerous
articles, abstracts, and clinical protocols on pumps, sensors, and related
topics. Mr. Hague is now semi-retired and turning even more of his
attention to writing about the medical industry. We thank Cliff for this
weeks feature: www.diabetesincontrol.com/feature21.htm 

This newsletter is the condensed version. If you would like to see the
full newsletter got to www.diabetesincontrol.com/issue36 

Item #5
Using an Insulin Pump in Uncontrolled Type 2 Diabetes

Glucotoxicity generated by hyperglycemia creates a vicious circle
worsening the imbalance of diabetes mellitus. A pump-optimized transient
insulin treatment can be used to break this fate and restore some degree
of insulin sensitivity in uncontrolled type 2 diabetes.

The aim of this retrospective study was to evaluate type 2 diabetics with
a secondary failure to a maximal oral anti-diabetic therapy, treated with
a transient subcutaneous insulin therapy during 3 days. The following
criteria were analyzed: delay before permanent insulin treatment,
prognosis factors of evolution, weight evolution and glucose control in
patients maintained under oral treatment. 250 type 2 diabetics, and 515
insulin infusions were studied. The average follow-up was 3.5 years.

Results: At the end of the follow-up 63 patients required insulin from the
inception of the study (Group 1), 76 secondarily resumed insulin (Group
2), and 111 remained with oral treatment (Group 3). Patients in Group 1
were significantly older, with higher HbA1c and a lower body mass index
(BMI). On average, the patients in Group 3 were submitted to less than 2
insulin infusions, their BMI from the beginning to the end of the
follow-up remained stable, while HbA1c improved. It was concluded that
transient optimized insulin treatment during 3 consecutive days is
effective. Thus, 45% of the initial global population remain under oral
therapy after 3.5 years with a better glucose control and a stable weight.
Department of Endocrinology, Hopital Begin, 69 avenue de Paris, France.
Diabetes Metab 2000 Nov;26(5):371-5

Item #8
Rapid-Acting Insulin Compatible With Pump-Delivered Continuous Insulin
Infusion Therapy

Results of a new study indicate the rapid-acting insulin analog, insulin
aspart, is safe and effective for continuous subcutaneous insulin infusion
(CSII) therapy.

Reported in the January issue of Diabetes Care, in a single-center
randomized open-label study, 19 patients received CSII with insulin
aspart, while 10 received CSII with buffered regular human insulin. Bolus
doses of insulin aspart were given immediately prior to meals, and bolus
doses of human insulin 30 minutes before meals.

The study lasted for 7 weeks. Insulin aspart and buffered regular human
insulin performed equally well in controlling daily blood glucose levels
and maintaining glycosylate hemoglobin levels.

Insulin aspart appears to have less hypoglycemia than regular insulin in
pump patients and is definitely more convenient. Currently, buffered
regular insulin is the only approved insulin for pumps. Insulin aspart is
a fast-acting insulin analogue that is comparable to Lilly's lispro
(humalog). The benefit is that it is compatible and efficacious in pumps
and should get FDA approval. Diabetes Care 2001;24:69-72.

Item #9
New Treatments Help Diabetics Reach Target Blood Glucose Levels More

It was discussed at an American Medical Association briefing on advances
in diabetes treatment and care, innovations in type 2 diabetes treatment
and monitoring have moved the management of this disease from the domain
of the healthcare practitioner to the patient.

They stated that with new medications, advances in blood sugar monitoring,
and patient education, people with diabetes have been given the freedom to
manage their blood sugar and better control their diabetes. For completes
story: www.diabetesincontrol.com/issue36/item9.htm 

Item #10
The Cure for Diabetes: Islet Sheet Medical Begins Collaboration With 
University of Alberta

Leading Research Center to Test New Bioartificial Pancreas

Islet Sheet Medical LLC, a privately held research company, today
announced the start of research in collaboration with Drs. James Shapiro
and Jonathan Lakey at the University of Alberta in Edmonton, Canada. The
University of Alberta is the world's leading islet transplantation
research center, last year reporting clinical success in diabetic patients
who no longer require insulin. The company and its collaborators have
planned large animal experiments designed to demonstrate that the Islet
Sheet can function for extended periods without immune suppression and if
effective can make islet transplantation available to millions more
people. For more info: www.diabetesincontrol.com/issue36/item10.htm 

Item #12
National Initiative to Help Prevent Blindness for People With Diabetes -
FREE eye exams now available!

Thousands of American seniors now have access to the eye care they need,
thanks to an innovative diabetes eye exam initiative. This historic
partnership between the public and private sector focuses on Medicare
beneficiaries with diabetes and addresses the two major barriers to
receiving eye care -- cost and transportation. It also raises awareness of
the connection between diabetes and blindness and the importance of an
annual dilated eye exam.

The Foundation of American Academy of Ophthalmology (FAAO) and the
American Optometric Association (AOA) have joined forces with the Health
Care Financing Administration (HCFA) to create the "Intervention for
Increasing Eye Exam Rates for Medicare Beneficiaries with Diabetes."
Additionally, many other organizations and people have been mobilized at
the national and local levels. HCFA's national network of Peer Review
Organizations (PROs) are playing an essential role by sending postcards
and brochures directly to Medicare beneficiaries who qualify for the
program, as well as addressing transportation issues through state and
local groups. State ophthalmic and optometric societies are partnering
with the PROs to help spread the word about the initiative to the local
press and media, and celebrity spokespersons have contributed their name
and support to the cause through public service announcements. For more
info and how to participate: www.diabetesincontrol.com/issue36/item12.htm 
for HELP or to subscribe/unsubscribe, contact: HELP@insulin-pumpers.org
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