Publication details

Insulin and new oral antidiabetic drugs as recently modified therapeutic approach in diabetologic outpatient department



Year of publication 2018
Type Article in Proceedings
Conference December 12-14. International Diabetes Congress. Plaza America Convention Center, Varadero, Matanzas, Cuba
Keywords diabetes mellitus type 2 - new options of the therapeutic appeoach
Description Background: Diabetes mellitus (DM) has a crucial impact on personal and social health. In the very old age it significantly affects also the social status of the individual. In the elderly DM occurs often in the domain of multi-morbidity and can conduce to incurrence and development of serious disability which can significantly influence further therapeutic procedures. Patients and Methods: During 2016 authors treated 2,232 diabetic out-patients altogether. Out of this number there were 1,132 men and 1,100 women of the average age (68.2 ±11.4 y. vs. 71.9 ±11.2 y.). All the patients have been long-term treated in the outpatient dept. for diabetes (DIASTOP). They have been non-selectively enrolled from the catchment area of Brno city where about 25,000 inhabitants live. Out of this number there were type1DM -98 patients (4.6%) and type2 -2,134 patients (95.6%). In the set we analyzed: age, duration of diabetes, kind of therapy, obesity, presence of late diabetic micro-vascular complications and we compared the results between the male and female genders. Results: The DM duration was 7.7±6.4 y. All T1DM diabetics were treated by intensified insulin regimen. Insulin as a crucial therapy of DM was used in therapy in 384 cases (17.2%). About three quarters of all the diabetics have been treated with insulin analogues. Insulin was applied once per day 31 times; twice 79 times; 3 times 84 times; and two kinds of insulin (short- and long-acting) 4 times 91 times and 5 times per day in 6 cases. Other T2DM were on diet only 18.3%; oral antidiabetic drugs (OAD) altogether 47.4%. Metformin was used in 26.2%; pioglitazone in 3.2%; sulphonylurea in 17.7%; gliptins (DPP4 inhibitors 17.9%); incretin mimetics (GLP1 agonists -1%) and gliflozins (SGLT2 inhibitors- 3.1%). Combination of insulin with OAD was used in 17.1%. Compensation of all registered diabetics according to the HbA1c (glycosylated haemoglobin) was good in 63.5%; satisfactory in 26.4% and non-satisfactory in 10.1%. In the subgroup of 384 diabetics treated by insulin it is possible to assess as good 131 times (34.1%); as satisfactory 160 times (41.7%) and non-satisfactgory in 93 cases (24.2%), but 162 of insulin treated patients were multi-morbid and older than 70 y. Conclusion: Permanent insulin therapy is in any age (especially in the old) kind of treatment which is very demanding for the patients as well as for the caring staff. Sometimes it could be also difficult starting and long-term usage of OAD (especially the ones which are new on the market).

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