Pramlintide in the Management of Insulin-Using Patients with Type 2 and Type 1 Diabetes

In patients with diabetes, dysregulation of multiple glucoregulatory hormones results in chronic hyperglycemia and an array of associated microvascular and macrovascular complications. Optimization of glycemic control, both overall (glycosylated hemoglobin [A1C]) and in the postprandial period, may reduce the risk of long-term vascular complications. However, despite significant recent therapeutic advances, most patients with diabetes are unable to attain and/or maintain normal or near-normal glycemia with insulin therapy alone. Pramlintide, an analog of amylin, is the first in a new class of pharmaceutical agents and is indicated as an adjunct to mealtime insulin for the treatment of patients with type 1 and type 2 diabetes. By mimicking the actions of the naturally occurring hormone amylin, pramlintide complements insulin by regulating the appearance of glucose into the circulation after meals via three primary mechanisms of action: slowing gastric emptying, suppressing inappropriate post-meal glucagon secretion, and increasing satiety. In long-term clinical trials, adjunctive pramlintide treatment resulted in improved postprandial glucose control and significantly reduced A1C and body weight compared with insulin alone. The combination of insulin and pramlintide may provide a more physiologically balanced approach to managing diabetes

Comparing Patch vs Pen Bolus Insulin Delivery in Type 2 Diabetes Using Continuous Glucose Monitoring Metrics and Profiles

OBJECTIVE: CeQur Simplicity™ (CeQur, Marlborough, MA) is a 3-day insulin delivery patch designed to meet mealtime insulin requirements. A recently reported 48-week, randomized, multicenter, interventional trial compared efficacy, safety and self-reported outcomes in 278 adults with type 2 diabetes (T2D) on basal insulin therapy who initiated and managed mealtime insulin therapy with a patch pump versus insulin pen. We assessed changes in key glycemic metrics among a subset of patients who wore a continuous glucose monitoring (CGM) device. METHODS: Study participants (patch, n = 49; pen, n = 48) wore a CGM device in masked setting during the baseline period and prior to week 24. Glycemic control was assessed using international consensus guidelines for percentage of Time In Range (%TIR: \u3e70% at 70-180 mg/dL), Time Below Range (%TBR: \u3c4% at \u3c70 mg/dL; \u3c1% at \u3c54 mg/dL), and Time Above Range (%TAR: \u3c25% at \u3e180 mg/dL; \u3c5% at \u3e250 mg/dL). RESULTS: Both the patch and pen groups achieved recommended targets in %TIR (74.1% ± 18.7%, 75.2 ± 16.1%, respectively) and marked reductions in %TAR \u3e180 mg/dL (21.1% ± 19.9%, 19.7% ± 17.5%, respectively) but with increased %TBR \u3c70 mg/dL (4.7% ± 5.2%, 5.1 ± 5.8, respectively), all P \u3c .0001. No significant between-group differences in glycemic improvements or adverse events were observed. CONCLUSIONS: CGM confirmed that the patch or pen can be used to safely initiate and optimize basal-bolus therapy using a simple insulin adjustment algorithm with SMBG. Preference data suggest that use of the patch vs pen may enhance treatment adherence

Implementation of Basal-Bolus Therapy in Type 2 Diabetes:A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen

Background: Barriers to mealtime insulin include complexity, fear of injections, and lifestyle interference. This multicenter, randomized controlled trial evaluated efficacy, safety, and self-reported outcomes in adults with type 2 diabetes, inadequately controlled on basal insulin, initiating and managing mealtime insulin with a wearable patch versus an insulin pen. Methods: Adults with type 2 diabetes (n = 278, age: 59.2 +/- 8.9 years), were randomized to patch (n = 139) versus pen (n = 139) for 48 weeks, with crossover at week 44. Baseline insulin was divided 1:1 basal: bolus. Using a pattern-control logbook, subjects adjusted basal and bolus insulin weekly using fasting and premeal glucose targets. Results: Glycated hemoglobin (HbA1c) change (least squares mean +/- standard error) from baseline to week 24 (primary endpoint) improved (P \u3c 0.0001) in both arms, -1.7% +/- 0.1% and -1.6% +/- 0.1% for patch and pen (-18.6 +/- 1.1 and -17.5 +/- 1.1 mmol/mol), and was maintained at 44 weeks. The coefficient of variation of 7-point self-monitoring blood glucose decreased more (P = 0.02) from baseline to week 44 for patch versus pen. There were no differences in adverse events, including hypoglycemia (three severe episodes per arm), and changes in weight and insulin doses. Subject-reported treatment satisfaction, quality of life, experience ratings at week 24, and device preferences at week 48 significantly favored the patch. Most health care providers preferred patch for mealtime insulin. Conclusions: Bolus insulin delivered by patch and pen using an algorithm-based weekly insulin dose titration significantly improved HbA1c in adults with type 2 diabetes, with improved subject and health care provider experience and preference for the patch

Economía, Sociedad y Procesos Hegemónicos en la Provincia de Misiones (ESOHE). 16H328

Actividades desarrolladas durante el período: Desde mediados de año se ha instalado un Taller Continuo que funciona los días viernes destinado a la puesta en común de información y la discusión de la marcha general del proyecto. El taller, se ha constituido en caja de resonancia de los avances y dificultades que se presentan y como el espacio donde se distribuyen tareas y responsabilices, se analizan las actividades y los aportes personales o de los integrantes de cada grupo responsable de alguna línea de investigación y se incorporan ideas y señalamientos. En este marco, se ha programado también un Ciclo de Lecturas teóricas y metodológicas que colaboran en la construcción de un lenguaje y una mirada común, necesaria para armonizar la labor de investigadores y becarios de postgrado con trayectorias disciplinares y experiencias muy disímiles; En la investigación sobre la historia económica de Misiones se ha avanzado en los siguientes puntos: Construcción de una periodización basada en ciclos económicos. Se trabaja en el reconocimiento y exploración de repositorios y fuentes escritas existentes a nivel local. exhaustivo relevamiento de las tesis de grado y postgrado, tanto en historia como en Antropología, existentes en las bibliotecas de la UNaM, referidas a temas empresariales y o al funcionamiento de las elites del poder. Se ha tomado contacto y accedido a ámbitos empresariales como las cámaras de la construcción, que en Misiones son 5, de PyMES y la Delegación Provincial de la Cámara Argentina de la Construcción que reúne a grandes empresas; Un grupo de investigadores y auxiliares del ESOHE está investigando los procesos de transformación del sistema educativo provincial (incluyendo tanto la componente pública como la privada), entendiendo que el sistema escolar es una de las instancias donde se socializa ideológicamente a la población y se promueven “sentidos de la realidad”; Entre las tareas en ejecución cabe mencionar: Lectura y fichaje de materia bibliográfico destinado a la actualización reajuste del encuadre teórico-metodológico. Identificación y caracterización de diferentes actores: funcionarios gubernamentales, empresas constructoras, e inmobiliarias, medios de comunicación, asociaciones civiles y otras organizaciones, grupos de interés y afectados por las obras que intervienen en la producción, disputa, apropiación y uso del espacio urbano en las ciudades de Encarnación y Posadas, Garupá y Candelaria. Elección y contacto de informantes calificados. Relevamiento de políticas y/o programas de intervención urbana a ambos lados de la frontera y sus procesos resultantes. Geo-referenciamiento de áreas de revalorización urbana, comerciales, de relegación y desplazamiento, así como de asentamientos precarios y zonas residenciales para sectores de alto poder adquisitivo. El trabajo realizado en esta primera etapa ha permitido avanzar en: Revisión bibliográfica; Redefinición del marco teórico de la investigación; Análisis de algunas relaciones concretas establecidas entre el estado y el sector civil organizado, en particular en el campo de las actividades económicas del tercer sector y en el marco de la implementación de planes y programas públicos; Análisis de las tensiones entre prácticas políticas y económicas que se desatan en el proceso de generación y funcionamiento de los emprendimientos productivos auto-gestionados y cooperativas de trabajo

Genotyping the hepatitis B virus with a fragment of the HBV DNA polymerase gene in Shenyang, China

The hepatitis B virus (HBV) has been classified into eight genotypes (A-H) based on intergenotypic divergence of at least 8% in the complete nucleotide sequence or more than 4% in the S gene. To facilitate the investigation of the relationship between the efficacy of drug treatment and the mutation with specific genotype of HBV, we have established a new genotyping strategy based on a fragment of the HBV DNA polymerase gene. Pairwise sequence and phylogenetic analyses were performed using CLUSTAL V (DNASTAR) on the eight (A-H) standard full-length nucleotide sequences of HBV DNA from GenBank (NCBI) and the corresponding semi-nested PCR products from the HBV DNA polymerase gene. The differences in the semi-nested PCR fragments of the polymerase genes among genotypes A through F were greater than 4%, which is consistent with the intergenotypic divergence of at least 4% in HBV DNA S gene sequences. Genotyping using the semi-nested PCR products of the DNA polymerase genes revealed that only genotypes B, C, and D were present in the 50 cases, from Shenyang, China, with a distribution of 11 cases (22%), 25 cases (50%), and 14 cases (28%) respectively. These results demonstrate that our new genotyping method utilizing a fragment of the HBV DNA polymerase gene is valid and can be employed as a general genotyping strategy in areas with prevalent HBV genotypes A through F. In Shenyang, China, genotypes C, B, and D were identified with this new genotyping method, and genotype C was demonstrated to be the dominant genotype

Five views of a secret: does cognition change during middle adulthood?

This study examined five aspects of change (or stability) in cognitive abilities in middle adulthood across a 12-year period. Data come from the Interdisciplinary Study on Adult Development. The sample consisted of N = 346 adults (43.8 years on average, 48.6% female). In total, 11 cognitive tests were administered to assess fluid and crystallized intelligence, memory, and processing speed. In a first series of analyses, strong measurement invariance was established. Subsequently, structural stability, differential stability, stability of divergence, absolute stability, and the generality of changes were examined. Factor covariances were shown to be equal across time, implying structural stability. Stability coefficients were around .90 for fluid and crystallized intelligence, and speed, indicating high, yet not perfect differential stability. The coefficient for memory was .58. Only in processing speed the variance increased across time, indicating heterogeneity in interindividual development. Significant mean-level changes emerged, with an increase in crystallized intelligence and decline in the other three abilities. A number of correlations among changes in cognitive abilities were significant, implying that cognitive change