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Comparison of different insulin protocols for type 2 diabetes
Many patients with type 2 diabetes mellitus (T2DM) initiate insulin therapy when other treatments fail; how best to do this is poorly defined. People with T2DM [n = 588; glycated haemoglobin A1C (A1C) >7.0%, mean baseline 9.4%] were randomized to twice-daily premixed protamine-aspart/aspart insulin (PM − 2), once-daily insulin glargine plus zero to one prandial insulin glulisine injection (G + 1), or insulin glargine plus zero to three prandial injections (G + 3). Insulin was titrated for 60 weeks. Efficacy and safety outcomes were assessed. A very interesting human Investigation!

Discontinuation rates were 53 of the 194 (27%), 44 of the 194 (23%) and 38 of the 194 (20%), for PM − 2, G + 1 and G + 3.

Glycaemic control improved in all groups (A1C 7.2 ± 1.37, 7.1 ± 1.68 and 7.0 ± 1.21% at 60 weeks; 7.5 ± 1.29, 7.2 ± 1.62 and 7.2 ± 1.63% at endpoint).

G + 1 was statistically non-inferior to PM − 2 in reducing A1C.

G + 3 was slightly superior to PM − 2 in attaining <7.0% at 60 weeks, but only when the analysis included Good Clinical Practice non-adherent sites.

Hypoglycaemia with plasma glucose <2.8 mmol/l was more frequent with PM − 2 versus G + 1 and G + 3; [adjusted incidence: 46 (p = 0.0087) vs. 33 (p = 0.0045) and 31.5%; events per patient-year: 1.9 vs. 0.8 and 0.9, p ≤ 0.0001].

Insulin dosage and weight-gain were similar.

Basal insulin plus a single prandial injection is as effective in improving glycaemic control as premixed insulin.

Full basal-prandial therapy is only slightly more effective than premixed insulin.

Stepwise basal-prandial regimens improve glycaemic control with less hypoglycaemia than twice-daily premixed insulin.


Source: Riddle, M. C., Rosenstock, J., Vlajnic, A. and Gao, L. (2014), Randomized, 1-year comparison of three ways to initiate and advance insulin for type 2 diabetes: twice-daily premixed insulin versus basal insulin with either basal-plus one prandial insulin or basal-bolus up to three prandial injections. Diabetes, Obesity and Metabolism, 16: 396–402. doi: 10.1111/dom.12225


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SMALL ANIMAL PRACTICE

Computed tomographic arthrography of the canine shoulder joint members
The aim of this retrospective, methods comparison study was to assess the diagnostic utility of computed tomographic arthrography in the assessment of various intraarticular shoulder pathologies in dogs in comparison with survey computed tomography (CT), using arthroscopic examination as the reference standard. Computed tomography, computed tomographic arthrography, and arthroscopic findings of 46 scapulohumeral joints of dogs with forelimb lameness were reviewed retrospectively.

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