BACKGROUND: Successful conversion from insulin therapy to glucagon-like peptide 1 receptor agonist (GLP-1RA) with basal insulin in well-controlled patients has already been demonstrated. However, the data concerning individuals with poor glycaemic control are scarce. The aim of this work was to assess the success rate of insulin therapy to liraglutide transition in poorly controlled diabetes in a real-world clinical setting and to define predictors of success. We are the first to present the method of a fasting test as a way to identify the patients at higher risk of failure after treatment de-intensification. METHODS: The retrospective observational study analyzed data of 62 poorly controlled obese diabetic patients on high-dose insulin therapy, who were subjected to a 72 h fasting test during hospitalization and subsequently switched to liraglutide ± basal insulin therapy. During the fasting, all antidiabetic treatment was discontinued. Patients were classified as responders if they remained on GLP-1RA treatment after 12 months. Non-responders restarted the basal-bolus insulin (BBI) regimen. Development of glycated hemoglobin (HbA1c) and body weight in both groups, alongside with parameters associated with the higher risk of return to the BBI regimen, were analyzed. RESULTS: A total of 71% of patients were switched successfully (=responders). Responders had more significant improvement in HbA1c (-6.4 ± 19.7 vs. -3.4 ± 22.9 mmol/mol) and weight loss (-4.6 ± 7.1 vs. -2.5 ± 4.0). Statistically significant difference between groups was found in initial HbA1c (75.6 ± 17.9 vs. 90.5 ± 23.6; p = 0.04), total daily dose of insulin (67.6 ± 36.4 vs. 90.8 ± 32.4; p = 0.02), and mean glycaemia during the fasting test (6.9 ± 1.7 vs. 8.6 ± 2.2 mmol/L; p < 0.01). CONCLUSIONS: This study confirms that therapy de-intensification in poorly controlled patients with a BBI regimen is possible. Higher baseline HbA1c, total daily insulin dose, and mean glucose during fasting test are negative predictive factors of successful therapy de-escalation.
- Publikační typ
- časopisecké články MeSH
UNLABELLED: The most common cause of vasoplegic shock in critical care is sepsis. However, although rarely and only in specifically sensitised individuals previously bitten by a tick, red meat may provoke a delayed allergic reaction called an alpha-gal syndrome. We present a case of a protracted life-threatening manifestation of alpha-gal syndrome, which, due to an unusual absence of typical features of anaphylaxis can masquerade as septic shock and calls attention to the premature diagnostic closure as a contributor to diagnostic error. Alpha-gal syndrome is a relatively new, but increasingly recognised health issue. We propose that alpha-gal syndrome should be considered in the differential diagnosis of vasoplegic shock of unclear aetiology even in the absence of typical allergic symptomatology and typical allergen exposure since alpha-gal is present in a wide variety of carriers. LEARNING POINTS: Alpha-gal syndrome, otherwise known as "red meat allergy", is a potentially life-threatening allergic syndrome induced by the immunological properties of tick saliva.A typical case of alpha-gal syndrome is a patient bitten by a tick who develops an allergic reaction, anaphylaxis or anaphylactic shock even after an ingestion of a significant amount of alpha-gal, typically present in red mammalian meat or organs.As global warming continues, we may expect tick-borne diseases to spread wider around the globe and due to the possibility of complete absence of typical allergic symptomatology and the delayed onset of symptoms, this syndrome needs to be considered when encountering vasoplegic shock of uncertain origin.
- Publikační typ
- časopisecké články MeSH
Glifloziny jsou a budou v naší společnosti čím dál hojněji využívaným léčivem. Opakovaně byly doloženy jejich výhody jak v léčbě diabetu, tak ve snížení kardiovaskulární a renální morbidity a mortality. V klinické praxi však musíme myslet i na možné nežádoucí účinky, zejména pak na riziko vývoje diabetické ketoacidózy. Kazuistika popisuje případ rozvoje této komplikace u pacientky s diabetes mellitus 2. typu, ke které došlo i přes včasné vysazení gliflozinu dva dny před zahájením lačnění. Důležitým mechanismem se přitom ukázala být protrahovaná glykosurie po vysazení gliflozinu, kterou jsme pozorovali v celkové době osmi dní, a to i přes normoglykemii u pacientky. Tento efekt může v rizikových situacích vést přes sníženou sekreci inzulínu a stimulaci ketogeneze k rozvoji euglykemické ketoacidózy. V popisu případu chceme upozornit na nutnost včasného vysazení léčiva před rizikovými situacemi a na fakt, že se s rozvojem euglykemické diabetické ketoacidózy můžeme setkat i s odstupem několika dnů po vysazení gliflozinu. V tomto smyslu je třeba edukovat i pacienta a zdravotnický personál a poučit je o nutnosti kontroly ketolátek v krvi v situaci rozvoje klinických obtíží, a to i přes normoglykemii a přes fakt, že riziková medikace je již několik dnů vysazena.
Gliflozins are and will be an increasingly widely used medicine in our society. Their benefits in the treatment of diabetes and in the reduction of cardiovascular and renal morbidity and mortality have been repeatedly demonstrated. However, in clinical practice, we must also think about possible side effects, especially the risk of developing diabetic ketoacidosis. The case report describes a case of development of this complication in a patient with type 2 diabetes mellitus, which occurred despite early discontinuation of gliflozin two days before the start of fasting. Prolonged glycosuria after discontinuation of gliflozin, which we observed over a total of eight days, proved to be an important mechanism, despite the patient’s normoglycaemia. This effect may lead to the development of euglycaemic ketoacidosis through reduced insulin secretion and stimulation of ketogenesis in high-risk situations. In this case, we want to draw attention to the need for early discontinuation of the drug before risky situations and the fact that the development of euglycaemic diabetic ketoacidosis can be encountered several days after discontinuation of gliflozin. In this sense, it is necessary to educate the patient and medical staff and instruct them on the need to control ketone bodies in the blood in a situation of developing clinical difficulties, despite normoglycaemia and the fact that risk medication has been discontinued for several days.
- MeSH
- biochemická analýza krve metody MeSH
- diabetes mellitus 2. typu farmakoterapie komplikace MeSH
- diabetická ketoacidóza diagnóza etiologie prevence a kontrola MeSH
- glifloziny * aplikace a dávkování škodlivé účinky MeSH
- glykosurie diagnóza MeSH
- ketolátky moč MeSH
- lidé MeSH
- nežádoucí účinky léčiv MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Klíčová slova
- teduglutid,
- MeSH
- glukagonu podobný peptid 2 terapeutické užití MeSH
- klinické zkoušky jako téma MeSH
- lidé MeSH
- nemoci střev * farmakoterapie MeSH
- selhání střeva MeSH
- syndrom krátkého střeva * farmakoterapie MeSH
- tenké střevo fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- ateroskleróza komplikace MeSH
- cévní mozková příhoda komplikace MeSH
- diabetes mellitus 1. typu * komplikace MeSH
- dyslipidemie farmakoterapie prevence a kontrola terapie MeSH
- financování organizované MeSH
- ischemická choroba srdeční diagnóza etiologie komplikace MeSH
- kardiovaskulární nemoci * komplikace prevence a kontrola MeSH
- komplikace diabetu farmakoterapie prevence a kontrola terapie MeSH
- lidé MeSH
- menopauza fyziologie metabolismus MeSH
- metaanalýza jako téma MeSH
- onemocnění periferních arterií komplikace MeSH
- primární prevence metody trendy MeSH
- rizikové faktory MeSH
- statiny * škodlivé účinky terapeutické užití MeSH
- statistika jako téma MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- abstrakt z konference MeSH
