The Utility of Continuous Subcutaneous Insulin Infusion for Management of Mild to Moderate Diabetic Ketoacidosis
Magui Abdel Moneim Shalash,
Ali Ahmed Abdel Rahim,
Kamel Hemida Rohoma,
Marwa Abdel Maaboud Elnabawy
Issue:
Volume 4, Issue 3, May 2016
Pages:
43-48
Received:
13 April 2016
Accepted:
22 April 2016
Published:
11 May 2016
Abstract: Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSII) to intravenous (IV) insulin infusion protocol using a short acting insulin analogue, glulisine, in patients with mild to moderate DKA. This is a prospective randomized controlled trial including 30 patients with DKA randomly assigned to receive Glulisine insulin via CSII or IV infusion. Metabolic parameters were observed till resolution of DKA. Primary end point was assessment of the duration till resolution. Secondary end points included total length of hospitalization, amount of insulin used and the number of hypoglycemic events. There were no statistical differences in the mean duration of treatment until correction of DKA being 16.58 ± 3.68 hours for CSII group versus 14.60 ± 3.2 hours in the IV group, p=0.136. There was no mortality and no differences in the length of hospital stay, or the number of hypoglycemic events among treatment groups. However, the total amount of insulin administration until resolution of ketoacidosis was significantly higher, 61.50 ± 13.89 units, in CSII group compared to 46.60 ± 13.53 units in the IV group, p=0.009. We concluded that the use of CSII of glulisine insulin represented a safe and effective alternative to the use of IV glulisine in the management of patients with mild to moderate DKA.
Abstract: Diabetic ketoacidosis (DKA) is the commonest hyperglycemic emergency in people with diabetes. Fluid and insulin, commonly via intravenous route, is the mainstay of treatment; however, other methods of insulin administration have been tried. In this study, we aimed at comparing the efficacy and safety of continuous subcutaneous insulin infusion (CSI...
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The Effect of Dose-Reduced Combination Oral Contraceptives Containing 20 µg of Ethinyl Estradiol and 100 µg of Levonorgestrel on Lipid Metabolism: A Meta-Analysis
Lin Chen,
Jun Xu,
Shaohui Cai
Issue:
Volume 4, Issue 3, May 2016
Pages:
49-59
Received:
20 April 2016
Accepted:
29 April 2016
Published:
17 May 2016
Abstract: Lipid metabolic disturbance induced by the synthetic steroids used in combination oral contraceptives (COCs) has been considered as one of the potential risk factors of cardiovascular diseases. A lower-dose preparation that contains 20 µg of ethinyl estradiol and 100 µg of levonorgestrel (20EE/LNG) has proven effective in most clinical studies, whereas its effect on lipid metabolism is still unclear. The purpose of this study was to estimate the effect of a lower dose of a COC (containing 20 µg of ethinyl estradiol and 100 µg of levonorgestrel) on lipid metabolism by conducting a systematic review and a meta-analysis. A literature search was performed using MEDLINE (PubMed), Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials (CENTRAL database). The studies that are randomized controlled trials to compare a lower-dose COC (20EE/LNG) with a placebo or another COC that differed in terms of the drug, dosage, regimen, and study length were included. Meanwhile, studies should have evaluated the index of lipid metabolism changes. However, the studies with the interventions fewer than three consecutive cycles or the patients were primarily used the treatment of non-contraceptive were excluded. We pooled the low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), and triglyceride (TG) results, and compared 20EE/LNG with conventional-dose COCs using fixed-effects meta-analysis with inverse-variance weighting. Five randomized controlled trials, with a total of 423 participants (age range: 18–35 years), were included in this study. The results derived from all the included studies were pooled. LDL-C of 20EE/LNG group showed significant lower than control group after three (SMD, 0.16; 95% CI, 0.03–0.30; P=0.02) and six (SMD, 0.16; 95% CI, 0.01–0.31; P=0.04) cycles of treatment. However, there was no difference between the two groups after 12 cycles of administration (SMD, -0.06; 95% CI, -0.31 to 0.18; P=0.61). The pooled results showed there was a significant increase in HDL-C in the 20EE/LNG group after three cycles of treatment (SMD, 0.43; 95% CI, 0.13–0.73; P=0.005). No significant difference was observed between TC and TG groups. For LDL-C, the low-dose group shows a higher risk of suffering from cardiovascular diseases after three and six cycles of treatment, while no difference is observed after 12 cycles of treatment. For HDL-C, the 20EE/LNG group exhibits favorable effects after three cycles of treatment compared with the control groups. Similar effects are found between TC and TG profiles groups.
Abstract: Lipid metabolic disturbance induced by the synthetic steroids used in combination oral contraceptives (COCs) has been considered as one of the potential risk factors of cardiovascular diseases. A lower-dose preparation that contains 20 µg of ethinyl estradiol and 100 µg of levonorgestrel (20EE/LNG) has proven effective in most clinical studies, whe...
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