The office will be closed January 17 and January 18 due to the inclement weather.
We will be open Thursday, December 28, and Thursday, January 4, to accommodate anyone who may need to see the doctor.
The office will be closed on December 25 and December 26 in observance of the Christmas holiday. The office will also be closed on January 1 and January 2 in observance of the new year. Happy holidays, merry Christmas and happy new year from Dr. Trippe and the staff at Endocrinology Associates.
A1c Control in a Primary Care Setting: Self-titrating an Insulin Analog Pre-mix (INITIATEplus Trial)
Purpose: To study glycemic control and hypoglycemia development upon initiation of insulin through a self-titration schedule in a 24-week trial, conducted with 4875 insulin-naïve patients with poorly controlled type 2 diabetes, predominantly in a primary care setting.
Methods: Subjects initiated twice-daily biphasic insulin aspart 70/30 with 6 units prebreakfast and 6 units presupper, self-titrating according to self-measured blood glucose values. Subjects were randomized (1:1:1) to telephone counseling provided by a registered dietician: no counseling (NC), 1 counseling session (1C), or 3 sessions (3C).
Results: Mean baseline HbA1c (9.9% across groups) decreased ∼2.5% to 7.49%±1.48, 7.48%±1.50, and 7.44%±1.46 in the NC, 1C, and 3C groups, respectively. Within these groups, a hemoglobin A1c (HbA1c) value <7% was achieved by 40.2%, 41.6%, and 41.8% of subjects, respectively. Eight-point blood glucose profiles were substantially improved from baseline for all groups. Hypoglycemia was experienced by 10.2%-11.4% of the subjects in each group. Rates of minor and major hypoglycemia were low but decreased as dietary counseling increased (minor hypoglycemia: 56 vs 50 vs 45 episodes per 100 patient-years; major hypoglycemia, 9 vs 6 vs 4 episodes per 100 patient-years, for the NC vs 1C vs 3C groups, respectively; P <.001, 3C vs NC). Weight increased by 3.13, 3.40, and 2.88 kg for the NC, 1C, and 3C groups, respectively.
Conclusion: In the primary care setting, self-titration of biphasic insulin aspart 70/30 was effective in achieving recommended HbA1c goals even with minimal dietary counseling.
By Bruce S. Trippe, M.D., F.A.C.E.
Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes, estimated to affect 50% of patients—approximately 4 million people in the United States alone.1-6 Its prevalence increases with the patient’s age, duration of diabetes, and poor glycemic control.7-10
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