EADSG Guidelines: Insulin Therapy in Diabetes

Abstract

A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A). Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A). Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin. Two or three premixed insulin injections per day may be used (A). The target glycated hemoglobin A1c (HbA1c) for all children with T1DM, including preschool children, is recommended to be < 7.5% (< 58 mmol/mol). The target is chosen aiming at minimizing hyperglycemia, severe hypoglycemia, hypoglycemic unawareness, and reducing the likelihood of development of long-term complications (B). For patients prone to glycemic variability, glycemic control is best evaluated by a combination of results with self-monitoring of blood glucose (SMBG) (B). Indications for exogenous insulin therapy in patients with type 2 diabetes mellitus (T2DM) include acute illness or surgery, pregnancy, glucose toxicity, contraindications to or failure to achieve goals with oral antidiabetic medications, and a need for flexible therapy (B). In T2DM patients, with regards to achieving glycemic goals, insulin is considered alone or in combination with oral agents when HbA1c is ≥ 7.5% (≥ 58 mmol/mol); and is essential for treatment in those with HbA1c ≥ 10% (≥ 86 mmol/mol), when diet, physical activity, and other antihyperglycemic agents have been optimally used (B). The preferred method of insulin initiation in T2DM is to begin by adding a long-acting (basal) insulin or once-daily premixed/co-formulation insulin or twice-daily premixed insulin, alone or in combination with glucagon-like peptide-1 receptor agonist (GLP-1 RA) or in combination with other oral antidiabetic drugs (OADs) (B). If the desired glucose targets are not met, rapid-acting or short-acting (bolus or prandial) insulin can be added at mealtime to control the expected postprandial raise in glucose. An insulin regimen should be adopted and individualized but should, to the extent possible, closely resemble a natural physiologic state and avoid, to the extent possible, wide fluctuating glucose levels (C). Blood glucose monitoring is an integral part of effective insulin therapy and should not be omitted in the patient's care plan. Fasting plasma glucose (FPG) values should be used to titrate basal insulin, whereas both FPG and postprandial glucose (PPG) values should be used to titrate mealtime insulin (B). Metformin combined with insulin is associated with decreased weight gain, lower insulin dose, and less hypoglycemia when compared with insulin alone (C). Oral medications should not be abruptly discontinued when starting insulin therapy because of the risk of rebound hyperglycemia (D). Analogue insulin is as effective as human insulin but is associated with less postprandial hyperglycemia and delayed hypoglycemia (B). The shortest needles (currently the 4-mm pen and 6-mm syringe needles) are safe, effective, and less painful and should be the first-line choice in all patient categories; intramuscular (IM) injections should be avoided, especially with long-acting insulins, because severe hypoglycemia may result; lipohypertrophy is a frequent complication of therapy that distorts insulin absorption, and therefore, injections and infusions should not be given into these lesions and correct site rotation will help prevent them (A). Many patients in East Africa reuse syringes for various reasons, including financial. This is not recommended by the manufacturer and there is an association between needle reuse and lipohypertrophy. However, patients who reuse needles should not be subjected to alarming claims of excessive morbidity from this practice (A). Health care authorities and planners should be alerted to the risks associated with syringe or pen needles 6 mm or longer in children (A).

References 167

1. 1.

   International Diabetes Federation. Diabetes atlas—8th edition. http://www.diabetesatlas.org/resources/2017-atlas.html. Accessed Dec 19, 2017.

   Not in our library

2. 2.

   Institute for Health Metrics and Evaluation Human Development Network. The World Bank. The global burden of disease: generating evidence, guiding policy—Sub-Saharan Africa Regional Edition. Seattle: IHME; 2013.

   Not in our library

3. 3.

   UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352(9131):854-865.

   Not in our library10.1016/s0140-6736(98)07037-8

4. 4.

   UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-853.

   Not in our library10.1016/s0140-6736(98)07019-6

5. 5.

   The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986.

   Not in our library10.1056/nejm199309303291401

6. 6.

   Bolen S, Tseng E, Hutfless S, et al. Diabetes medications for adults with type 2 diabetes: an update. Comparative effectiveness review no. 173. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2012-00007-I.). AHRQ Publication No.16-EHC013-EF. Rockville: Agency for Healthcare Research and Quality; 2016. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm.

   Not in our library

7. 7.

   Wirtz VJ, Knox R, Cao C, Mehrtash H, Posner NW. Insulin market profile. 2016.

   Not in our library

8. 8.

   Kalra S, Baruah MP, Sahay R, Kishor K. Pentads and hexads in diabetes care: numbers as targets; numbers as tools. Indian J Endocrinol Metab. 2017;21(6):794.

   Not in our library10.4103/ijem.ijem_281_17

9. 9.

   Lachin JM, Genuth S, Cleary P, Davis MD, Nathan DM. Retinopathy and nephropathy in patients with type 1 diabetes four years after a trial of intensive therapy. N Engl J Med. 2000;342(6):381-389.

   Not in our library10.1056/nejm200002103420603

10. 10.

    American Diabetes Association. Standards of medical care in diabetes—2018. Diabetes Care. 2018;41(1):S1-S155.

    Not in our library

11. 11.

    Damodaran GK, Gilsa E, Andrews M, Mathew C, George J, Ajith V. Apo lipoprotein B, total cholesterol, HDL-C, non HDL-C, LDL-C and triglycerides as risk factors of atherosclerotic vascular disease. Int J Adv Res. 2015;3(2):814-819.

    Not in our library

12. 12.

    Heine RJ, Balkau B, Ceriello A, Del Prato S, Horton ES, Taskinen MR. What does postprandial hyperglycaemia mean? Diabet Med. 2004;21(3):208-213.

    Not in our library10.1111/j.1464-5491.2004.01149.x

13. 13.

    Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28(2):103-117.

    Not in our library10.1016/0168-8227(95)01064-k

14. 14.

    ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560-2572.

    Not in our library10.1056/nejmoa0802987

15. 15.

    Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376(9739):419-430.

    Not in our library10.1016/s0140-6736(10)60576-4

16. 16.

    Saremi A, Moritz TE, Anderson RJ, et al. Rates and determinants of coronary and abdominal aortic artery calcium progression in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care. 2010;33(12):2642-2647.

    Not in our library10.2337/dc10-1388

17. 17.

    Handelsman Y, Bloomgarden ZT, Grunberger G, et al. American Association of Clinical Endocrinologists and American College of Endocrinology—clinical practice guidelines for developing a diabetes mellitus comprehensive care plan—2015. Endocr Pract. 2015;21(Suppl 1):1-87.

    Not in our library10.4158/ep15672.glsuppl

18. 18.

    Duckworth W, Abraira C, Moritz T, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009;360(2):129-139.

    Not in our library10.1056/nejmoa0808431

19. 19.

    Kahn CR, Weir GC, King GL, Jacobson AM, Moses AC, Smith RJ. Joslin: Diabetes Melito-14. Artmed Editora; 2009.

    Not in our library

20. 20.

    Turner R. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) (vol 352, pg 837, 1998). Lancet. 1999;354(9178):602.

    Not in our library10.1016/s0140-6736(05)77957-5

21. 21.

    Reuven Y, Dreiher J, Shvartzman P. The prevalence of diabetes, hypertension and obesity among immigrants from East Africa and the former Soviet Union: a retrospective comparative 30-year cohort study. Cardiovasc Diabetol. 2016;15:74.

    Not in our library10.1186/s12933-016-0392-7

22. 22.

    Bahendeka S, Wesonga R, Mutungi G, Muwonge J, Neema S, Guwatudde D. Prevalence and correlates of diabetes mellitus in Uganda: a population-based national survey. Trop Med Int Health. 2016;21(3):405-416.

    Not in our library10.1111/tmi.12663

23. 23.

    Gomez-Perez FJ, Aguilar-Salinas CA, Almeda-Valdes P, Cuevas-Ramos D, Garber IL, Rull JA. HbA1c for the diagnosis of diabetes mellitus in a developing country. A position article. Arch Med Res. 2010;41:302-308.

    Not in our library10.1016/j.arcmed.2010.05.007

24. 24.

    Mayige M, Kagaruki G. Tanzania STEPS Survey Report. Ministry of Health and Social Welfare and National Institute for Medial Research in Collaboration with World Health Organizaation; 2013. https://www.researchgate.net/publication/311065616_TANZANIA_STEPS_SURVEY_REPORT. Accessed Dec 23, 2017.

    Not in our library

25. 25.

    Unnikrishnan IR, Anjana R, Mohan V. Importance of controlling diabetes early–the concept of metabolic memory, legacy effect and the case for early insulinisation. J Assoc Physicians India. 2005;53:283-287.

    Not in our library

26. 26.

    World Health Organization. World Health Organization—noncommunicable diseases (NCD) country profiles, 2014. http://www.who.int/nmh/countries/bdi_en.pdf. Accessed Dec 23, 2017.

    Not in our library

27. 27.

    Kong M-F, Bickerton A. Insulin should be prescribed at the outset of diagnosis of type 2 diabetes. Pract Diab Int. 2011;28(2):85-87.

    Not in our library10.1002/pdi.1564

28. 28.

    World Health Organization. Ethiopia 2015 STEPS fast sheet. http://www.who.int/chp/steps/Ethiopia_2015_STEPS_FactSheet.pdf?ua=1. Accessed on Dec 4, 2017.

    Not in our library

29. 29.

    Manne-Goehler J, Atun R, Stokes A, et al. Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries. Lancet Diabetes Endocrinol. 2016;4(11):903-912.

    Not in our library10.1016/s2213-8587(16)30181-4

30. 30.

    Atun R, Davies JI, Gale EAM, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 2017;5(8):622-667.

    Not in our library10.1016/s2213-8587(17)30181-x

31. 31.
    Readiness of Ugandan health services for the management of outpatients with chronic diseases · 2015

    No notice
32. 32.

    Vedanthan R, Kamano JH, Bloomfield GS, Manji I, Pastakia S, Kimaiyo SN. Engaging the entire care cascade in Western Kenya: a model to achieve the cardiovascular disease secondary prevention roadmap goals. Glob Heart. 2015;10(4):313-317.

    Not in our library10.1016/j.gheart.2015.09.003

33. 33.

    Nnko S, Bukenya D, Kavishe BB, et al. Chronic diseases in North-West Tanzania and Southern Uganda. Public perceptions of terminologies, aetiologies, symptoms and preferred management. PLoS One. 2015;10(11):e0142194.

    Not in our library10.1371/journal.pone.0142194

34. 34.

    Nielsen J, Bahendeka SK, Bygbjerg IC, Meyrowitsch DW, Whyte SR. Accessing diabetes care in rural Uganda: economic and social resources. Glob Public Health. 2017;12(7):892–908.

    Not in our library10.1080/17441692.2016.1172100

35. 35.

    Cook AR. Notes on the disease met with in Uganda, Central Africa. J Trop Med. 1901;4(17):5-8.

    Not in our library

36. 36.

    Amendezo E, Walker Timothy D, Karamuka V, et al. Effects of a lifestyle education program on glycemic control among patients with diabetes at Kigali University Hospital, Rwanda: a randomized controlled trial. Diabetes Res Clin Pract. 2017;126:129-137.

    Not in our library10.1016/j.diabres.2017.02.001

37. 37.

    Marshall SL, Edidin D, Arena VC, et al. Prevalence and incidence of clinically recognized cases of type 1 diabetes in children and adolescents in Rwanda, Africa. Diabet Med. 2015;32(9):1186-1192.

    Not in our library10.1111/dme.12701

38. 38.

    Ngwiri T, Were F, Predieri B, Ngugi P, Iughetti L. Glycemic control in Kenyan children and adolescents with type 1 diabetes mellitus. Int J Endocrinol. 2015;2015:761759.

    Not in our library10.1155/2015/761759

39. 39.

    Majaliwa ES, Munubhi E, Ramaiya K, et al. Survey on acute and chronic complications in children and adolescents with type 1 diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania. Diabetes Care. 2007;30(9):2187-2192.

    Not in our library10.2337/dc07-0594

40. 40.

    Osujih M. Exploration of the frontiers of tradomedical practices: basis for development of alternative medical healthcare services in developing countries. J R Soc Health. 1993;113(4):190-194.

    Not in our library10.1177/146642409311300409

41. 41.

    Agyemang C, de-Graft Aikins A, Bhopal R. Ethnicity and cardiovascular health research: pushing the boundaries by including comparison populations in the countries of origin. Ethn Health. 2012;17(6):579-596.

    Not in our library10.1080/13557858.2012.730607

42. 42.

    Majaliwa ES, Elusiyan BE, Adesiyun OO, et al. Type 1 diabetes mellitus in the African population: epidemiology and management challenges. Acta Biomed. 2008;79(3):255-259.

    Not in our library

43. 43.

    Muze KC, Majaliwa ES. Type 1 diabetes care updates: Tanzania. Indian J Endocrinol Metab. 2015;19(Suppl 1):S12-S13.

    Not in our library10.4103/2230-8210.155348

44. 44.

    McLarty D, Pollitt C, Swai A. Diabetes in Africa. Diabet Med. 1990;7(8):670-684.

    Not in our library10.1111/j.1464-5491.1990.tb01470.x

45. 45.

    Mwebaze RM, Kibirige D. Peripheral arterial disease among adult diabetic patients attending a large outpatient diabetic clinic at a national referral hospital in Uganda: a descriptive cross sectional study. PLoS One. 2014;9(8):e105211.

    Not in our library10.1371/journal.pone.0105211

46. 46.

    Abbas ZG. Diabetic foot—an African perspective. JSM Foot Ankle. 2016;1(1):1005.

    Not in our library

47. 47.

    Byrne MM, Sturis J, Sobel RJ, Polonsky KS. Elevated plasma glucose 2 h postchallenge predicts defects in beta-cell function. Am J Physiol Endocrinol Metab. 1996;270(4):E572-E579.

    Not in our library10.1152/ajpendo.1996.270.4.e572

48. 48.

    Owens DR, Zinman B, Bolli GB. Insulins today and beyond. Lancet. 2001;358(9283):739-746.

    Not in our library10.1016/s0140-6736(01)05842-1

49. 49.

    Pettus J, Santos Cavaiola T, Tamborlane WV, Edelman S. The past, present, and future of basal insulins. Diabetes Metab Res Rev. 2016;32(6):478-496.

    Not in our library10.1002/dmrr.2763

50. 50.

    Heneghan C, Badenoch D. Evidence-based medicine toolkit. 2013.

    Not in our library

51. 51.

    Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm—2017 executive summary. Endocr Pract. 2017;23(2):207-238.

    Not in our library10.4158/ep161682.cs

52. 52.

    International Diabetes Federation Guideline Development Group. Global guideline for type 2 diabetes. Diabetes Res Clin Pract. 2014;104(1):1-52.

    Not in our library10.1016/j.diabres.2012.10.001

53. 53.

    Mohan V, Kalra S, Kesavadev J, et al. Consensus on initiation and intensification of premix insulin in type 2 diabetes management. J Assoc Physicians India. 2017;65(4):59-73.

    Not in our library

54. 54.

    Das AK, Sahay BK, Seshiah V, et al. Indian National Consensus Group: national guidelines on initiation and intensification of insulin therapy with premixed insulin analogs. Med Update. 2013;2013:227.

    Not in our library

55. 55.

    SEMDSA 2017 guidelines for the management of type 2 diabetes mellitus. J Endocrinol Metab Diabetes S Afr. 2017;22(1):S1–S196.

    Not in our library

56. 56.

    Hinson AM, Stack BC. Evidence-based medicine: approach and references classification. Medical and surgical treatment of parathyroid diseases. 2017;11-13.

    Not in our library

57. 57.

    Gardner KE. ‘The art of insulin treatment:’ diabetes, insulin, and the 1920s. J Med Humanit. 2017:1–10.

    Not in our library10.1007/s10912-017-9493-x

58. 58.

    Quianzon CC, Cheikh I. History of insulin. J Community Hosp Intern Med Perspect. 2012;2(2). 10.3402/jchimp.v2i2.18701.

    Not in our library10.3402/jchimp.v2i2.18701

59. 59.

    Gill G, Yudkin JS, Tesfaye S, et al. Essential medicines and access to insulin. Lancet Diabetes Endocrinol. 2017;5(5):324-325.

    Not in our library10.1016/s2213-8587(17)30090-6

60. 60.

    Mayfield JA, White RD. Insulin therapy for type 2 diabetes: rescue, augmentation, and replacement of beta-cell function. Am Fam Physician. 2004;70(3):489-500.

    Not in our library

61. 61.

    Neu A, Lange K, Barrett T, et al. Classifying insulin regimens—difficulties and proposal for comprehensive new definitions. Pediatr Diabetes. 2015;16(6):402-406.

    Not in our library10.1111/pedi.12275

62. 62.

    Guthrie DW, Guthrie RA, Hinnen D, Childs BP. It’s time to abandon the sliding scale. J Fam Pract. 2011;60(5):266-270.

    Not in our library

63. 63.

    Jackson RL, Storvick WO, Hollinden CS, Stroeh LE, Stilz JG. Neutral regular insulin. Diabetes. 1972;21(4):235-245.

    Not in our library10.2337/diab.21.4.235

64. 64.

    Salonen KM, Ryhänen S, Härkönen T, Ilonen J, Knip M. Autoantibodies against zinc transporter 8 are related to age, metabolic state and HLA DR genotype in children with newly diagnosed type 1 diabetes. Diabetes Metab Res Rev. 2013;29(8):646-654.

    Not in our library10.1002/dmrr.2440

65. 65.

    Home PD. The pharmacokinetics and pharmacodynamics of rapid-acting insulin analogues and their clinical consequences. Diabetes Obes Metab. 2012;14(9):780-788.

    Not in our library10.1111/j.1463-1326.2012.01580.x

66. 66.

    Kalra S. Newer basal insulin analogues: degludec, detemir, glargine. J Pak Med Assoc. 2013;63(11):1442-1444.

    Not in our library

67. 67.

    Turner H, Matthews D. The use of fixed-mixture insulins in clinical practice. Eur J Clin Pharmacol. 2000;56(1):19-25.

    Not in our library10.1007/s002280050715

68. 68.

    Frias PF, Frias JP. New basal insulins: a clinical perspective of their use in the treatment of type 2 diabetes and novel treatment options beyond basal insulin. Curr Diabetes Rep. 2017;17(10):91.

    Not in our library10.1007/s11892-017-0926-8

69. 69.

    NICE. Type 1 diabetes in adults: diagnosis and management. London: National Institute for Health and Care Excellence: Clinical Guidelines; 2015.

    Not in our library

70. 70.

    Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, McGibbon A, Richardson C, Hernandez C, Dornan J. Pharmacotherapy in type 1 diabetes. Can J Diabetes. 2013;37(Suppl 1):S56-S60.

    Not in our library10.1016/j.jcjd.2013.01.020

71. 71.

    Kaur KK, Allahbadia G, Singh M. An update on a etiopathogenesis and management of obesity. Obes Control Ther. 2016;3(1):1-17.

    Not in our library

72. 72.

    Nokoff N, Rewers M. Pathogenesis of type 1 diabetes: lessons from natural history studies of high-risk individuals. Ann NY Acad Sci. 2013;1281(1):1-15.

    Not in our library10.1111/nyas.12021

73. 73.

    NICE. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. London: National Institute for Health and Care Excellence: Clinical Guidelines; 2015.

    Not in our library

74. 74.

    Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643-2653.

    Not in our library10.1056/nejmoa052187

75. 75.

    Garg SK, Rosenstock J, Ways K. Optimized basal-bolus insulin regimens in type 1 diabetes: insulin glulisine versus regular human insulin in combination with basal insulin glargine. Endocr Pract. 2005;11(1):11-17.

    Not in our library10.4158/ep.11.1.11

76. 76.

    DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus: scientific review. JAMA. 2003;289(17):2254-2264.

    Not in our library10.1001/jama.289.17.2254

77. 77.

    Chatterjee S, Jarvis-Kay J, Rengarajan T, Lawrence IG, McNally PG, Davies MJ. Glargine versus NPH insulin: efficacy in comparison with insulin aspart in a basal bolus regimen in type 1 diabetes–the glargine and aspart study (GLASS) a randomised cross-over study. Diabetes Res Clin Pract. 2007;77(2):215-222.

    Not in our library10.1016/j.diabres.2006.11.002

78. 78.

    De Leeuw I, Vague P, Selam JL, et al. Insulin detemir used in basal-bolus therapy in people with type 1 diabetes is associated with a lower risk of nocturnal hypoglycaemia and less weight gain over 12 months in comparison to NPH insulin. Diabetes Obes Metab. 2005;7(1):73-82.

    Not in our library10.1111/j.1463-1326.2004.00363.x

79. 79.

    Birkeland KI, Home PD, Wendisch U, et al. Insulin degludec in type 1 diabetes: a randomized controlled trial of a new-generation ultra-long-acting insulin compared with insulin glargine. Diabetes Care. 2011;34(3):661-665.

    Not in our library10.2337/dc10-1925

80. 80.

    Chen JW, Lauritzen T, Bojesen A, Christiansen JS. Multiple mealtime administration of biphasic insulin aspart 30 versus traditional basal-bolus human insulin treatment in patients with type 1 diabetes. Diabetes Obes Metab. 2006;8(6):682-689.

    Not in our library10.1111/j.1463-1326.2005.00557.x

81. 81.

    Mortensen H, Kocova M, Teng LY, Keiding J, Bruckner I, Philotheou A. Biphasic insulin aspart vs. human insulin in adolescents with type 1 diabetes on multiple daily insulin injections. Pediatr Diabetes. 2006;7(1):4-10.

    Not in our library10.1111/j.1399-543x.2006.00138.x

82. 82.

    Vella S, Buetow L, Royle P, Livingstone S, Colhoun HM, Petrie JR. The use of metformin in type 1 diabetes: a systematic review of efficacy. Diabetologia. 2010;53(5):809-820.

    Not in our library10.1007/s00125-009-1636-9

83. 83.

    Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577-1589.

    Not in our library10.1056/nejmoa0806470

84. 84.

    Kalra S, Gupta Y. Insulin initiation: bringing objectivity to choice. J Diabetes Metab Disord. 2015;14:17.

    Not in our library10.1186/s40200-015-0146-1

85. 85.

    Hermansen K, Davies M, Derezinski T, Martinez Ravn G, Clauson P, Home P. A 26-week, randomized, parallel, treat-to-target trial comparing insulin detemir with NPH insulin as add-on therapy to oral glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetes Care. 2006;29(6):1269-1274.

    Not in our library10.2337/dc05-1365

86. 86.

    Laubner K, Molz K, Kerner W, et al. Daily insulin doses and injection frequencies of neutral protamine Hagedorn (NPH) insulin, insulin detemir and insulin glargine in type 1 and type 2 diabetes: a multicenter analysis of 51 964 patients from the German/Austrian DPV-wiss database. Diabetes Metab Res Rev. 2014;30(5):395-404.

    Not in our library10.1002/dmrr.2500

87. 87.

    Rosenstock J, Davies M, Home PD, Larsen J, Koenen C, Schernthaner G. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia. 2008;51(3):408-416.

    Not in our library10.1007/s00125-007-0911-x

88. 88.

    Unnikrishnan AG, Tibaldi J, Hadley-Brown M, et al. Practical guidance on intensification of insulin therapy with BIAsp 30: a consensus statement. Int J Clin Pract. 2009;63(11):1571-1577.

    Not in our library10.1111/j.1742-1241.2009.02192.x

89. 89.

    El Naggar NK, Soewondo P, Khamseh ME, Chen JW, Haddad J. Switching from biphasic human insulin 30 to biphasic insulin aspart 30 in type 2 diabetes is associated with improved glycaemic control and a positive safety profile: results from the A(1)chieve study. Diabetes Res Clin Pract. 2012;98(3):408-413.

    Not in our library10.1016/j.diabres.2012.09.043

90. 90.

    Shah S, Yang W, Hasan MI, Malek R, Molskov Bech O, Home P. Biphasic insulin aspart 30 in insulin-naive people with type 2 diabetes in non-western nations: results from a regional comparative multinational observational study (A(1)chieve). Diabetes Technol Ther. 2013;15(11):954-963.

    Not in our library10.1089/dia.2013.0074

91. 91.

    Kramer CK, Zinman B, Retnakaran R. Short-term intensive insulin therapy in type 2 diabetes mellitus: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2013;1(1):28-34.

    Not in our library10.1016/s2213-8587(13)70006-8

92. 92.

    Kann PH, Wascher T, Zackova V, et al. Starting insulin therapy in type 2 diabetes: twice-daily biphasic insulin aspart 30 plus metformin versus once-daily insulin glargine plus glimepiride. Exp Clin Endocrinol Diabetes. 2006;114(9):527-532.

    Not in our library10.1055/s-2006-949655

93. 93.

    Raskin PR, Hollander PA, Lewin A, et al. Basal insulin or premix analogue therapy in type 2 diabetes patients. Eur J Intern Med. 2007;18(1):56-62.

    Not in our library10.1016/j.ejim.2006.09.006

94. 94.

    Oyer DS, Shepherd MD, Coulter FC, et al. Efficacy and tolerability of self-titrated biphasic insulin aspart 70/30 in patients aged > 65 years with type 2 diabetes: an exploratory post hoc subanalysis of the INITIATEplus trial. Clin Ther. 2011;33(7):874-883.

    Not in our library10.1016/j.clinthera.2011.05.093

95. 95.

    Strojek K, Bebakar WM, Khutsoane DT, et al. Once-daily initiation with biphasic insulin aspart 30 versus insulin glargine in patients with type 2 diabetes inadequately controlled with oral drugs: an open-label, multinational RCT. Curr Med Res Opin. 2009;25(12):2887-2894.

    Not in our library10.1185/03007990903354674

96. 96.

    Kalra S, Plata-Que T, Kumar D, et al. Initiation with once-daily BIAsp 30 results in superior outcome compared to insulin glargine in Asians with type 2 diabetes inadequately controlled by oral anti-diabetic drugs. Diabetes Res Clin Pract. 2010;88(3):282-288.

    Not in our library10.1016/j.diabres.2010.03.004

97. 97.

    Raskin P, Allen E, Hollander P, et al. Initiating insulin therapy in type 2 diabetes: a comparison of biphasic and basal insulin analogs. Diabetes Care. 2005;28(2):260-265.

    Not in our library10.2337/diacare.28.2.260

98. 98.

    Buse JB, Wolffenbuttel BH, Herman WH, et al. DURAbility of basal versus lispro mix 75/25 insulin efficacy (DURABLE) trial 24-week results: safety and efficacy of insulin lispro mix 75/25 versus insulin glargine added to oral antihyperglycemic drugs in patients with type 2 diabetes. Diabetes Care. 2009;32(6):1007-1013.

    Not in our library10.2337/dc08-2117

99. 99.

    Buse JB, Wolffenbuttel BH, Herman WH, et al. The DURAbility of Basal versus Lispro mix 75/25 insulin Efficacy (DURABLE) trial: comparing the durability of lispro mix 75/25 and glargine. Diabetes Care. 2011;34(2):249-255.

    Not in our library10.2337/dc10-1701

100. 100.

     Jothydev K, Rajput R, John M, Annamalai AK, Rao PV. Consensus statement on choice of insulin therapy in type 2 diabetes. J Assoc Physicians India. 2016;64:13–18.

     Not in our library

101. 101.

     Christiansen JS, Niskanen L, Rasmussen S, Johansen T, Fulcher G. Lower rates of hypoglycemia during maintenance treatment with insulin degludec/insulin aspart versus biphasic insulin aspart 30: a combined analysis of two phase 3a studies in type 2 diabetes. J Diabetes. 2016;8(5):720-728.

     Not in our library10.1111/1753-0407.12355

102. 102.

     Kaneko S, Chow F, Choi DS, et al. Insulin degludec/insulin aspart versus biphasic insulin aspart 30 in Asian patients with type 2 diabetes inadequately controlled on basal or pre-/self-mixed insulin: a 26-week, randomised, treat-to-target trial. Diabetes Res Clin Pract. 2015;107(1):139-147.

     Not in our library10.1016/j.diabres.2014.09.026

103. 103.

     Shi LX, Li PF, Hou JN. Differential treatment response to insulin intensification therapy: a post hoc analysis of a randomized trial comparing premixed and basal-bolus insulin regimens. Diabetes Ther. 2017;8(4):915-928.

     Not in our library10.1007/s13300-017-0286-z

104. 104.

     Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140-149.

     Not in our library10.2337/dc14-2441

105. 105.

     Mwanri AW, Kinabo J, Ramaiya K, Feskens EJ. Prevalence of gestational diabetes mellitus in urban and rural Tanzania. Diabetes Res Clin Pract. 2014;103(1):71-78.

     Not in our library10.1016/j.diabres.2013.11.021

106. 106.

     Nakabuye B, Bahendeka S, Byaruhanga R. Prevalence of hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes at St. Francis Hospital Nsambya. BMC Res Notes. 2017;10(1):174.

     Not in our library10.1186/s13104-017-2493-0

107. 107.

     Muganyizi PS, Kidanto HL. Impact of change in maternal age composition on the incidence of caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999–2005. BMC Pregnancy Childbirth. 2009;9:30.

     Not in our library10.1186/1471-2393-9-30

108. 108.

     World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. 2013.

     Not in our library

109. 109.

     Balsells M, Garcia-Patterson A, Sola I, Roque M, Gich I, Corcoy R. Glibenclamide, metformin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ. 2015;350:h102.

     Not in our library10.1136/bmj.h102

110. 110.

     Balaji V, Balaji MS, Alexander C, et al. Premixed insulin aspart 30 (BIAsp 30) versus premixed human insulin 30 (BHI 30) in gestational diabetes mellitus: a randomized open-label controlled study. Gynecol Endocrinol. 2012;28(7):529-532.

     Not in our library10.3109/09513590.2011.650661

111. 111.

     Stanifer JW, Jing B, Tolan S, et al. The epidemiology of chronic kidney disease in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Glob Health. 2014;2(3):e174-e181.

     Not in our library10.1016/s2214-109x(14)70002-6

112. 112.

     Iglesias P, Diez JJ. Insulin therapy in renal disease. Diabetes Obes Metab. 2008;10(10):811-823.

     Not in our library10.1111/j.1463-1326.2007.00802.x

113. 113.

     Kengne AP, Amoah AG, Mbanya JC. Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation. 2005;112(23):3592-3601.

     Not in our library10.1161/circulationaha.105.544312

114. 114.

     Onyekwere CA, Ogbera AO, Balogun BO. Non-alcoholic fatty liver disease and the metabolic syndrome in an urban hospital serving an African community. Ann Hepatol. 2011;10(2):119-124.

     Not in our library

115. 115.

     Edghill EL, Flanagan SE, Patch AM, et al. Insulin mutation screening in 1,044 patients with diabetes: mutations in the INS gene are a common cause of neonatal diabetes but a rare cause of diabetes diagnosed in childhood or adulthood. Diabetes. 2008;57(4):1034-1042.

     Not in our library10.2337/db07-1405

116. 116.

     Nyangabyaki-Twesigye C, Muhame MR, Bahendeka S. Permanent neonatal diabetes mellitus—a case report of a rare cause of diabetes mellitus in East Africa. Afr Health Sci. 2015;15(4):1339-1341.

     Not in our library10.4314/ahs.v15i4.37

117. 117.

     Rubio-Cabezas O, Hattersley AT, Njolstad PR, et al. ISPAD clinical practice consensus guidelines 2014. The diagnosis and management of monogenic diabetes in children and adolescents. Pediatr Diabetes. 2014;15(Suppl 20):47-64.

     Not in our library10.1111/pedi.12192

118. 118.

     von Muhlendahl KE, Herkenhoff H. Long-term course of neonatal diabetes. N Engl J Med. 1995;333(11):704-708.

     Not in our library10.1056/nejm199509143331105

119. 119.

     Salti I, Benard E, Detournay B, et al. A population-based study of diabetes and its characteristics during the fasting month of Ramadan in 13 countries: results of the epidemiology of diabetes and Ramadan 1422/2001 (EPIDIAR) study. Diabetes Care. 2004;27(10):2306-2311.

     Not in our library10.2337/diacare.27.10.2306

120. 120.

     Jabbar A, Hassanein M, Beshyah SA, Boye KS, Yu M, Babineaux SM. CREED study: hypoglycaemia during Ramadan in individuals with type 2 diabetes mellitus from three continents. Diabetes Res Clin Pract. 2017;132:19-26.

     Not in our library10.1016/j.diabres.2017.07.014

121. 121.

     Al-Arouj M, Assaad-Khalil S, Buse J, et al. Recommendations for management of diabetes during Ramadan: update 2010. Diabetes Care. 2010;33(8):1895-1902.

     Not in our library10.2337/dc10-0896

122. 122.

     Hassanein M, Al-Arouj M, Hamdy O, et al. Diabetes and Ramadan: practical guidelines. Diabetes Res Clin Pract. 2017;126:303-316.

     Not in our library10.1016/j.diabres.2017.03.003

123. 123.

     Grunberger G. Insulin analogs-are they worth it? Yes! Diabetes Care. 2014;37(6):1767-1770.

     Not in our library10.2337/dc14-0031

124. 124.

     Akram J, De Verga V. Insulin lispro (Lys(B28), Pro(B29) in the treatment of diabetes during the fasting month of Ramadan. Ramadan Study Group. Diabet Med. 1999;16(10):861-866.

     Not in our library10.1046/j.1464-5491.1999.00164.x

125. 125.

     Mattoo V, Milicevic Z, Malone JK, et al. A comparison of insulin lispro Mix25 and human insulin 30/70 in the treatment of type 2 diabetes during Ramadan. Diabetes Res Clin Pract. 2003;59(2):137-143.

     Not in our library10.1016/s0168-8227(02)00202-4

126. 126.

     Hui E, Bravis V, Salih S, Hassanein M, Devendra D. Comparison of Humalog Mix 50 with human insulin Mix 30 in type 2 diabetes patients during Ramadan. Int J Clin Pract. 2010;64(8):1095-1099.

     Not in our library10.1111/j.1742-1241.2010.02347.x

127. 127.

     Bakiner O, Ertorer ME, Bozkirli E, Tutuncu NB, Demirag NG. Repaglinide plus single-dose insulin glargine: a safe regimen for low-risk type 2 diabetic patients who insist on fasting in Ramadan. Acta Diabetol. 2009;46(1):63-65.

     Not in our library10.1007/s00592-008-0062-7

128. 128.

     Shehadeh N, Maor Y, Ramadan Study Group. Effect of a new insulin treatment regimen on glycaemic control and quality of life of Muslim patients with type 2 diabetes mellitus during Ramadan fast—an open label, controlled, multicentre, cluster randomised study. Int J Clin Pract. 2015;69(11):1281-1288.

     Not in our library10.1111/ijcp.12695

129. 129.

     Soeatmadji DW, Sanusi H, Adam JMF, Soewondo P. A multicenter, prospective, non-interventional evaluation of efficacy and safety of using biphasic insulin aspart as monotherapy, or in combination with oral hypoglycemic agent, in the treatment of type 2 diabetic patients before, during, and after Ramadan. J Indones Med Assoc. 2009;59(12).

     Not in our library

130. 130.

     Kassem HS, Zantout MS, Azar ST. Insulin therapy during Ramadan fast for type 1 diabetes patients. J Endocrinol Invest. 2005;28(9):802-805.

     Not in our library10.1007/bf03347569

131. 131.

     Benbarka MM, Khalil AB, Beshyah SA, Marjei S, Awad SA. Insulin pump therapy in Moslem patients with type 1 diabetes during Ramadan fasting: an observational report. Diabetes Technol Ther. 2010;12(4):287-290.

     Not in our library10.1089/dia.2009.0130

132. 132.

     Acquah S, Boampong JN, Eghan Jnr BA, Eriksson M. Evidence of insulin resistance in adult uncomplicated malaria: result of a two-year prospective study. Malar Res Treat. 2014;2014:136148.

     Not in our library10.1155/2014/136148

133. 133.

     Mohapatra MK. Profile of severe falciparum malaria in diabetics. Int J Diabetes Dev Ctries. 2001;21:156-161.

     Not in our library

134. 134.

     Kalra S, Aggarwal S, Khandelwal D, Dutta D. Management of glycemia in acute febrile illness. Indian J Endocrinol Metab. 2017;21(3):460-463.

     Not in our library10.4103/ijem.ijem_544_16

135. 135.

     Jacobi J, Bircher N, Krinsley J, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012;40(12):3251-3276.

     Not in our library10.1097/ccm.0b013e3182653269

136. 136.

     Larson R, Capili B, Eckert-Norton M, Colagreco JP, Anastasi JK. Disorders of glucose metabolism in the context of human immunodeficiency virus infection. J Am Acad Nurse Pract. 2006;18(3):92-103.

     Not in our library10.1111/j.1745-7599.2006.00109.x

137. 137.

     Kalra S, Kalra B, Agrawal N, Unnikrishnan A. Understanding diabetes in patients with HIV/AIDS. Diabetol Metab Syndr. 2011;3(1):2.

     Not in our library10.1186/1758-5996-3-2

138. 138.

     Sobngwi E, Vexiau P, Levy V, et al. Metabolic and immunogenetic prediction of long-term insulin remission in African patients with atypical diabetes. Diabet Med. 2002;19(10):832-835.

     Not in our library10.1046/j.1464-5491.2002.00802.x

139. 139.

     Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med. 2006;144(5):350-357.

     Not in our library10.7326/0003-4819-144-5-200603070-00011

140. 140.

     Murata GH, Shah JH, Hoffman RM, et al. Intensified blood glucose monitoring improves glycemic control in stable, insulin-treated veterans with type 2 diabetes: the Diabetes Outcomes in Veterans Study (DOVES). Diabetes Care. 2003;26(6):1759-1763.

     Not in our library10.2337/diacare.26.6.1759

141. 141.

     DeVries JH. Postprandial or fasting hyperglycemia: time to move on? Diabetes Technol Ther. 2015;17(7):441-442.

     Not in our library10.1089/dia.2015.0158

142. 142.

     Wambui Charity K, Kumar AMV, Hinderaker SG, Chinnakali P, Pastakia SD, Kamano J. Do diabetes mellitus patients adhere to self-monitoring of blood glucose (SMBG) and is this associated with glycemic control? Experiences from a SMBG program in western Kenya. Diabetes Res Clin Pract. 2016;112:37-43.

     Not in our library10.1016/j.diabres.2015.11.006

143. 143.

     Institute For Safe Medication Practices. ISMP guidelines for optimizing safe subcutaneous insulin use in adults. 2017. https://www.ismp.org/tools/guidelines/Insulin-Guideline.pdf. Accessed 4 Dec 2018.

     Not in our library

144. 144.

     Wako A, Belay S, Feleke Y, Kebede T. Assessment of the magnitude, severity and associated factors of hypoglycemia in diabetic patients attending National Diabetes Referral Clinic at Tikur Anbessa Hospital, Addis Ababa, Ethiopia. J Diabetes Metab. 2017;8:471.

     Not in our library10.4172/2155-6156.1000741

145. 145.

     Liu SC, Tu YK, Chien MN, Chien KL. Effect of antidiabetic agents added to metformin on glycaemic control, hypoglycaemia and weight change in patients with type 2 diabetes: a network meta-analysis. Diabetes Obes Metab. 2012;14(9):810-820.

     Not in our library10.1111/j.1463-1326.2012.01606.x

146. 146.

     Almaatouq MA, Al-Arouj M, Amod A, et al. Barriers to the delivery of optimal antidiabetic therapy in the Middle East and Africa. Int J Clin Pract. 2014;68(4):503-511.

     Not in our library10.1111/ijcp.12342

147. 147.

     Otieno CF, Kanu JE, Karari EM, Okech-Helu V, Joshi MD, Mutai K. Glucose-lowering therapies, adequacy of metabolic control, and their relationship with comorbid depression in outpatients with type 2 diabetes in a tertiary hospital in Kenya. Diabetes Metab Syndr Obes. 2017;10:141-149.

     Not in our library10.2147/dmso.s124473

148. 148.

     Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care. 2009;32(6):1119-1131.

     Not in our library10.2337/dc09-9029

149. 149.

     International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2017;40(1):155-157.

     Not in our library10.2337/dc16-2215

150. 150.

     Giugliano D, Chiodini P, Maiorino MI, Bellastella G, Esposito K. Intensification of insulin therapy with basal-bolus or premixed insulin regimens in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Endocrine. 2016;51(3):417-428.

     Not in our library10.1007/s12020-015-0718-3

151. 151.

     Bellido V, Suarez L, Rodriguez MG, et al. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with type 2 diabetes. Diabetes Care. 2015;38(12):2211-2216.

     Not in our library10.2337/dc15-0160

152. 152.

     Rehman HU, Mohammed K. Perioperative management of diabetic patients. Curr Surg. 2003;60(6):607-611.

     Not in our library10.1016/j.cursur.2003.07.002

153. 153.

     Meneghini LF. Perioperative management of diabetes: translating evidence into practice. Cleve Clin J Med. 2009;76(Suppl 4):S53-S59.

     Not in our library10.3949/ccjm.76.s4.09

154. 154.

     Corsino L, Dhatariya K, Umpierrez G. Management of diabetes and hyperglycemia in hospitalized patients. In: De Groot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A, Hershman JM, et al., editors. Endotext: South Dartmouth; 2000.

     Not in our library

155. 155.

     Brady VJ. Insulin therapy: the old, the new and the novel—an overview. Nurs Clin North Am. 2017;52(4):539-552.

     Not in our library10.1016/j.cnur.2017.07.004

156. 156.

     Ogle GD, Abdullah M, Mason D, Januszewski AS, Besancon S. Insulin storage in hot climates without refrigeration: temperature reduction efficacy of clay pots and other techniques. Diabet Med. 2016;33(11):1544–53.

     Not in our library10.1111/dme.13194

157. 157.

     Frid AH, Kreugel G, Grassi G, et al. New insulin delivery recommendations. Mayo Clin Proc. 2016;91(9):1231-1255.

     Not in our library10.1016/j.mayocp.2016.06.010

158. 158.

     Elisabetta R, Prüss-Ustün HY. Assessing the burden of disease from sharps injuries to healthcare workers at national and local levels. 2005;11.

     Not in our library

159. 159.

     Heinemann L. Biosimilar insulins. Expert Opin Biol Ther. 2012;12(8):1009-1016.

     Not in our library10.1517/14712598.2012.688024

160. 160.

     Bommer C, Heesemann E, Sagalova V, et al. The global economic burden of diabetes in adults aged 20–79 years: a cost-of-illness study. Lancet Diabetes Endocrinol. 2017;5(6):423–30.

     Not in our library10.1016/s2213-8587(17)30097-9

161. 161.

     Kamara NT, Asiimwe S. Dyslipidaemia and hypertension among adults with diabetes in rural Uganda. Trop Doct. 2010;40(1):41-42.

     Not in our library10.1258/td.2009.090086

162. 162.

     Cheung BM, Ong KL, Cherny SS, Sham P-C, Tso AW, Lam KS. Diabetes prevalence and therapeutic target achievement in the United States, 1999 to 2006. Am J Med. 2009;122(5):443-453.

     Not in our library10.1016/j.amjmed.2008.09.047

163. 163.

     Brown JB, Nichols GA, Perry A. The burden of treatment failure in type 2 diabetes. Diabetes Care. 2004;27(7):1535-1540.

     Not in our library10.2337/diacare.27.7.1535

164. 164.

     ORIGIN Trial Investigators. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med. 2012;2012(367):319-328.

     Not in our library10.1056/nejmoa1203858

165. 165.

     Li Y, Xu W, Liao Z, et al. Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients is associated with improvement of β-cell function. Diabetes Care. 2004;27(11):2597-2602.

     Not in our library10.2337/diacare.27.11.2597

166. 166.

     Weng J, Li Y, Xu W, et al. Effect of intensive insulin therapy on β-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet. 2008;371(9626):1753-1760.

     Not in our library10.1016/s0140-6736(08)60762-x

167. 167.

     Hu Y, Li L, Xu Y, et al. Short-term intensive therapy in newly diagnosed type 2 diabetes partially restores both insulin sensitivity and β-cell function in subjects with long-term remission. Diabetes Care. 2011;34(8):1848-1853.

     Not in our library10.2337/dc10-2105

Cited by papers we hold 3

• Enhancing Choices Regarding the Administration of Insulin Among Patients With Diabetes Requiring Insulin Across Countries and Implications for Future Care · 2022
  Not checked
• Gut microbiota: A new target for T2DM prevention and treatment · 2022
  No notice
• Continuous glucose monitoring assessment of metabolic control in east African children and young adults with type 1 diabetes: A pilot and feasibility study · 2020
  Not checked

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.