Somatostatin analogue, octreotide, reduces increased glomerular filtration rate and kidney size in insulin-dependent diabetes

Article Abstract:

As many as 45 percent of the patients with insulin-dependent diabetes mellitus (IDDM) develop a certain type of kidney disease (diabetic nephropathy); once it begins, this complication progresses steadily. Its rate of progress, however, can be slowed by certain treatments, such as those that lower blood pressure. One factor apparently related to the extent of diabetic nephropathy is the rate of glomerular filtration (the rate at which fluid is filtered from the capillaries into the glomerulus, the structure in the kidney that first collects urine); when the rate is high (hyperfiltration), disease is more likely to develop. To evaluate the effects on glomerular hyperfiltration in IDDM patients by octreotide (a substance chemically similar to somatostatin, which inhibits growth hormone), 11 patients were studied. They were randomly assigned to receive either octreotide or a placebo as a continuous infusion with a portable pump for 12 weeks. Before treatment started, once during the study, and after the study's end, patients were evaluated to determine glomerular filtration rate, kidney volume (increased volume is a sign of disease and can be related to filtration rate), presence of gallstones, and glycemic control (control of blood sugar levels). Results showed that the five patients in the octreotide group had a reduced glomerular filtration rate compared with the six patients in the placebo group: four of the five had markedly reduced rates (between 22 and 32 percent reduction). In addition, the kidney volume in the octreotide group had been significantly lowered. Glycemic control was similar for both groups, but patients in the octreotide group needed a lower daily insulin dose than placebo-group patients to maintain that control. A discussion is presented of the role of glomerular hyperfiltration in diabetic nephropathy; it is not universally accepted as a predictor of this type of kidney disease. While the ways octreotide affects kidney filtration and volume are not known, the results indicate that the hormone analogue does have these effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abnormalities, Prevention, Physiological aspects, Diabetic nephropathies, Glomerular filtration rate, Octreotide acetate

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Rotation of the anatomic regions used for insulin injections and day-to-day variability of plasma glucose in type I diabetic subjects

Article Abstract:

Type I, or insulin-dependent, diabetes mellitus is characterized by hyperglycemia (high blood sugar) which can be stabilized by injecting insulin one or more times per day. The goal is to keep blood glucose levels as close to normal as possible, since severe hyper- or hypoglycemia can be fatal. Less extreme deviations from normal glucose levels over long periods have been implicated in the development of diabetic complications. Unfortunately, the blood sugar tends to fluctuate, and these fluctuations often cannot be predicted. The factors that influence blood glucose level, which include diet, exercise, and stress, interact in such a way that the same dosage of insulin may control glucose one day and lead to elevations the next. Another factor affecting blood glucose is the rate at which insulin is absorbed after injection under the skin; research has shown that insulin is absorbed more rapidly from some sites of the body (the abdomen) than others (the thighs and buttocks). Diabetics are usually instructed to rotate the site of injection from one part of the body to another, rather than consistently inject into a certain region. A study evaluated whether injecting insulin into one site, the abdomen, for three days would result in less variability in blood sugar than rotating between the arms, thighs, and abdomen for three days. Twelve type I diabetics participated, each following both protocols. The variation in blood sugar readings, taken nine times per day, was significantly less at all time points when the abdomen was used as the only injection site than when the injection site was rotated. These results suggest that the standard practice of rotating the injection site contributes to greater day-to-day variation in blood sugar, and it is recommended that only one region of the body be used for all injections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Measurement, Blood sugar, Blood glucose, Dosage and administration, Hyperglycemia, Injections

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Continuous peritoneal insulin infusion and implantable infusion pumps for diabetic control

Article Abstract:

This article describes the latest insulin infusion techniques and devices which involves the continuous release of insulin through implantation or by an external pump that may be inserted beneath the skin. The reported recommendations are derived from a DATTA, Diagnostic and Therapeutic Technology Assessment, panel composed of a group of specialists in the field. The general consensus indicated that the routine use of these techniques on patients is premature but, further investigation and experimentation should be pursued. The two primary methods discussed were continuous subcutaneous insulin infusion by an external pump or by an implantable internal device. Although the objectives of these treatments were endorsed, several problems associated with these techniques were noted. Delivery of insulin by way of the peritoneal cavity may result in peritonitis or in catheter obstruction. Both internal and external mechanical pumps are subject to obstructions and mechanical malfunction. This problem has been, in part, remedied by the new insulin preparations that are clot resistant. The technique when refined, may prove particularly useful to patients who have problems with currently available methods. Clinical trials are underway to develop improvements in these techniques and to identify groups of patients who should be targeted for this process.

Evaluation, Insulin pumps

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