Diabetes Obesity & Metabolism

doi: 10.1111/dom.13781pmid: N/A

Russell‐Jones, David L.; Hutchison, Ewan J.; Roberts, Graham A.

doi: 10.1111/dom.14375pmid: 33710744

People with diabetes treated with insulin have often faced blanket bans from safety‐critical occupations, largely because of fear of incapacitation due to hypoglycaemia. Recent advances in insulin therapies, modes of administration, monitoring, and noninvasive monitoring techniques have allowed stereotypical views to be challenged. The aviation sector has led the way, in allowing pilots to fly while on insulin. Recently, countries that have traditionally been opposed to this have changed their minds, largely due to the increasing evidence of safety. The purpose of this review was to gather all available information to update clinicans. The physiology and pathophysiology underpinning glucose regulation and the management of diabetes in the air allowing certain insulin‐treated pilots to fly are discussed.

Gomez‐Peralta, Fernando; Al‐Ozairi, Ebaa; Jude, Edward B.; Li, Xiaoying; Rosenstock, Julio

doi: 10.1111/dom.14365pmid: 33651460

Despite novel therapeutic options, many people with type 2 diabetes (T2D) do not achieve their HbA1c targets. Given the progressive nature of T2D, many individuals not controlled with oral therapy will require advancement to injectable therapy using either a glucagon‐like peptide‐1 receptor agonist (GLP‐1 RA), recently recommended as a first option, or traditionally a basal insulin. However, premix insulins remain frequently used, either as initial injectable therapy or as intensification from basal insulin. Premix insulin injections can potentially provide significant glycaemic improvements to basal insulin but at the expense of increased hypoglycaemia and weight gain and the need for multiple daily doses, which may affect treatment adherence. Real‐world evidence suggests that glycaemic control often remains suboptimal with premix insulins. Fixed‐ratio combinations (FRCs) of basal insulin and GLP‐1 RAs provide a novel alternative to premix insulin for therapy intensification. While no direct comparisons between premix insulins and FRCs are available, results from meta‐analyses suggest that FRCs may offer better HbA1c reductions, a lower risk of hypoglycaemia and less weight gain compared with premix insulin in a simplified treatment regimen. A head‐to‐head trial of T2D treatment intensification with premix insulin and a FRC of basal insulin plus a GLP‐1 RA is currently in progress, which should help to clarify the outcomes for each treatment option. This review discusses the unmet needs of people with T2D treated with premix insulin and provides evidence supporting FRCs of basal insulin and GLP‐1 RAs as an alternative treatment option.

Rassen, Jeremy A.; Murk, William; Schneeweiss, Sebastian

doi: 10.1111/dom.14338pmid: 33566434

Gardiner, Julian; Oben, Jude; Sutcliffe, Alastair

doi: 10.1111/dom.14357pmid: 33620765

Tan, Tricia M.‐M.; Minnion, James; Khoo, Bernard; Ball, Laura‐Jayne; Malviya, Reshma; Day, Emily; Fiorentino, Francesca; Brindley, Charlie; Bush, Jim; Bloom, Stephen R.

doi: 10.1111/dom.14358pmid: 33606914

Baviera, Marta; Genovese, Stefano; Lepore, Vito; Colacioppo, Pierluca; Robusto, Fabio; Tettamanti, Mauro; D'Ettorre, Antonio; Avanzini, Fausto; Fortino, Ida; Nicolucci, Antonio; Roncaglioni, Maria C.; Giorgino, Francesco

Araki, Eiichi; Mathieu, Chantal; Shiraiwa, Toshihiko; Maeda, Hajime; Ikeda, Hiroki; Thoren, Fredrik; Arya, Niki; Asano, Michiko; Iqbal, Nayyar

doi: 10.1111/dom.14362pmid: 33620762

Oldgren, Jonas; Laurila, Sanna; Åkerblom, Axel; Latva‐Rasku, Aino; Rebelos, Eleni; Isackson, Henrik; Saarenhovi, Maria; Eriksson, Olof; Heurling, Kerstin; Johansson, Edvin; Wilderäng, Ulrica; Karlsson, Cecilia; Esterline, Russell; Ferrannini, Ele; Oscarsson, Jan; Nuutila, Pirjo

Ling, Joanna Z.J.; Montvida, Olga; Khunti, Kamlesh; Zhang, Anthony L.; Xue, Charlie C.; Paul, Sanjoy K.

doi: 10.1111/dom.14364pmid: 33651456