AACE ePoster Library

UTILIZATION OF REGULAR INSULIN IN V-GO® FOR PATIENTS UNCONTROLLED WITH TYPE 2 DIABETES MELLITUS (T2DM): A CASE SERIES
AACE ePoster Library. Lajara R. 05/13/15; 97798; 248
Dr. Rosemarie Lajara
Dr. Rosemarie Lajara
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Abstract
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Background:
The cost of diabetes continues to rise and less expensive treatment options are needed.

Patients aged 65 and older are routinely burdened with substantial medical and drug costs.

Regular insulin (U-100) may provide patients with a cost savings alternative to analogue insulin and has been shown to improve glycemic control in patients with diabetes.

Data is limited on the administration of regular insulin by V-Go Disposable Insulin Delivery Device (V-Go). We report two cases in patients poorly controlled with type 2 diabetes (T2DM) where regular insulin was delivered using V-Go. Data was collected from an electronic medical records database.

Results or Case Presentation:
Case 1: A 65 year old male with T2DM of 10 years, poorly controlled, HbA1c 12.3%, with stage 3 CKD presented to our endocrine clinic for initial evaluation and management of diabetes. His diabetic regimen upon presentation was 30-35U BID of NPH insulin, a sodium glucose cotransporter 2 (SGLT2) inhibitor and a sulfonylurea. Upon the initial visit, patient was switched to regular insulin delivered using V-Go and remained on the sulfonylurea (SU). The SGLT2 was discontinued due to renal insufficiency. After three months of both fasting and prandial blood glucose coverage with V-Go therapy, the HbA1c was reduced by 3.5%, despite administering less insulin and the discontinuation of SGLT-2. FPG although improved remained elevated at 221 mg/dl. The TDD was titrated on V-Go during the 3 months, however the TDD remained below baseline. Patient reported occasional mild to moderate hypoglycemia when meals were missed but did not feel problematic. The sulfonylurea was discontinued at the 3 month visit.

Case 2: A 66 year old male was evaluated for uncontrolled T2DM, HbA1c 9.6%, without mention of complication in our endocrine clinic. The patient’s insulin requirement had progressively increased and prandial insulin was added at preceding visit. Prior to being switched to V-Go,
his regimen consisted of 25 U BID of insulin detemir and 14 U/day of insulin aspart. Patient was switched from multiple daily injections to V-Go and experienced an improvement in HbA1c using rapid acting insulin which was maintained when replaced with regular insulin in V-Go. FPG decreased (range 101 to 120 mg/dl) despite patient using less basal insulin. TDD did not change between visits using V-Go (36 units/day) and remained below baseline dose. After 3 months of using RAI in V-Go his HbA1c decreased to 8.3%. The RAI was substituted with regular insulin to decrease insulin cost to patient. Following 6 months administering 30 to 36 U of regular insulin by V-Go the HbA1c was further reduced to 8.0%. The patient reported occasional hypoglycemia in the morning on V-Go.

Discussion:
Patients are often forced to make decisions between medical care and living expenditures. Many discontinue taking necessary medications or skip doses to save money. Utilization of regular insulin can result in significant cost savings for those where cost is a barrier.

Regular insulin is a less expensive option compared to many therapeutic regimens and when administered by V-Go in this small evaluation, resulted in improved glycemic control and reduced total daily insulin requirements.

Controlled studies are needed to fully evaluate the safety and efficacy of using regular insulin in V-Go
Background:
The cost of diabetes continues to rise and less expensive treatment options are needed.

Patients aged 65 and older are routinely burdened with substantial medical and drug costs.

Regular insulin (U-100) may provide patients with a cost savings alternative to analogue insulin and has been shown to improve glycemic control in patients with diabetes.

Data is limited on the administration of regular insulin by V-Go Disposable Insulin Delivery Device (V-Go). We report two cases in patients poorly controlled with type 2 diabetes (T2DM) where regular insulin was delivered using V-Go. Data was collected from an electronic medical records database.

Results or Case Presentation:
Case 1: A 65 year old male with T2DM of 10 years, poorly controlled, HbA1c 12.3%, with stage 3 CKD presented to our endocrine clinic for initial evaluation and management of diabetes. His diabetic regimen upon presentation was 30-35U BID of NPH insulin, a sodium glucose cotransporter 2 (SGLT2) inhibitor and a sulfonylurea. Upon the initial visit, patient was switched to regular insulin delivered using V-Go and remained on the sulfonylurea (SU). The SGLT2 was discontinued due to renal insufficiency. After three months of both fasting and prandial blood glucose coverage with V-Go therapy, the HbA1c was reduced by 3.5%, despite administering less insulin and the discontinuation of SGLT-2. FPG although improved remained elevated at 221 mg/dl. The TDD was titrated on V-Go during the 3 months, however the TDD remained below baseline. Patient reported occasional mild to moderate hypoglycemia when meals were missed but did not feel problematic. The sulfonylurea was discontinued at the 3 month visit.

Case 2: A 66 year old male was evaluated for uncontrolled T2DM, HbA1c 9.6%, without mention of complication in our endocrine clinic. The patient’s insulin requirement had progressively increased and prandial insulin was added at preceding visit. Prior to being switched to V-Go,
his regimen consisted of 25 U BID of insulin detemir and 14 U/day of insulin aspart. Patient was switched from multiple daily injections to V-Go and experienced an improvement in HbA1c using rapid acting insulin which was maintained when replaced with regular insulin in V-Go. FPG decreased (range 101 to 120 mg/dl) despite patient using less basal insulin. TDD did not change between visits using V-Go (36 units/day) and remained below baseline dose. After 3 months of using RAI in V-Go his HbA1c decreased to 8.3%. The RAI was substituted with regular insulin to decrease insulin cost to patient. Following 6 months administering 30 to 36 U of regular insulin by V-Go the HbA1c was further reduced to 8.0%. The patient reported occasional hypoglycemia in the morning on V-Go.

Discussion:
Patients are often forced to make decisions between medical care and living expenditures. Many discontinue taking necessary medications or skip doses to save money. Utilization of regular insulin can result in significant cost savings for those where cost is a barrier.

Regular insulin is a less expensive option compared to many therapeutic regimens and when administered by V-Go in this small evaluation, resulted in improved glycemic control and reduced total daily insulin requirements.

Controlled studies are needed to fully evaluate the safety and efficacy of using regular insulin in V-Go

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