Papers by Wolfgang Landgraf
Diabetes Therapy, Jun 15, 2024
Der Internist, Sep 1, 2001
The Lancet, Mar 1, 2008
Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type... more Once-daily basal insulin glargine versus thrice-daily prandial insulin lispro in people with type 2 diabetes on oral hypoglycaemic agents (APOLLO): an open randomized controlled trial.
Primary Care Diabetes, Aug 1, 2023
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PubMed, Jan 14, 2010
Evaluation of a new disposable insulin pen and injection habits of diabetes patients in everyday ... more Evaluation of a new disposable insulin pen and injection habits of diabetes patients in everyday clinical practice Background: Injection devices (pens) for insulin application play a major role in treatment acceptance and adherence in insulin-treated diabetes patients. The mechanical disposable pen SoloStar containing the insulin analogs glargine or glulisine (each 100 IE/ml) provides modern design with user-friendly handling features. Methods: In two independent, non-interventional, observational studies conducted nation-wide between April and December 2007 in outpatient practices, patients with diabetes newly instructed on how to use the pen were interviewed by their trainers (physicians, diabetes consultants) after approx. 6-8 weeks of pen use to give feedback on technical deficiencies, handling problems with the pen, injection habits, as well as on pen properties. Trainers were also asked to assess pen properties and particularly to document the time required for pen training. The evaluation applied a grading system similar to that used in German schools (1: very good; 6: very insufficient/failed). Furthermore, trainers were asked to retrospectively record any adverse events occurring during the observational period. Results: A total of 2,412 trainers from 1,626 centres and 8,428 patients (80% type 2) participated in the studies. In each study 0.5% of patients reported 41 and 19 technical problems with the pen, respectively. Similarly 3% of patients from each study reported handling problems. Recommended changes of needles and safety checks of the pen before each injection were performed by 40% and max. 25% of the patients, respectively. The features of the new disposable pen were all rated "very good" to "good" by the majority of patients and trainers. The best rated features were usability, dose adjustment and the low effort for the dose release. Pen training of patients were rated as "very simple" or "simple" by the training staff and average instruction time was reported not to exceed more than 10 minutes for the majority of patients. In 19 patients (0.2%) a total of 34 adverse events were documented. Conclusion: The results of these two observational studies showed no relevant technical deficiencies and handling problems associated with the new disposable pen in everyday clinical practice. Ease of use and little time required for pen training may contribute to a high acceptance and satisfaction by the patients and training staff. Injection habits, however, indicated that patients did not well comply with recommendations given for needle changes and safety tests.
European Endocrinology, 2010
This paper discusses the results of a survey on the usability of a new half-unit insulin pen, Jun... more This paper discusses the results of a survey on the usability of a new half-unit insulin pen, JuniorSTAR ® (CE mark pending, under the responsibility of Haselmeier), in children with type 1 diabetes. Insulin pen devices have advantages over the traditional vial-and-syringe method of insulin delivery, including improved patient satisfaction and adherence, greater ease of use and superior accuracy, especially when delivering small doses of insulin. The accuracy and design of insulin pens is particularly important in the paediatric population. Young children often require half-unit adjustments. As the incidence of type 1 diabetes is expected to increase in the coming years in children less than 5 years old, a higher use of half-unit dosing pens may be anticipated. A survey with JuniorSTAR half-unit insulin pen has shown that it is easy to use, read, carry and dial back. This was confirmed by patients and also by nurses. In conclusion, the JuniorSTAR half-unit pen is well suited to the lifestyle of young people with type 1 diabetes and could help them to gain autonomy to self-inject.
Diabetes Care, Nov 1, 2009
Diabetologie Und Stoffwechsel, Apr 1, 2009
Diabetes Research and Clinical Practice, Apr 1, 2022
Diabetes Research and Clinical Practice, Feb 1, 2017
W. (2016). Patient-level meta-analysis of efficacy and hypoglycaemia in people with type 2 diabet... more W. (2016). Patient-level meta-analysis of efficacy and hypoglycaemia in people with type 2 diabetes initiating insulin glargine 100 U/mL or neutral protamine Hagedorn insulin analysed according to concomitant oral antidiabetes therapy. Diabetes Research and Clinical Practice _____________________________________________________________ This article is brought to you by Swansea University. Any person downloading material is agreeing to abide by the terms of the repository licence. Authors are personally responsible for adhering to publisher restrictions or conditions.
Diabetologie Und Stoffwechsel, Apr 1, 2009
Diabetologie Und Stoffwechsel, Apr 1, 2009
Diabetes Research and Clinical Practice, Aug 1, 2022
Experimental and Clinical Endocrinology & Diabetes, Jan 18, 2011
We aimed to compare time spent at low glucose level (silent hypoglycemia, glucose <3.0 mmo... more We aimed to compare time spent at low glucose level (silent hypoglycemia, glucose <3.0 mmol/l) and glycemic variability in patients who reached HbA1c <7.0% with those who did not. In 108 type 2 diabetic patients the interstitial glucose concentration was measured with CGMS (Continuous Glucose Monitoring System) over 72 h. Patients were divided in group 1 with an HbA1c <7.0% (n=63) and group 2 with an HbA1c≥7.0% (n=45). 24% in group 1 experienced silent hypoglycemia vs. 11% in group 2 (n. s.), duration of silent hypoglycemia over 48 h was 27±71 min vs. 7±36 min (n. s.). This was also valid for the subgroups treated with insulin. Patients in group 2 had a significantly higher standard deviation of average glucose (2.3±0.8 vs. 1.3±0.6; p<0.001) and MAGE (mean amplitude of glycemic excursions) (4.8±2.1 vs. 2.6±1.1; p<0.001). Silent hypoglycemia tended to occur more often and to last longer in patients with HbA1c <7%. However, patients with HbA1c >7% had a higher glycemic variability. HbA1c >7% wasn't a reliable indicator of lower risk of hypoglycemia.
Acta Diabetologica, Feb 21, 2013
We investigated whether basal insulin as firstline treatment in recently diagnosed type 2 diabete... more We investigated whether basal insulin as firstline treatment in recently diagnosed type 2 diabetes (T2D) can improve glucose control, microvascular function and preserve insulin secretion in comparison with metformin (MET). In this open-label, randomized, prospective 36-week study, 75 patients (44 m, 31 f, mean age 60.7 ± 9.2 year) were allocated to treatment with either MET 1,000 mg b.i.d. (n = 36) or insulin glargine (GLA) at bedtime (n = 39). At baseline and study end, we performed a continuous glucose monitoring for assessment of interstitial glucose (IG) and measured microvascular function using Laser-Doppler fluxmetry. GLA versus MET treatment resulted in a more pronounced reduction in FPG (D: 3.1 ± 2.5 vs. 1.4 ± 1.5 mmol/l; p \ 0.001) and overall IG (D AUC. 671 ± 507 vs. 416 ± 537 mmol/l min; p = 0.04). Postprandial PG and IG differences after a standardized test meal did not reach significance. Proinsulin/C-peptide and HOMA B as marker of endogenous insulin secretion were significantly more improved by GLA. Microvascular blood flow improved only in MET-treated patients. Early basal insulin treatment with GLA in T2D patients provided a better control of FPG, overall IG load and biomarker of beta-cell function compared to the standard treatment with MET. MET treatment resulted in an improvement of microvascular function. Studies of longer duration are needed to evaluate the durability of glucose control and b cell protection with early GLA treatment.
Diabetes, Obesity and Metabolism, Jun 13, 2023
AimTo compare the efficacy and safety of insulin glargine‐300 once daily (Gla‐300) with insulin d... more AimTo compare the efficacy and safety of insulin glargine‐300 once daily (Gla‐300) with insulin degludec/aspart (IDegAsp) once daily in patients with type 2 diabetes (T2D) inadequately controlled on oral anti‐diabetic drugs (OADs).Materials and methodsA systematic literature review of randomized controlled trials was followed by an indirect treatment comparison of studies involving insulin naïve adults, inadequately controlled [glycated haemoglobin (HbA1c) ≥7.0%] on OADs, who received Gla‐300 or IDegAsp once daily. Outcomes of interest were change in HbA1c, blood glucose, weight and insulin dose, as well as incidence and event rate of hypoglycaemia and other adverse events.ResultsFour trials with broadly similar baseline patient characteristics were included in the meta‐analyses and indirect treatment comparison. At 24‐28 weeks, the indirect comparison of Gla‐300 to IDegAsp once daily estimated no statistically significant difference for change in HbA1c (%) from baseline [mean difference of 0.10% (95% CI: −0.20, 0.39; p = .52)]; a statistically significant mean difference of −1.31 kg (95% CI: −1.97, −0.65; p < .05) for change in body weight from baseline; statistically significant odds ratios of 0.62 (95% CI: 0.41, 0.93; p < .05) for incidence of any hypoglycaemia; and 0.47 (95% CI: 0.25, 0.87; p < .05) for incidence of anytime confirmed hypoglycaemia (plasma glucose <3.0‐3.1 mmol/L). No significant differences were observed for insulin dose and adverse events.ConclusionIn insulin‐naïve patients with T2D inadequately controlled on OADs, commencing Gla‐300 shows a comparable HbA1c reduction, but with significantly less weight gain and a lower incidence of any and confirmed hypoglycaemia compared with commencing IDegAsp.
Diabetologie Und Stoffwechsel, May 1, 2012
European Endocrinology, 2016
Insulin replacement therapy is the standard of care for patients with type 1 and advanced type 2 ... more Insulin replacement therapy is the standard of care for patients with type 1 and advanced type 2 diabetes mellitus. Porcine and bovine pancreatic tissue was the source of the hormone for many years, followed by semisynthetic human insulin obtained by modification of animal insulin. With the development of recombinant DNA technology, recombinant (biosynthetic) human insulin became available in large amounts by biosynthesis in microorganisms (Escherichia coli, yeast) providing reliable supplies of the hormone worldwide at affordable costs. The purity and pharmaceutical quality of recombinant human insulin was demonstrated to be superior to animal and semisynthetic insulin and patients with diabetes could be safely and effectively transferred from animal or semisynthetic human insulin to recombinant human insulin with no change expected in insulin dose. The decision for change remains a clinical objective, follow-up after any change of insulin product is recommended to confirm clinical efficacy. This review provides a summary and retrospective assessment of early clinical studies with recombinant insulins (Insuman ® , Humulin ® , Novolin ®).
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Papers by Wolfgang Landgraf