| Manufacturer | Insulin (brand name) | Discard after | How to store opened vial |
|---|---|---|---|
| Sanofi-Aventis | Glulisine (Apidra) | 28 days | Refrigerated or room temperature |
| Sanofi-Aventis | Glargine (Lantus) | 28 days | Refrigerated or room temperature |
| Novo Nordisk | Detemir (Levemir) | 42 days | Refrigerated or room temperature |
| Novo Nordisk | Aspart (NovoLog) | 28 days | Refrigerated or room temperature |
| Novo Nordisk | NovoLog MIX 70/30 | 28 days | Refrigerated preferred, room temperature acceptable |
| Eli Lilly | Lispro protamine/lispro (Humalog 50/50) | 28 days | Refrigerated or room temperature |
| Eli Lilly | lispro (Humalog) | 28 days | Refrigerated or room temperature |
| Eli Lilly | NPH (Humulin N) | Expiration date on vial | Refrigerated preferred, room temperature acceptable |
| Eli Lilly | Regular (Humulin R) | Expiration date on vial | Refrigerated preferred, room temperature acceptabl |
Wednesday, May 7, 2014
How Long Can a Vial of Insulin Be Used After It Is Started
Monday, November 7, 2011
Featured in Journal Watch: Colonoscopy Protects Against Colorectal Cancer for as Long as 20 Years
After a single negative colonoscopy, the age- and sex-adjusted odds ratios for colorectal cancer at the following intervals were 0.14 (1–2 years), 0.10 (3–4 years), 0.26 (5–9 years), 0.36 (10–19 years), and 0.41 (20 years or more). The findings from this case-control study offer additional support for clinicians following the U.S. guidelines to perform colonoscopy at 10-year rather than 5-year intervals.
Sunday, July 31, 2011
Prostate Screening Adds No Survival Benefit at 20 Years
Screening for prostate cancer confers no significant protection against death from the disease, according to a BMJ study.
Researchers randomized every sixth man in a Swedish city between the ages of 50 and 70 to screening every 3 years; the others underwent no screening. The study, begun in 1987, used digital rectal exam in the first two screenings, and then in 1993, screening for prostate-specific antigen was added. Suggestive results led to fine-needle aspiration biopsy. Outcomes were followed by using national registries of cancer and mortality.
The rate of prostate cancer diagnosis was higher in the screening group than among controls (5.7% vs. 3.9%). Localized tumors were more than twice as frequent in the screened group, but the rate of non-localized tumors was similar between groups. Over 20 years, the prostate cancer–specific death risk ratio between groups was not significant.
Researchers randomized every sixth man in a Swedish city between the ages of 50 and 70 to screening every 3 years; the others underwent no screening. The study, begun in 1987, used digital rectal exam in the first two screenings, and then in 1993, screening for prostate-specific antigen was added. Suggestive results led to fine-needle aspiration biopsy. Outcomes were followed by using national registries of cancer and mortality.
The rate of prostate cancer diagnosis was higher in the screening group than among controls (5.7% vs. 3.9%). Localized tumors were more than twice as frequent in the screened group, but the rate of non-localized tumors was similar between groups. Over 20 years, the prostate cancer–specific death risk ratio between groups was not significant.
Thursday, July 28, 2011
In Determining Blood Pressure, More Measurements Improve Accuracy
A single measurement doesn't correctly classify a patient's hypertensive status, according to an Annals of Internal Medicine study.
Department of Veterans Affairs researchers followed some 450 patients with hypertension. Over 18 months, systolic pressures were determined from home recordings, routine clinical visits, and scheduled research-associated visits. When examined by method of measurement, 28% of patients were within BP control limits according to routine clinical measurements, 47% according to home measurements, and 68% according to research-visit measurements.
When examined by frequency of measurement, within-patient variances (usually about 10%) decreased dramatically when two or more measurements were made, although there was little benefit beyond five or six measurements. The advantage of repetition held across all methods of measurement.
The authors call for use of averaged home readings to ensure high-quality care. Editorialists, citing the widespread prevalence of sloppy technique, review the proper method and also advocate use of BP measurement as a performance metric
Department of Veterans Affairs researchers followed some 450 patients with hypertension. Over 18 months, systolic pressures were determined from home recordings, routine clinical visits, and scheduled research-associated visits. When examined by method of measurement, 28% of patients were within BP control limits according to routine clinical measurements, 47% according to home measurements, and 68% according to research-visit measurements.
When examined by frequency of measurement, within-patient variances (usually about 10%) decreased dramatically when two or more measurements were made, although there was little benefit beyond five or six measurements. The advantage of repetition held across all methods of measurement.
The authors call for use of averaged home readings to ensure high-quality care. Editorialists, citing the widespread prevalence of sloppy technique, review the proper method and also advocate use of BP measurement as a performance metric
FDA: Data Inconclusive on Link Between Bisphosphonates and Esophageal Cancer
Evidence is inconclusive on a possible association between the use of oral bisphosphonates and an increased risk for esophageal cancer, the FDA said Thursday. The agency added that there are "insufficient data" to recommend endoscopy for asymptomatic patients taking the drugs.
As part of its ongoing safety review, the FDA looked at two analyses from the U.K. General Practice Research Database: one study found no increase in risk with bisphosphonates, while the other found twice the risk for esophageal cancer in patients who filled at least 10 prescriptions or who used bisphosphonates for 3 or more years. The agency noted that other studies showed either no increase in risk or a reduced risk for esophageal cancer.
The FDA reminds providers that esophagitis has been observed in some bisphosphonate users, especially those not following package instructions. Accordingly, patients should be advised to follow the instructions carefully (e.g., they should not lie down for 30 to 60 minutes after taking the drugs).
As part of its ongoing safety review, the FDA looked at two analyses from the U.K. General Practice Research Database: one study found no increase in risk with bisphosphonates, while the other found twice the risk for esophageal cancer in patients who filled at least 10 prescriptions or who used bisphosphonates for 3 or more years. The agency noted that other studies showed either no increase in risk or a reduced risk for esophageal cancer.
The FDA reminds providers that esophagitis has been observed in some bisphosphonate users, especially those not following package instructions. Accordingly, patients should be advised to follow the instructions carefully (e.g., they should not lie down for 30 to 60 minutes after taking the drugs).
Vitamin D lessens mortality
Cochrane Database Syst Rev. 2011; (7):CD007470 (ISSN: 1469-493X)
Bjelakovic G; Gluud LL; Nikolova D; Whitfield K; Wetterslev J; Simonetti RG; Bjelakovic M; Gluud C
Department of Internal Medicine - Gastroenterology and Hepatology, Medical Faculty, University of Nis, Zorana Djindjica 81, Nis, Serbia, 18000.
BACKGROUND: The available evidence on vitamin D and mortality is inconclusive.
OBJECTIVES: To assess the beneficial and harmful effects of vitamin D for prevention of mortality in adults.
SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science (to January 2011). We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials.
SELECTION CRITERIA: We included randomised trials that compared vitamin D at any dose, duration, and route of administration versus placebo or no intervention. Vitamin D could have been administered as supplemental vitamin D (vitamin D(3) (cholecalciferol) or vitamin D(2) (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol) or 1,25-dihydroxyvitamin D (calcitriol)).
DATA COLLECTION AND ANALYSIS: Six authors extracted data independently. Random-effects and fixed-effect model meta-analyses were conducted. For dichotomous outcomes, we calculated the risk ratios (RR). To account for trials with zero events, meta-analyses of dichotomous data were repeated using risk differences (RD) and empirical continuity corrections. Risk of bias was considered in order to minimise risk of systematic errors. Trial sequential analyses were conducted to minimise the risk of random errors.
MAIN RESULTS: Fifty randomised trials with 94,148 participants provided data for the mortality analyses. Most trials included elderly women (older than 70 years). Vitamin D was administered for a median of two years. More than one half of the trials had a low risk of bias. Overall, vitamin D decreased mortality (RR 0.97, 95% confidence interval (CI) 0.94 to 1.00, I(2) = 0%). When the different forms of vitamin D were assessed separately, only vitamin D(3) decreased mortality significantly (RR 0.94, 95% CI 0.91 to 0.98, I(2) = 0%; 74,789 participants, 32 trials) whereas vitamin D(2), alfacalcidol, or calcitriol did not. Trial sequential analysis supported our finding regarding vitamin D(3), corresponding to 161 individuals treated to prevent one additional death. Vitamin D(3) combined with calcium increased the risk of nephrolithiasis (RR 1.17, 95% CI 1.02 to 1.34, I(2) = 0%). Alfacalcidol and calcitriol increased the risk of hypercalcaemia (RR 3.18, 95% CI 1.17 to 8.68, I(2) = 17%). Data on health-related quality of life and health economics were inconclusive.
AUTHORS' CONCLUSIONS: Vitamin D in the form of vitamin D(3) seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care. Vitamin D(2), alfacalcidol, and calcitriol had no statistically significant effect on mortality. Vitamin D(3) combined with calcium significantly increased nephrolithiasis. Both alfacalcidol and calcitriol significantly increased hypercalcaemia.
Bjelakovic G; Gluud LL; Nikolova D; Whitfield K; Wetterslev J; Simonetti RG; Bjelakovic M; Gluud C
Department of Internal Medicine - Gastroenterology and Hepatology, Medical Faculty, University of Nis, Zorana Djindjica 81, Nis, Serbia, 18000.
BACKGROUND: The available evidence on vitamin D and mortality is inconclusive.
OBJECTIVES: To assess the beneficial and harmful effects of vitamin D for prevention of mortality in adults.
SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE, EMBASE, LILACS, the Science Citation Index Expanded, and Conference Proceedings Citation Index-Science (to January 2011). We scanned bibliographies of relevant publications and asked experts and pharmaceutical companies for additional trials.
SELECTION CRITERIA: We included randomised trials that compared vitamin D at any dose, duration, and route of administration versus placebo or no intervention. Vitamin D could have been administered as supplemental vitamin D (vitamin D(3) (cholecalciferol) or vitamin D(2) (ergocalciferol)) or an active form of vitamin D (1α-hydroxyvitamin D (alfacalcidol) or 1,25-dihydroxyvitamin D (calcitriol)).
DATA COLLECTION AND ANALYSIS: Six authors extracted data independently. Random-effects and fixed-effect model meta-analyses were conducted. For dichotomous outcomes, we calculated the risk ratios (RR). To account for trials with zero events, meta-analyses of dichotomous data were repeated using risk differences (RD) and empirical continuity corrections. Risk of bias was considered in order to minimise risk of systematic errors. Trial sequential analyses were conducted to minimise the risk of random errors.
MAIN RESULTS: Fifty randomised trials with 94,148 participants provided data for the mortality analyses. Most trials included elderly women (older than 70 years). Vitamin D was administered for a median of two years. More than one half of the trials had a low risk of bias. Overall, vitamin D decreased mortality (RR 0.97, 95% confidence interval (CI) 0.94 to 1.00, I(2) = 0%). When the different forms of vitamin D were assessed separately, only vitamin D(3) decreased mortality significantly (RR 0.94, 95% CI 0.91 to 0.98, I(2) = 0%; 74,789 participants, 32 trials) whereas vitamin D(2), alfacalcidol, or calcitriol did not. Trial sequential analysis supported our finding regarding vitamin D(3), corresponding to 161 individuals treated to prevent one additional death. Vitamin D(3) combined with calcium increased the risk of nephrolithiasis (RR 1.17, 95% CI 1.02 to 1.34, I(2) = 0%). Alfacalcidol and calcitriol increased the risk of hypercalcaemia (RR 3.18, 95% CI 1.17 to 8.68, I(2) = 17%). Data on health-related quality of life and health economics were inconclusive.
AUTHORS' CONCLUSIONS: Vitamin D in the form of vitamin D(3) seems to decrease mortality in predominantly elderly women who are mainly in institutions and dependent care. Vitamin D(2), alfacalcidol, and calcitriol had no statistically significant effect on mortality. Vitamin D(3) combined with calcium significantly increased nephrolithiasis. Both alfacalcidol and calcitriol significantly increased hypercalcaemia.
BP meds hs for diabetics
Hermida RC; Ayala DE; Mojón A; Fernández JR
Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain. rhermida@uvigo.es
OBJECTIVE: We prospectively investigated in hypertensive patients with type 2 diabetes if bedtime treatment with ≥1 hypertension medications exerts better blood pressure control and cardiovascular risk reduction than conventional therapy, in which all medications are ingested in the morning.
RESEARCH DESIGN AND METHODS: We conducted a prospective, randomized, open-label, blinded end point trial on 448 hypertensive patients with type 2 diabetes, 255 men/193 women, mean ± SD age 62.5 ± 10.8 years, randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. Ambulatory blood pressure was measured for 48 h at baseline and again annually or even more frequently (quarterly) after adjustments in treatment.
RESULTS: After a median follow-up of 5.4 years, patients ingesting ≥1 hypertension medications at bedtime showed a significantly lower cardiovascular risk (adjusted by age and sex) than subjects ingesting all medications upon awakening (hazard ratio 0.33 [95% CI 0.21-0.54]; P < 0.001). The difference between groups in the adjusted risk of major events (cardiovascular death, myocardial infarction, and stroke) was also statistically significant (0.25 [0.10-0.61]; P = 0.003). Patients treated at bedtime showed significantly lower sleep time blood pressure mean and higher prevalence of controlled ambulatory blood pressure (62.5 vs. 50.9%; P = 0.013). There was a significant 12% cardiovascular risk reduction per each 5 mmHg decrease in asleep systolic blood pressure during follow-up (P < 0.001).
CONCLUSIONS: Among patients with diabetes, treatment with ≥1 hypertension medications at bedtime, compared with all medications upon waking, resulted in improved ambulatory blood pressure control and significantly reduced cardiovascular morbidity and mortality.
Bioengineering and Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain. rhermida@uvigo.es
OBJECTIVE: We prospectively investigated in hypertensive patients with type 2 diabetes if bedtime treatment with ≥1 hypertension medications exerts better blood pressure control and cardiovascular risk reduction than conventional therapy, in which all medications are ingested in the morning.
RESEARCH DESIGN AND METHODS: We conducted a prospective, randomized, open-label, blinded end point trial on 448 hypertensive patients with type 2 diabetes, 255 men/193 women, mean ± SD age 62.5 ± 10.8 years, randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. Ambulatory blood pressure was measured for 48 h at baseline and again annually or even more frequently (quarterly) after adjustments in treatment.
RESULTS: After a median follow-up of 5.4 years, patients ingesting ≥1 hypertension medications at bedtime showed a significantly lower cardiovascular risk (adjusted by age and sex) than subjects ingesting all medications upon awakening (hazard ratio 0.33 [95% CI 0.21-0.54]; P < 0.001). The difference between groups in the adjusted risk of major events (cardiovascular death, myocardial infarction, and stroke) was also statistically significant (0.25 [0.10-0.61]; P = 0.003). Patients treated at bedtime showed significantly lower sleep time blood pressure mean and higher prevalence of controlled ambulatory blood pressure (62.5 vs. 50.9%; P = 0.013). There was a significant 12% cardiovascular risk reduction per each 5 mmHg decrease in asleep systolic blood pressure during follow-up (P < 0.001).
CONCLUSIONS: Among patients with diabetes, treatment with ≥1 hypertension medications at bedtime, compared with all medications upon waking, resulted in improved ambulatory blood pressure control and significantly reduced cardiovascular morbidity and mortality.
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