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  1. Article ; Online: Insulin requirements are eternally dynamic.

    Hodish, Israel

    Diabetes, obesity & metabolism

    2021  Volume 23, Issue 10, Page(s) 2409–2410

    MeSH term(s) Humans ; Insulin ; Insulin, Regular, Human
    Chemical Substances Insulin ; Insulin, Regular, Human
    Language English
    Publishing date 2021-07-19
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.14460
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  2. Article: Challenges in Insulin Therapy for Type 2 Diabetes : Regarding the Article "Expert Opinion: A Call for Basal Insulin Titration in Patients with Type 2 Diabetes in Daily Practice: Southeast European Perspective" by Nicolae Hancu et al.

    Hodish, Israel

    Diabetes therapy : research, treatment and education of diabetes and related disorders

    2021  Volume 12, Issue 12, Page(s) 3243–3244

    Language English
    Publishing date 2021-10-16
    Publishing country United States
    Document type Letter
    ZDB-ID 2566702-6
    ISSN 1869-6961 ; 1869-6953
    ISSN (online) 1869-6961
    ISSN 1869-6953
    DOI 10.1007/s13300-021-01164-1
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  3. Article ; Online: For debate; pharmacological priorities in advanced type 2 diabetes.

    Hodish, Israel

    Journal of diabetes and its complications

    2019  Volume 34, Issue 5, Page(s) 107510

    Abstract: A multitude of therapeutic agents have been available to treat patients with Type 2 diabetes. Unfortunately, many patients with advanced Type 2 diabetes continue to suffer from complications and premature death. To date, all available guidelines ... ...

    Abstract A multitude of therapeutic agents have been available to treat patients with Type 2 diabetes. Unfortunately, many patients with advanced Type 2 diabetes continue to suffer from complications and premature death. To date, all available guidelines emphasize a variety of therapeutic aspects, goals, and pharmacological combinations, without directing the clinician as to which is a higher priority. The following review attempts to clarify which therapeutic option is more important for prognosis in patients with advanced type 2 diabetes. The body of evidence presented, reveal that the most important marker for prognosis is HbA1c. Each 1% incrementally higher HbA1c than ~7% is associated with 15%-45% reduced survival rates. Therefore, any agents that can achieve the time-sensitive objective of lowering HbA1c levels should be used.
    Language English
    Publishing date 2019-12-12
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1105840-7
    ISSN 1873-460X ; 1056-8727
    ISSN (online) 1873-460X
    ISSN 1056-8727
    DOI 10.1016/j.jdiacomp.2019.107510
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  4. Article ; Online: Insulin therapy, weight gain and prognosis.

    Hodish, Israel

    Diabetes, obesity & metabolism

    2018  Volume 20, Issue 9, Page(s) 2085–2092

    Abstract: Insulin therapy is mainly used by people with type 2 diabetes who have failed other therapies and have become insulin-deficient. This group represents about a quarter of all people with type 2 diabetes. Almost all those with type 2 diabetes who start ... ...

    Abstract Insulin therapy is mainly used by people with type 2 diabetes who have failed other therapies and have become insulin-deficient. This group represents about a quarter of all people with type 2 diabetes. Almost all those with type 2 diabetes who start insulin therapy or intensify it gain weight, which may potentially diminish the prognostic advantage of improved glycaemia. To date, all available guidelines emphasize both the attainment of glycated haemoglobin (HbA1c) goals and weight control, without directing the clinician as to which element is of a higher priority. The following review attempts to clarify the issue using the available literature. The body of evidence presented in this review indicates that glycaemic management with exogenous insulin replacement is of a much higher priority than weight gain. Lower weight or weight loss do not show prognostic benefit in advanced stages of diabetes; therefore, weight gain should not discourage providers from achieving and maintaining HbA1c goals with insulin therapy, regardless of insulin dosage or other medications.
    MeSH term(s) Blood Glucose/analysis ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/physiopathology ; Glycated Hemoglobin A/analysis ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin/therapeutic use ; Prognosis ; Weight Gain/physiology
    Chemical Substances Blood Glucose ; Glycated Hemoglobin A ; Hypoglycemic Agents ; Insulin ; hemoglobin A1c protein, human
    Language English
    Publishing date 2018-06-22
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.13367
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    Zs.A 5442: Show issues Location:
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  5. Article ; Online: A scalable application of Artificial Intelligence-Driven Insulin Titration Program to transform Type 2 Diabetes Management.

    Warren, Mark Lowe / Bergenstal, Richard M / Hager, Matthew R / Bashan, Eran / Hodish, Israel

    Diabetes technology & therapeutics

    2024  

    Abstract: Background: Despite new pharmacotherapy, most patients with long-term Type 2 Diabetes are still hyperglycemic. This could have been solved by insulin with its unlimited potential efficacy, but its dynamic physiology demands frequent titrations which are ...

    Abstract Background: Despite new pharmacotherapy, most patients with long-term Type 2 Diabetes are still hyperglycemic. This could have been solved by insulin with its unlimited potential efficacy, but its dynamic physiology demands frequent titrations which are overdemanding. This report provides a real-life account for a scalable transformation of diabetes care in a community-based endocrinology center by harnessing AI-based autonomous insulin titration.
    Methods: The center embedded the d-Nav® technology and its dedicated clinical support. Reported outcomes include treatment efficacy/safety in the first 600 patients and use of cardiorenal-risk reduction pharmacotherapy.
    Findings: Patients used d-Nav for 8.2±3.0 months with 82% retention. Age was 67.1±11.5 years and duration of diabetes was 19.8±11.0 years. During the last 3 years before d-Nav, HbA1c had been overall higher than 8% and at the beginning of the program it was as high as 8.6%±2.1% with 29.3% of the patients with HbA1c>9%. With d-Nav, HbA1c decreased to 7.3%±1.2% with 5.7% of patients with HbA1c>9%. During the first 3 months, d-Nav reduced total daily dose of insulin in 1 of every 5 patients due to relatively low glucose levels to minimize the risk of hypoglycemia. GLP-1 or dual GLP-1 and GIP receptor agonists were prescribed in about a half of the patients and SGLT2 inhibitor in a third. The frequency of hypoglycemia (<54mg/dl) was 0.4±0.6/month and severe hypoglycemia 1.7/100-patient-years.
    Interpretation: The use of d-Nav allowed for improvement in overall diabetes management with appropriate use of both insulin and non-insulin pharmacologic agents in a scalable way.
    Language English
    Publishing date 2024-03-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1452816-2
    ISSN 1557-8593 ; 1520-9156
    ISSN (online) 1557-8593
    ISSN 1520-9156
    DOI 10.1089/dia.2024.0041
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  6. Article ; Online: Time in range in patients with type 2 diabetes who are long-term users of d-Nav®, an artificial intelligence-driven technology for autonomous titration of insulin dosing.

    Williams, Kevin J / Bashan, Eran / Kruse, Caitlin / Sritharan, Sajitha / Hodish, Israel

    Diabetes, obesity & metabolism

    2023  Volume 25, Issue 12, Page(s) 3845–3848

    Language English
    Publishing date 2023-09-18
    Publishing country England
    Document type Letter
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.15280
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  7. Article ; Online: Insulin dosing guidance to optimise type 2 diabetes management - Authors' reply.

    Bergenstal, Richard M / Johnson, Mary L / Bashan, Eran / Hodish, Israel

    Lancet (London, England)

    2019  Volume 394, Issue 10206, Page(s) 1321

    MeSH term(s) Diabetes Mellitus, Type 2 ; Glycated Hemoglobin A/analysis ; Humans ; Hypoglycemic Agents ; Insulin
    Chemical Substances Glycated Hemoglobin A ; Hypoglycemic Agents ; Insulin
    Language English
    Publishing date 2019-10-18
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(19)31895-1
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  8. Article ; Online: Challenging the 50-50 rule for the basal-bolus insulin ratio in patients with type 2 diabetes who maintain stable glycaemic control.

    Harper, Roy / Bashan, Eran / Williams, Kevin J / Sritharan, Sajitha / Willis, Mark / Marriott, Deanna J / Hodish, Israel

    Diabetes, obesity & metabolism

    2022  Volume 25, Issue 2, Page(s) 581–585

    Abstract: Background: For patients using basal-bolus insulin therapy, it is widespread clinical practice to aim for a 50-50 ratio between basal and total daily bolus. However, this practice was based on a small study of individuals without diabetes. To assess the ...

    Abstract Background: For patients using basal-bolus insulin therapy, it is widespread clinical practice to aim for a 50-50 ratio between basal and total daily bolus. However, this practice was based on a small study of individuals without diabetes. To assess the rule in real-world practice, we retrospectively analyzed patients on basal-bolus therapy that was adjusted at least weekly by an artificial intelligence-driven titration within the d-Nav® Insulin Management Technology.
    Materials and methods: We obtained de-identified data from the Diabetes Centre of Ulster Hospital for patients with four inclusion criteria: type 2 Diabetes (T2D), on d-Nav >6 months, on basal-bolus insulin therapy >80% of the time (based on insulin analogs), and no gap in data >3 months.
    Results: We assembled a cohort of 306 patients, followed by the d-Nav service for 3.4 ± 1.8 years (mean ± SD), corresponding to about 180 autonomous insulin dose titrations and about 5000 autonomous individual dose recommendations per patient. After an initial run-in period, mean glycated hemoglobin (HbA1c) values in the cohort were maintained close to 7%. Surprisingly, in just over three-quarters of the cohort, the average basal insulin fraction was <50%; in half of the cohort average basal insulin fraction <41.2%; and in one-quarter the basal insulin fraction was <33.6%. Further, the basal insulin fraction did not remain static over time. In half of the patients, the basal insulin fraction varied by ≥1.9×; and, in 25% of the patients, ≥2.5×.
    Conclusion: Our data show that a 50-50 ratio of basal-to-bolus insulin does not generally apply to patients with T2D who successfully maintain stable glycemia. Therefore, the 50-50 ratio should not serve as an ongoing treatment guide. Moreover, our results emphasize the importance of at least weekly insulin titrations.
    MeSH term(s) Humans ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/chemically induced ; Hypoglycemic Agents/therapeutic use ; Insulin Glargine/therapeutic use ; Glycemic Control ; Retrospective Studies ; Artificial Intelligence ; Blood Glucose ; Treatment Outcome ; Insulin/therapeutic use
    Chemical Substances Hypoglycemic Agents ; Insulin Glargine (2ZM8CX04RZ) ; Blood Glucose ; Insulin
    Language English
    Publishing date 2022-12-02
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1454944-x
    ISSN 1463-1326 ; 1462-8902
    ISSN (online) 1463-1326
    ISSN 1462-8902
    DOI 10.1111/dom.14904
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  9. Article ; Online: Temporary Reductions in Insulin Requirements Are Associated with Hypoglycemia in Type 2 Diabetes.

    Harper, Roy / Bashan, Eran / Bisgaier, Stanley G / Willis, Mark / Isaman, Deanna J M / Hodish, Israel

    Diabetes technology & therapeutics

    2019  Volume 20, Issue 12, Page(s) 817–824

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Diabetes Mellitus, Type 2/drug therapy ; Humans ; Hypoglycemia ; Hypoglycemic Agents/administration & dosage ; Insulin/administration & dosage ; Time Factors
    Chemical Substances Hypoglycemic Agents ; Insulin
    Language English
    Publishing date 2019-12-27
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1452816-2
    ISSN 1557-8593 ; 1520-9156
    ISSN (online) 1557-8593
    ISSN 1520-9156
    DOI 10.1089/dia.2018.0266
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  10. Article: Adrenal Lymphangioma Masquerading as a Catecholamine Producing Tumor.

    Hodish, Israel / Schmidt, Lindsay / Moraitis, Andreas G

    Case reports in endocrinology

    2015  Volume 2015, Page(s) 380151

    Abstract: Objective. To report the unusual case of an adrenal lymphangioma presenting in a patient with an adrenal cystic lesion and biochemical testing concerning for pheochromocytoma. The pertinent diagnostic and imaging features of adrenal lymphangiomas are ... ...

    Abstract Objective. To report the unusual case of an adrenal lymphangioma presenting in a patient with an adrenal cystic lesion and biochemical testing concerning for pheochromocytoma. The pertinent diagnostic and imaging features of adrenal lymphangiomas are reviewed. Methods. We describe a 59-year-old patient who presented with hyperhidrosis and a 2.2 by 2.2 cm left adrenal nodule. Biochemical evaluation revealed elevated plasma-free normetanephrine, urine normetanephrine, urine vanillylmandelic acid, and urine norepinephrine levels. Elevated plasma norepinephrine levels were not suppressed appropriately with clonidine administration. Results. Given persistent concern for pheochromocytoma, the patient underwent adrenalectomy. The final pathology was consistent with adrenal lymphangioma. Conclusions. Lymphangiomas are benign vascular lesions that can very rarely occur in the adrenal gland. Imaging findings are generally consistent with a cyst but are nonspecific. Excluding malignancy in patients presenting with adrenal cysts can be difficult. Despite its benign nature, the diagnosis of adrenal lymphangioma may ultimately require pathology.
    Language English
    Publishing date 2015-11-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2627633-1
    ISSN 2090-651X ; 2090-6501
    ISSN (online) 2090-651X
    ISSN 2090-6501
    DOI 10.1155/2015/380151
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