Objective: The aim of this study was to evaluate the outcomes of transitioning to the MiniMed™... more Objective: The aim of this study was to evaluate the outcomes of transitioning to the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system in adult individuals with type 1 diabetes (T1DM) naïve to CSII and CGM technologies. Research Design and Methods: The trial was a two-center, randomized controlled, parallel group study evaluating individuals with T1DM aged 26-60 years managed with Multiple Daily Injection (MDI) and self-monitoring of blood glucose (BGM), with an HbA1c <10%. Results: 41 participants were recruited and randomized to either the AHCL (20) or the MDI+BGM (21) group. 37 participants (age 40.3±8.0 years; duration of diabetes 17.3 ± 12.1 years; BMI 25.1±3.1 kg/m2; HbA1c 7.2% ± 1.0) completed the study. Time spent in target (TIR) increased from 69.3±12.3% at baseline to 85.0±6.3% at 3 months in the AHCL group, while remaining unchanged in the control group: treatment effect 21.5% [95% CI 15.7, 27.3%]; p < 0.001. The Time Below Range (<70 mg/dl; TBR) decr...
IntroductionFor many people with type 1 diabetes who struggle to achieve glycaemic control with m... more IntroductionFor many people with type 1 diabetes who struggle to achieve glycaemic control with multiple daily injections of insulin (MDI) plus self-monitoring of blood glucose, MDI plus intermittently scanned continuous glucose monitoring (IS-CGM) or real-time continuous glucose monitoring (RT-CGM), or insulin administration using insulin pump therapy represent optimised care in many regions. Through technological advances an advanced hybrid closed loop (AHCL) system has been developed; studies of incremental effects relative to MDI plus IS-CGM are lacking.Methods and analysisThe Advanced Hybrid Closed Loop study in Adult Population with Type 1 Diabetes (ADAPT) study is a multinational, prospective, open-label, confirmatory and exploratory randomised controlled trial to examine outcomes with the MiniMed 670G version 4.0 AHCL system (with an equivalent algorithm and commercialised as the MiniMed 780G system, referred to as AHCL) relative to MDI plus IS-CGM in adults with baseline Hb...
Journal of diabetes science and technology, Nov 1, 2016
Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes ... more Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes because of inconsistencies in evidence of effectiveness. We reviewed published guidelines on intensive insulin therapy in type 2 diabetes to assess whether updating of guidance is needed with respect to evidence used and recommendations for CSII in diabetes management. A literature review was performed to identify published national and international guidelines on type 2 diabetes management. Searches were performed using PubMed, Cochrane Library, and Embase databases, and websites of national health care agencies, reimbursement agencies, and professional associations. Searches were limited to articles published in English between 2004 and 2014 and 1666 unique hits were identified, of which 22 were reviewed following screening. Only 6 of the 22 guidelines identified from North and South America, Western Europe, Greece, and Israel provided specific recommendations on intensive insulin ther...
This analysis investigated factors associated with the decrease in HbA1c in patients receiving co... more This analysis investigated factors associated with the decrease in HbA1c in patients receiving continuous subcutaneous insulin infusion (CSII) in the OpT2mise randomized trial. In this study, patients with type 2 diabetes and HbA1C >8% following multiple daily injections (MDI) optimization were randomized to receive CSII (n = 168) or MDI (n = 163) for 6 months. Patient-related and treatment-related factors associated with decreased HbA1c in the CSII arm were identified by univariate and multivariate analyses. CSII produced a significantly greater reduction in HbA1c than MDI, and the treatment difference increased with baseline HbA1c . In the CSII arm, the only factors significantly associated with decreased HbA1C were higher baseline HbA1C (P<0.001), geographical region (P<0.001), higher educational level (P=0.012), higher total cholesterol level (P=0.002), lower variability of baseline glucose values on continuous glucose monitoring (P<0.001), and the decrease in averag...
To compare insulin pump therapy and multiple daily injections (MDI) in patients with type 2 diabe... more To compare insulin pump therapy and multiple daily injections (MDI) in patients with type 2 diabetes receiving basal and prandial insulin analogues. Following a 2-month dose-optimization period, 331 patients with glycated haemoglobin ≥8.0% and ≤12% were randomized to pump therapy or continued MDI for 6 months (randomization phase, RP). The MDI group was subsequently switched to pump therapy during a 6-month continuation phase (CP). The primary end point was the between-group difference in change in mean glycated haemoglobin from baseline to the end of the RP. Baseline mean glycated haemoglobin was 9% in both groups. At the end of the RP, the reduction in glycated haemoglobin was significantly greater with pump therapy than with MDI (-1.1±1.2% versus -0.4±1.1%, P<0.001). The pump therapy group maintained this improvement to 12 months while MDI patients switched to pump therapy showed a 0.8% reduction: final glycated haemoglobin was identical in both arms. In the RP, total daily in...
Aims. To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an at... more Aims. To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an attempt to predict which patient would be more likely to reduce HbA1c levels (success) on CSII. Methods. 18 Type 2 diabetes patients who began insulin pump therapy in our institute were included. All patients were previously treated by insulin with a mean duration of 54.9?51.4 months. Results. Mean duration of follow-up with CSII was 42.2?27.0 months. No significant changes were seen in HbA1c in total cohort (p=0.064), but fasting plasma glucose was reduced from 10,5?2,9 to 7,6?1,9 mmol/l, p=0.007. No weight gain and no severe hypoglycemia were noted. All patients were divided to three groups according to their HbA1c levels: those whose treatment was successful (A), failed (B) or neutral (C), (5, 8, 5 patients respectively). A difference was found in insulin/weight (IWR) ratio within the group A: 0.81?0.29 U/kg before vs. 0.41 ?0.12 U/kg on CSII, p=0.043. There was a difference in IWR on C...
Insulin-treated diabetes mellitus has traditionally been considered disqualifying for aviation du... more Insulin-treated diabetes mellitus has traditionally been considered disqualifying for aviation duties, the major concern being the risk of hypoglycemia. This phenomenon may lead to impaired judgment and even loss of consciousness, potentially leading to a mishap. Blood glucose awareness training has been advanced as a strategy to avoid hypoglycemia by teaching individuals to use the appearance of autonomic and neuroglycopenic symptoms as indicators of decreasing blood glucose levels. We present two military aviators with newly diagnosed type 1 diabetes mellitus who were returned to flying duty in a multicrew aircraft. Blood glucose awareness training was used as a tool for the education of these aviators regarding the early signs of hypoglycemia in order to avoid development of more significant hypoglycemia. These cases attest to the importance of blood glucose awareness training in the return of diabetic patients to the cockpit.
Aims. To seek high risk population for diabetes and to improve their health care by investigating... more Aims. To seek high risk population for diabetes and to improve their health care by investigating the characteristics and outcome of hospitalization in hospitals with predominant Arab patients in Northern Israel.Methods. Retrospective analysis of the prevalence of diabetes and the outcome of diabetic in comparison to nondiabetic patients hospitalized in the internal medicine and intensive cardiac units in two major hospitals with one-year postdischarge data between 1.1.2009 and 31.12.2009.Results. Thirty-nine percent of the patients were diagnosed with diabetes. The preponderance of women in the diabetes group was noted. Diabetic patients had an increase in the duration of hospitalization (P=0.0008), with one hospital having a high readmission rate for the diabetic patients. The average glycemia during hospitalization exceeded the recommended threshold of 180 mg% without major changes in the therapeutic regimens in comparison to preadmission regimens.Conclusions. Arab populations, w...
Two studies examined the contribution of aging to various aspects of sexual functioning. Study 1 ... more Two studies examined the contribution of aging to various aspects of sexual functioning. Study 1 examined the association between age and sexual response among 289 women. Results showed that aging and relationship length were associated with relatively low sexual desire, excitement, and intimacy, with sexual intimacy mediating the association between relationship length and sexual excitement. Furthermore, the negative association between aging and sexual desire was particularly pronounced among women experiencing lower sexual intimacy. In Study 2, 93 women were classified according to menopausal status. Findings paralleled those of Study 1, indicating that postmenopausal state was negatively associated with sexual desire, mainly among women who experienced low sexual intimacy. Implications for the understanding of sexuality of women at midlife are discussed.
Objective: We assessed the accuracy of the FreeStyle Mini™ (FSM) meter for use in glycemic clamp ... more Objective: We assessed the accuracy of the FreeStyle Mini™ (FSM) meter for use in glycemic clamp and meal protocols in comparison with the HemoCue Glucose 201 DM Analyzer (HemoCue) and the YSI 2300 STAT Glucose Oxidase Analyzer (YSI). Methods: Seven volunteers with type 2 diabetes mellitus, 35–69 years old, underwent a frequently sampled meal test and a graded hyperglycemic test, on two separate days, with one of the volunteers undergoing each test twice. Samples for glucose measurements were obtained from arterialized venous blood. A total of 420 samples (with glucose levels ranging from 63 to 388 mg/dl) were available for comparison. On average, 10 measurements were available for every 5 mg/dl increment in glucose level in the range of 130–310 mg/dl. Blood glucose measurements were done on each sample with the FSM, HemoCue, and YSI. Results: FreeStyle Mini blood glucose values correlated closely with the YSI readings. Of the FSM measurements, 99.0% were within the Clarke error gri...
Objective: We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aide... more Objective: We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aided, fixed-activity radioiodine therapy of large, multinodular goiters (MNGs) in elderly patients with comorbidities. Design: This was a short-term, observational study. Methods: We measured 24-h thyroid radioiodine uptake (RAIU) of 2 μCi 131-iodine at baseline and 24 h after intramuscular injection of 0.03 mg rhTSH in 17 patients (aged 60–86 years, 12 women), who subsequently received 30 mCi 131-iodine 24 h after an identical rhTSH injection. TSH and free thyroxine (FT4) were measured at baseline and days 10, 30 and 90 after therapy. Thyroid volume was assessed by computed tomography at baseline and day 180. Results: rhTSH, 0.03 mg, significantly increased mean 24-h thyroid RAIU from 25.8% ± 10.3% to 43.3% ± 8.4% (68% relative increase; t(16) = −8.43, P < 0.001). The proportion of patients overtly or subclinically hyperthyroid (TSH < 0.5 mU/l) decreased from 71% (12/17) at baseline ...
Objective: The aim of this study was to evaluate the outcomes of transitioning to the MiniMed™... more Objective: The aim of this study was to evaluate the outcomes of transitioning to the MiniMed™ 780G advanced hybrid closed-loop (AHCL) system in adult individuals with type 1 diabetes (T1DM) naïve to CSII and CGM technologies. Research Design and Methods: The trial was a two-center, randomized controlled, parallel group study evaluating individuals with T1DM aged 26-60 years managed with Multiple Daily Injection (MDI) and self-monitoring of blood glucose (BGM), with an HbA1c <10%. Results: 41 participants were recruited and randomized to either the AHCL (20) or the MDI+BGM (21) group. 37 participants (age 40.3±8.0 years; duration of diabetes 17.3 ± 12.1 years; BMI 25.1±3.1 kg/m2; HbA1c 7.2% ± 1.0) completed the study. Time spent in target (TIR) increased from 69.3±12.3% at baseline to 85.0±6.3% at 3 months in the AHCL group, while remaining unchanged in the control group: treatment effect 21.5% [95% CI 15.7, 27.3%]; p < 0.001. The Time Below Range (<70 mg/dl; TBR) decr...
IntroductionFor many people with type 1 diabetes who struggle to achieve glycaemic control with m... more IntroductionFor many people with type 1 diabetes who struggle to achieve glycaemic control with multiple daily injections of insulin (MDI) plus self-monitoring of blood glucose, MDI plus intermittently scanned continuous glucose monitoring (IS-CGM) or real-time continuous glucose monitoring (RT-CGM), or insulin administration using insulin pump therapy represent optimised care in many regions. Through technological advances an advanced hybrid closed loop (AHCL) system has been developed; studies of incremental effects relative to MDI plus IS-CGM are lacking.Methods and analysisThe Advanced Hybrid Closed Loop study in Adult Population with Type 1 Diabetes (ADAPT) study is a multinational, prospective, open-label, confirmatory and exploratory randomised controlled trial to examine outcomes with the MiniMed 670G version 4.0 AHCL system (with an equivalent algorithm and commercialised as the MiniMed 780G system, referred to as AHCL) relative to MDI plus IS-CGM in adults with baseline Hb...
Journal of diabetes science and technology, Nov 1, 2016
Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes ... more Continuous subcutaneous insulin infusion (CSII) is used less for type 2 than for type 1 diabetes because of inconsistencies in evidence of effectiveness. We reviewed published guidelines on intensive insulin therapy in type 2 diabetes to assess whether updating of guidance is needed with respect to evidence used and recommendations for CSII in diabetes management. A literature review was performed to identify published national and international guidelines on type 2 diabetes management. Searches were performed using PubMed, Cochrane Library, and Embase databases, and websites of national health care agencies, reimbursement agencies, and professional associations. Searches were limited to articles published in English between 2004 and 2014 and 1666 unique hits were identified, of which 22 were reviewed following screening. Only 6 of the 22 guidelines identified from North and South America, Western Europe, Greece, and Israel provided specific recommendations on intensive insulin ther...
This analysis investigated factors associated with the decrease in HbA1c in patients receiving co... more This analysis investigated factors associated with the decrease in HbA1c in patients receiving continuous subcutaneous insulin infusion (CSII) in the OpT2mise randomized trial. In this study, patients with type 2 diabetes and HbA1C >8% following multiple daily injections (MDI) optimization were randomized to receive CSII (n = 168) or MDI (n = 163) for 6 months. Patient-related and treatment-related factors associated with decreased HbA1c in the CSII arm were identified by univariate and multivariate analyses. CSII produced a significantly greater reduction in HbA1c than MDI, and the treatment difference increased with baseline HbA1c . In the CSII arm, the only factors significantly associated with decreased HbA1C were higher baseline HbA1C (P<0.001), geographical region (P<0.001), higher educational level (P=0.012), higher total cholesterol level (P=0.002), lower variability of baseline glucose values on continuous glucose monitoring (P<0.001), and the decrease in averag...
To compare insulin pump therapy and multiple daily injections (MDI) in patients with type 2 diabe... more To compare insulin pump therapy and multiple daily injections (MDI) in patients with type 2 diabetes receiving basal and prandial insulin analogues. Following a 2-month dose-optimization period, 331 patients with glycated haemoglobin ≥8.0% and ≤12% were randomized to pump therapy or continued MDI for 6 months (randomization phase, RP). The MDI group was subsequently switched to pump therapy during a 6-month continuation phase (CP). The primary end point was the between-group difference in change in mean glycated haemoglobin from baseline to the end of the RP. Baseline mean glycated haemoglobin was 9% in both groups. At the end of the RP, the reduction in glycated haemoglobin was significantly greater with pump therapy than with MDI (-1.1±1.2% versus -0.4±1.1%, P<0.001). The pump therapy group maintained this improvement to 12 months while MDI patients switched to pump therapy showed a 0.8% reduction: final glycated haemoglobin was identical in both arms. In the RP, total daily in...
Aims. To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an at... more Aims. To evaluate long-term efficacy of CSII for treating type 2 diabetes patients. To make an attempt to predict which patient would be more likely to reduce HbA1c levels (success) on CSII. Methods. 18 Type 2 diabetes patients who began insulin pump therapy in our institute were included. All patients were previously treated by insulin with a mean duration of 54.9?51.4 months. Results. Mean duration of follow-up with CSII was 42.2?27.0 months. No significant changes were seen in HbA1c in total cohort (p=0.064), but fasting plasma glucose was reduced from 10,5?2,9 to 7,6?1,9 mmol/l, p=0.007. No weight gain and no severe hypoglycemia were noted. All patients were divided to three groups according to their HbA1c levels: those whose treatment was successful (A), failed (B) or neutral (C), (5, 8, 5 patients respectively). A difference was found in insulin/weight (IWR) ratio within the group A: 0.81?0.29 U/kg before vs. 0.41 ?0.12 U/kg on CSII, p=0.043. There was a difference in IWR on C...
Insulin-treated diabetes mellitus has traditionally been considered disqualifying for aviation du... more Insulin-treated diabetes mellitus has traditionally been considered disqualifying for aviation duties, the major concern being the risk of hypoglycemia. This phenomenon may lead to impaired judgment and even loss of consciousness, potentially leading to a mishap. Blood glucose awareness training has been advanced as a strategy to avoid hypoglycemia by teaching individuals to use the appearance of autonomic and neuroglycopenic symptoms as indicators of decreasing blood glucose levels. We present two military aviators with newly diagnosed type 1 diabetes mellitus who were returned to flying duty in a multicrew aircraft. Blood glucose awareness training was used as a tool for the education of these aviators regarding the early signs of hypoglycemia in order to avoid development of more significant hypoglycemia. These cases attest to the importance of blood glucose awareness training in the return of diabetic patients to the cockpit.
Aims. To seek high risk population for diabetes and to improve their health care by investigating... more Aims. To seek high risk population for diabetes and to improve their health care by investigating the characteristics and outcome of hospitalization in hospitals with predominant Arab patients in Northern Israel.Methods. Retrospective analysis of the prevalence of diabetes and the outcome of diabetic in comparison to nondiabetic patients hospitalized in the internal medicine and intensive cardiac units in two major hospitals with one-year postdischarge data between 1.1.2009 and 31.12.2009.Results. Thirty-nine percent of the patients were diagnosed with diabetes. The preponderance of women in the diabetes group was noted. Diabetic patients had an increase in the duration of hospitalization (P=0.0008), with one hospital having a high readmission rate for the diabetic patients. The average glycemia during hospitalization exceeded the recommended threshold of 180 mg% without major changes in the therapeutic regimens in comparison to preadmission regimens.Conclusions. Arab populations, w...
Two studies examined the contribution of aging to various aspects of sexual functioning. Study 1 ... more Two studies examined the contribution of aging to various aspects of sexual functioning. Study 1 examined the association between age and sexual response among 289 women. Results showed that aging and relationship length were associated with relatively low sexual desire, excitement, and intimacy, with sexual intimacy mediating the association between relationship length and sexual excitement. Furthermore, the negative association between aging and sexual desire was particularly pronounced among women experiencing lower sexual intimacy. In Study 2, 93 women were classified according to menopausal status. Findings paralleled those of Study 1, indicating that postmenopausal state was negatively associated with sexual desire, mainly among women who experienced low sexual intimacy. Implications for the understanding of sexuality of women at midlife are discussed.
Objective: We assessed the accuracy of the FreeStyle Mini™ (FSM) meter for use in glycemic clamp ... more Objective: We assessed the accuracy of the FreeStyle Mini™ (FSM) meter for use in glycemic clamp and meal protocols in comparison with the HemoCue Glucose 201 DM Analyzer (HemoCue) and the YSI 2300 STAT Glucose Oxidase Analyzer (YSI). Methods: Seven volunteers with type 2 diabetes mellitus, 35–69 years old, underwent a frequently sampled meal test and a graded hyperglycemic test, on two separate days, with one of the volunteers undergoing each test twice. Samples for glucose measurements were obtained from arterialized venous blood. A total of 420 samples (with glucose levels ranging from 63 to 388 mg/dl) were available for comparison. On average, 10 measurements were available for every 5 mg/dl increment in glucose level in the range of 130–310 mg/dl. Blood glucose measurements were done on each sample with the FSM, HemoCue, and YSI. Results: FreeStyle Mini blood glucose values correlated closely with the YSI readings. Of the FSM measurements, 99.0% were within the Clarke error gri...
Objective: We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aide... more Objective: We aimed to assess low-dose recombinant human thyroid-stimulating hormone (rhTSH)-aided, fixed-activity radioiodine therapy of large, multinodular goiters (MNGs) in elderly patients with comorbidities. Design: This was a short-term, observational study. Methods: We measured 24-h thyroid radioiodine uptake (RAIU) of 2 μCi 131-iodine at baseline and 24 h after intramuscular injection of 0.03 mg rhTSH in 17 patients (aged 60–86 years, 12 women), who subsequently received 30 mCi 131-iodine 24 h after an identical rhTSH injection. TSH and free thyroxine (FT4) were measured at baseline and days 10, 30 and 90 after therapy. Thyroid volume was assessed by computed tomography at baseline and day 180. Results: rhTSH, 0.03 mg, significantly increased mean 24-h thyroid RAIU from 25.8% ± 10.3% to 43.3% ± 8.4% (68% relative increase; t(16) = −8.43, P < 0.001). The proportion of patients overtly or subclinically hyperthyroid (TSH < 0.5 mU/l) decreased from 71% (12/17) at baseline ...
Uploads
Papers by ohad cohen