Sugar Crash: Oral Basal Insulin Versus Subcutaneous Glargine in T2DM & The Effect of Tranexamic Acid on Functional Outcomes


Jonathan Gravel, epidemiologist and family medicine resident at the University of Toronto, is hosting this week’s episode of The Rounds Table alongside Bradley Kaplansky, academic primary care physician in Toronto and host of podcast Primary Care Spiel.  This week they are covering the efficacy and safety of oral basal insulin versus subcutaneous insulin glargine in type 2 diabetes mellitus (T2DM) and the effect of tranexamic acid (TXA) on functional outcomes – an analysis of the CRASH-2 trial.

In patients with poorly-controlled type 2 diabetes who are already on multiple oral agents, insulin seems like the next logical step.  Oral insulin helps to overcome the difficulty with route of administration but also oral insulin better mimics pancreatic insulin secretion as it is absorbed via the portal vein directly to the liver.  Brad compares subcutaneous insulin versus novel oral insulin in terms of glycemic control and safety profile for patients with poorly-controlled type 2 diabetes who are insulin-naïve.

The Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) trial showed that TXA improved survival in severely injured adults.  Jon shares an exploratory analysis of the CRASH-2 trial which investigates TXA compared to placebo in terms of overall functional outcomes in severely injured adults.

This week on The Good Stuff segment, Brad reviews an article highlighting that the average life expectancy increases with the supply of primary care doctors.  Jon discusses a hearing held by a subcommittee for the House of Representatives in the U.S. on the ongoing measles outbreak and the politics around this.

Finally, this week Emily Hughes and Sheliza Halani are interviewing special guest, Dr. Lisa Richardson, general internist and clinician-educator at the University of Toronto, on person-centred care.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Jonathan Gravel @gravel_jon, Bradley Kaplansky @drbradkaplansky, Emily Hughes @emmy_hughes and Sheliza Halani @sheliza_halani

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. Oral basal insulin: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30372-3/fulltext

2. TXA: https://www.annemergmed.com/article/S0196-0644(18)31467-7/fulltext

3. CRASH-2: http://caribbean.scielo.org/scielo.php?script=sci_arttext&pid=S0043-31442010000600006

Good Stuff

1. Life expectancy: http://www.cmaj.ca/content/191/12/E347

2. Measles: https://www.newyorker.com/news/our-columnists/why-measles-is-a-quintessential-political-issue-of-our-time

Special Segment: Person Centred Care

1. Person-Centred Care: http://emergencymedicine.utoronto.ca/person-centred-care-education

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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