Dataset Information

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

ABSTRACT:

Objective

To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia.

Methods

Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n?=?476) and DM2 (n?=?541) outpatients, with eGFR >30 mL/min/1.73 m², on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031.

Results

Total daily insulin dose was significantly higher in DM2 patients (52.3?±?22.5 vs. 46?±?20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46?±?0.14 in DM1 and 0.43?±?0.15 in DM2 patients (p?=?0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1.

Conclusion

The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

SUBMITTER: Castellano E

PROVIDER: S-EPMC6405380 | biostudies-literature | 2018 Dec

REPOSITORIES: biostudies-literature

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Publications

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

Castellano Elena E Attanasio R R Giagulli V A VA Boriano A A Terzolo M M Papini E E Guastamacchia E E Monti S S Aglialoro A A Agrimi D D Ansaldi E E Babini A C AC Blatto A A Brancato D D Casile C C Cassibba S S Crescenti C C De Feo M L ML Del Prete A A Disoteo O O Ermetici F F Fiore V V Fusco A A Gioia D D Grassi A A Gullo D D Lo Pomo F F Miceli A A Nizzoli M M Pellegrino M M Pirali B B Santini C C Settembrini S S Tortato E E Triggiani V V Vacirca A A Borretta G G

Journal of diabetes and metabolic disorders 20181001 2

<h4>Objective</h4>To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia.<h4>Methods</h4>Multicentric, observational, cross-sectional study in Italy. Adult DM1 (<i>n</i> = 476) and DM2 (<i>n</i> = 541) outpatients, with eGFR >30 mL/min/1.73 m<sup>2</sup>, on a basal-bolus regimen for at least six months, were recruited ...[more]

PMID: 30918874

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Project description:IntroductionTo date, there have been few head-to-head comparisons between semaglutide once-weekly (OW) and short-acting meal-time insulin in participants with type 2 diabetes (T2D) treated with basal insulin and requiring treatment intensification. This indirect comparison evaluated the effects of these regimens on glycated haemoglobin (HbA1c), body weight, hypoglycaemia, and other clinically relevant outcomes.MethodsA post-hoc, unanchored, individual participant data meta-analysis was conducted on the basis of data from single treatment arms in the SUSTAIN 5 and DUAL 7 trials. Semaglutide 0.5 mg OW and 1.0 mg OW plus basal insulin were compared with an optimised (treat-to-target) basal-bolus regimen of insulin glargine and insulin aspart over 26 weeks, using regression adjustment to account for baseline differences between the trials.ResultsOver 26 weeks, semaglutide 1.0 mg OW plus basal insulin reduced mean HbA1c by significantly more than the basal-bolus regimen (treatment difference: - 0.36%; p = 0.003), while semaglutide 0.5 mg OW plus basal insulin was comparable with basal-bolus insulin (treatment difference: 0.08%, p = 0.53). Both doses of semaglutide were associated with significant weight loss relative to insulin intensification (treatment differences: 6.8-9.4 kg; p < 0.001). At both doses, semaglutide intensification required less basal insulin per day than bolus intensification, and more participants on semaglutide met HbA1c targets of < 7.0% and ≤ 6.5% without hypoglycaemia or weight gain (odds ratio [OR] for < 7.0%, 21.9; OR for ≤ 6.5%, 16.2; both p < 0.001).ConclusionsIn T2D uncontrolled by basal insulin, intensification with semaglutide 1.0 mg OW was associated with better glycaemic control, weight loss, and reduced hypoglycaemia versus a basal-bolus regimen, while limiting the treatment burden associated with frequent injections. Clinicians could consider treatment intensification with semaglutide when T2D is uncontrolled by basal insulin, especially when weight management is a priority. Effective glycaemic control coupled with weight management can alleviate the burden of diabetes-associated complications.

Dataset Information

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

Objective

Methods

Results

Conclusion

Publications

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

Similar Datasets

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