1114-P: Feasibility Study of a Novel Way to Initiate Insulin Treatment in Persons with Type 2 Diabetes

Abstract

Introduction: Insulin initiation in type 2 diabetes (T2D) can be a complex process. In U.S., more than 60% of T2Ds treated with insulin do not reach recommended glycemic targets. Aim: To investigate the feasibility of using a simple dose response model for predicting the basal insulin dose needed to reach glycemic target for a person with T2D. Methods: To support initiation of a long acting insulin (insulin Degludec), we used CGM and injection data during insulin initiation to create an individual dose response model. Insulin naïve persons with T2D were included. Patients wore a CGM until the glycemic target was reached. CGM data from the first two weeks were used to identify the lowest glucose value of a day. The estimated safe and effective insulin dose (the 2-week dose estimates) were obtained by combining these lowest daily glucose periods with corresponding insulin doses, and extrapolating to a target range of 4-6 mmol/L. At end of study, the 2-week dose estimate was compared to the actual dose needed for glycemic control to assess how safe and effective the initial estimate would have been. Results: Of the first 7 of 10 patients who completed the study, 5 were males of average age 60.3 (9.1) years, BMI 30.5 (4.1) kg/m2 and diabetes duration 15.8 (8.8) years. The observed actual dose for reaching the glycemic target was 49.9 (31.4) IU, and the 2-week dose prediction for reaching 4 and 6 mmol/L was 31.4 (12.6) IU and 45.5 (17.7) IU, respectively. At the end of study, a dose range for reaching the 4-6 mmol/L range was estimated using all the collected data, and all estimates were within or below this range. Conclusion: Preliminary results from this feasibility study show that the insulin Degludec dose predicted two weeks after initiation was within or below the dose range needed for optimal control, thus the prediction errors were on the safe side in all cases. The results indicate that linear glucose and insulin extrapolation can be a safe and effective way to support initiation of insulin Degludec for people with T2D. Disclosure T. Aradóttir: None. H. Bengtsson: None. M.L. Jensen: Employee; Self; Novo Nordisk A/S. N.K. Poulsen: None. D. Boiroux: None. S. Schmidt: Speaker's Bureau; Self; Novo Nordisk A/S. K. Nørgaard: Advisory Panel; Self; Abbott, Medtronic, Novo Nordisk A/S. Speaker's Bureau; Self; Bayer US, Medtronic, Roche Diabetes Care, Rubin Medical, Sanofi, Zealand Pharma A/S. Stock/Shareholder; Self; Novo Nordisk A/S. Funding Novo Nordisk A/S; Innovation Fund Denmark (5189-00033B); Novo Nordisk Foundation