Basal and Bolus Insulin Dose Changes after Switching Basal Insulin to Insulin Degludec in Patients with Type 1 DiabetesMellitus: A Pilot Study.

Abstract

Ultra-long-acting insulin degludec (DEG) has a longer duration of action and less daily variability relative to other basal insulin (BI), and thus may benefit patients with type 1 diabetes mellitus (T1DM). We examined the impact of switching BI to DEG on glycemic control and insulin dose in T1DM. T1DM patients (n=22; six male; mean age: 64.5±12.6years) receiving basal-bolus insulin therapy were included. Initially, the BI dose was replaced with DEG in a 1:1 ratio; 80-100% of the total dose was replaced with DEG for multiple basal insulin injections. DEG was titrated according to study protocol. Changes in HbA1c, daily insulin dose, glycemic self-monitored blood glucose variations, and hypoglycemia frequency were evaluated for 24weeks. Once-daily DEG significantly decreased HbA1c levels when switched from once-daily BI (7.9±0.8 vs. 7.5±0.9%, p=0.020) and maintained HbA1c when switched from twice-daily BI (8.5±1.6 vs. 8.4±1.2%, p=0.457). The BI dose decreased by -7.8±13.9% (p=0.017) and -16.6±16.9% (p=0.050) when switched from once-daily BI and twice-daily BI, respectively. The total bolus insulin dose significantly decreased when switched from once-daily BI (21.7±8.3 to 19.3±8.8 U/day, p=0.016) especially in the injection before breakfast and evening meal. Body weight and hypoglycemia frequency was not significantly different. DEG improved glycemic control when switched from once-daily BI and maintained glycemic control when switched from twice-daily BI without increasing hypoglycemia.