Abstract
Introduction Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. The recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control. Materials and Methods We included 260 consecutive patients with T1DM (159 women and 101 men) treated with continuous subcutaneous insulin infusion at the Department of Metabolic Diseases, Krakow, Poland. Data were downloaded from patients' pumps and collected from medical records. We analyzed the settings of BI and the association of %BI with HbA1c level. Linear regression was performed. Results The mean age of T1DM individuals was 26.6 ± 8.2 years, BMI was 23.1 ± 3.0 kg/m2, T1DM duration was 13.3 ± 6.4 years, and HbA1c level was 7.4%. There were 69.6% (n=181) of T1DM patients with %BI in the recommended range. The T1DM duration and HbA1c level of patients with a %BI <30% (n=23) was 9.5 years and 6.4%, respectively; for a %BI of 30–50%, it was 13.2 years and 7.4%; and for a %BI >50% (n=56), it was 15.8 years and 7.8% (p < 0.001 for both three-group comparisons). Multiple regression identified %BI among independent predictors of the HbA1c level. Conclusion In this real-life analysis, the recommendations concerning %BI dosing were not followed by almost one-third of adult T1DM patients. Low %BI was associated with better glycemic control; however, this requires further confirmation.
Highlights
Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. e recommended percentage of the total BI to daily insulin dose ranges between 30 and 50%
Whether these recommendations are followed in real-life clinical practice and if %BI in adults with T1DM treated with Continuous subcutaneous insulin infusion (CSII) affects glycemic control have not been assessed so far. is is intriguing in light of the clinical observations that keeping the %BI below 40% and encouraging the patient to bolus more frequently might lead to improved glycemic control with less weight gain [7]
Patients with T1DM with optimal glycemic control (HbA1c level ≤7%; n 119) were using on average 0.68 Insulin units per hour (IU)/kg/day and 39.4% of %BI, while individuals with HbA1c >7.0% (n 141) were using 0.73 IU/kg/day and 44.5% of BI (p 0.016 and p < 0.0000, resp.). e two subgroups differed with respect to age, daily insulin dose (DID), average glycemia, and number of blood glucose measurements per day
Summary
Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. e recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. E recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50% We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control. One algorithm that is commonly used in adults with T1DM suggests programming of BI as a half of the DID [6] Whether these recommendations are followed in real-life clinical practice and if %BI in adults with T1DM treated with CSII affects glycemic control have not been assessed so far. It is a common practice for the CSII initiation to use three to four different BI rates per day to respond to changes in insulin sensitivity [12]
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