Efficacy of a Basal-Plus Regimen

Abstract

Aim: To find out Efficacy of a basal plus regimen. Objectives: 1. To find out the efficacy of basal plus regime by evaluating the changes in HbA1c at 24 weeks. 2. To find out changes in weight and frequency of hypoglycemia after initiation of the basal plus regime. Method: The study was a prospective analysis of 24 weeks after initiation of basal plus regime. Inclusion criteria: T2DM>5 Years; On 3OAD + basal insulin, HbA1c- 7.5-8.5%. Exclusion Criteria: critically ill patients, acute infection, pregnant, T1D. All patients matching the inclusion criteria were analyzed on the basis of SMBG chart to find out their highest glycemic excursion of post prandial and fasting readings. Based on the diet recall and sugar reading charts these patients were initiated on bolus insulin with the largest meal of the day where their post prandial corresponded to the highest reading. They were educated on proper insulin injection techniques and SMBG and asked to follow-up with their sugar readings using telemedicine application every day. Result: We studied 220 patients (F=124 M=96) with HbA1c at baseline 7.5-8.5% (avg-8.0). After addition of bolus insulin at 12 weeks target HbA1c <7% was achieved in 55.9% (n=123) patients with minor dose titrations. Average HbA1c at 12 Weeks was 7.3%. At 24Weeks target HbA1c was achieved in 88.18% (n=194) of patients after uptitration of bolus dose. Average HbA1c at 24Weeks was 6.9%. 5 patients experienced severe hypoglycemic episode. Cases of 15 average mild to moderate hypoglycemic episodes were reported. Regular SMBG and follow-up of the patients through telemedicine applications is continued for insulin dose titration. Fasting sugar target of below 110 mg/dl was achieved through titration of basal insulin in all 220 patients at the end of 12 weeks. Post prandial glycemic readings at the end of 12 weeks were achieved below 160 mg/dl in 167 patients and at 24 weeks in 198 patients. Conclusion: After failure of OADS and basal insulin a basal plus regime with addition of 1 bolus insulin with the largest meal of the day helped achieve the target HbA1c of <7% effectively. Disclosure B.D.J. Saboo: None. D. Hasnani: None. H. Chandarana: None. S. Bhandari: None. S. Joshi: None. J. Kesavadev: Advisory Panel; Self; Novo Nordisk India Private Limited. Speaker's Bureau; Self; Novo Nordisk India Private Limited. Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; MSD. Speaker's Bureau; Self; MSD. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. A. Maheshwari: None. H. Thacker: Research Support; Self; Wockhardt LTD.