Evaluation of a New Protocol of Insulin Dose Adjustment in a Low-Resource Setting

Abstract

Glycemic control (GC) is difficult to achieve in settings where only NPH, R and pre-mixed insulins are available, test strips are scarce, and food insecurity is common. We evaluated the impact of a sliding-scale based insulin adjustment protocol in Haiti. Thirty youth aged 11-28 years with T1D treated with 70/30 Mixtard were randomized to remain on 70/30 (G70, n=15) or switch to self-mixed NPH+R (GNR, n=15). Carbohydrate (CHO) ratio and insulin sensitivity factor were calculated based on total daily insulin dose (TDD), and translated into sliding scales with either insulin correction dose (ICD) only (G70), or the sum of a 60 g CHO meal dose and ICD (GNR). Self-monitored blood glucose (SMBG) and insulin were administered before AM and PM meals. All had bi-monthly visits for 12 weeks. In G70 vs. GNR, age (19.3±4.5 vs. 19.2±5.4 years), sex (40 vs. 53% m), normal BMI (87 vs. 80%), diabetes duration (5.3±4.2 vs. 5.3±4.5 years), and baseline A1c (9.8±2.1 vs. 10.8±2.9%, p=0.27) did not differ. A1c declined to 8.0±1.3% (-1.8%, p<0.006) vs. 8.9±1.2% (-1.9%, p<0.02), p=0.83, without severe acute complication. Skipped meals per week (3.7±2.9 vs. 4.1±3.3), missed SMBG (3.5±3.4 vs. 7.4±7.6%, p=0.07), and increase of TDD (7.7±7.8 vs. 6.6±9.6 units) were similar. Use of sliding scales adjusted for SMBG and meals omission, and frequent clinic visits significantly improved GC in youth with T1D in a low-resource setting, regardless of pre- or self-mixed insulin. Disclosure E. Jean Baptiste: None. P. Larco: None. M. Charles Larco: None. J.E. von Oettingen: None. E. Dubois: None. R. Paul: None. E. Fleury-Milfort: None. R. Charles: None. G.D. Ogle: None.