Variability of Basal Rate Profiles in Insulin Pump Therapy and Association with Complications in Type 1 Diabetes Mellitus.

Markus Laimer,Markus Laimer,Markus Laimer,Julia M Hermann,Reinhard W Holl,Andreas Melmer,Reinhard W Holl,Julia M Hermann,Reinhard W Holl,Martin Pfeifer,Julia M Hermann,Christoph Stettler,Gabriele Götz,Julia M Hermann,Ingrid Schütz-Fuhrmann,Julia M Hermann,Heide-Rose Engels,Reinhard W Holl,Julia K Mader,Andreas Melmer,Reinhard W Holl

doi:10.1371/journal.pone.0150604

Abstract

BackgroundTraditionally, basal rate profiles in continuous subcutaneous insulin infusion therapy are individually adapted to cover expected insulin requirements. However, whether this approach is indeed superior to a more constant BR profile has not been assessed so far. This study analysed the associations between variability of BR profiles and acute and chronic complications in adult type 1 diabetes mellitus.Materials and MethodsBR profiles of 3118 female and 2427 male patients from the “Diabetes-Patienten-Verlaufsdokumentation” registry from Germany and Austria were analysed. Acute and chronic complications were recorded 6 months prior and after the most recently documented basal rate. The “variability index” was calculated as variation of basal rate intervals in percent and describes the excursions of the basal rate intervals from the median basal rate.ResultsThe variability Index correlated positively with severe hypoglycemia (r = .06; p<0.001), hypoglycemic coma (r = .05; p = 0.002), and microalbuminuria (r = 0.05; p = 0.006). In addition, a higher variability index was associated with higher frequency of diabetic ketoacidosis (r = .04; p = 0.029) in male adult patients. Logistic regression analysis adjusted for age, gender, duration of disease and total basal insulin confirmed significant correlations of the variability index with severe hypoglycemia (β = 0.013; p<0.001) and diabetic ketoacidosis (β = 0.012; p = 0.017).ConclusionsBasal rate profiles with higher variability are associated with an increased frequency of acute complications in adults with type 1 diabetes.

Highlights

Logistic regression analysis adjusted for age, gender, duration of disease and total basal insulin confirmed significant correlations of the variability index with severe hypoglycemia (β = 0.013; p
Basal rate profiles with higher variability are associated with an increased frequency of acute complications in adults with type 1 diabetes
While much attention has been attributed to the adjustment of bolus insulin doses to carbohydrate consumption, physical activity, and pre-meal blood glucose concentrations in continuous subcutaneous insulin infusion therapy (CSII), considerably less is known regarding individual basal insulin requirements.[1]

Summary

Introduction

While much attention has been attributed to the adjustment of bolus insulin doses to carbohydrate consumption, physical activity, and pre-meal blood glucose concentrations in continuous subcutaneous insulin infusion therapy (CSII), considerably less is known regarding individual basal insulin requirements.[1]. [3] To the best of our knowledge, no studies are available that compare the effectiveness between circadian and flat basal rate programming strategies to improve glycemic control in adult type 1 diabetic patients. Basal rates and glucose profiles are intrinsically individual, identifying an association between basal insulin variation and acute or chronic complications could extend our knowledge on basal rate programming. Basal rate profiles in continuous subcutaneous insulin infusion therapy are individually adapted to cover expected insulin requirements. Whether this approach is superior to a more constant BR profile has not been assessed so far. This study analysed the associations between variability of BR profiles and acute and chronic complications in adult type 1 diabetes mellitus

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