The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen

all on behalf of Associazione Medici Endocrinologi (AME)

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. Methods: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. Results: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. Conclusion: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

Original languageEnglish
JournalJournal of Diabetes and Metabolic Disorders
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Outpatients
Hypoglycemia
Insulin
Metformin
Incidence
Type 1 Diabetes Mellitus
Italy
Caregivers
Multivariate Analysis
Cross-Sectional Studies
Body Weight

Keywords

  • Basal bolus
  • Hypoglycemia
  • Insulin therapy
  • Type 1 diabetes
  • Type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen. / all on behalf of Associazione Medici Endocrinologi (AME).

In: Journal of Diabetes and Metabolic Disorders, 01.01.2018.

Research output: Contribution to journalArticle

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title = "The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen",
abstract = "Objective: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. Methods: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. Results: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. Conclusion: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.",
keywords = "Basal bolus, Hypoglycemia, Insulin therapy, Type 1 diabetes, Type 2 diabetes",
author = "{all on behalf of Associazione Medici Endocrinologi (AME)} and Elena Castellano and R. Attanasio and Giagulli, {V. A.} and A. Boriano and M. Terzolo and E. Papini and E. Guastamacchia and S. Monti and A. Aglialoro and D. Agrimi and E. Ansaldi and Babini, {A. C.} and A. Blatto and D. Brancato and C. Casile and S. Cassibba and C. Crescenti and {De Feo}, {M. L.} and {Del Prete}, A. and O. Disoteo and F. Ermetici and V. Fiore and A. Fusco and D. Gioia and A. Grassi and D. Gullo and {Lo Pomo}, F. and A. Miceli and M. Nizzoli and M. Pellegrino and B. Pirali and C. Santini and S. Settembrini and E. Tortato and V. Triggiani and A. Vacirca and G. Borretta",
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T1 - The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen

AU - all on behalf of Associazione Medici Endocrinologi (AME)

AU - Castellano, Elena

AU - Attanasio, R.

AU - Giagulli, V. A.

AU - Boriano, A.

AU - Terzolo, M.

AU - Papini, E.

AU - Guastamacchia, E.

AU - Monti, S.

AU - Aglialoro, A.

AU - Agrimi, D.

AU - Ansaldi, E.

AU - Babini, A. C.

AU - Blatto, A.

AU - Brancato, D.

AU - Casile, C.

AU - Cassibba, S.

AU - Crescenti, C.

AU - De Feo, M. L.

AU - Del Prete, A.

AU - Disoteo, O.

AU - Ermetici, F.

AU - Fiore, V.

AU - Fusco, A.

AU - Gioia, D.

AU - Grassi, A.

AU - Gullo, D.

AU - Lo Pomo, F.

AU - Miceli, A.

AU - Nizzoli, M.

AU - Pellegrino, M.

AU - Pirali, B.

AU - Santini, C.

AU - Settembrini, S.

AU - Tortato, E.

AU - Triggiani, V.

AU - Vacirca, A.

AU - Borretta, G.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. Methods: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. Results: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. Conclusion: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

AB - Objective: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. Methods: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. Results: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. Conclusion: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

KW - Basal bolus

KW - Hypoglycemia

KW - Insulin therapy

KW - Type 1 diabetes

KW - Type 2 diabetes

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JF - Journal of Diabetes and Metabolic Disorders

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