Introduction: There is no valid evidenced-based recommendation for the optimum basal insulin dose in type-1 diabetes mellitus when supplied either by continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). We studied this previously by evaluating the dose associated with successful fasting. Another way of looking at this is by evaluating the association between basal insulin dose and HbA1c. To this end we performed a retrospective study of 89 children and young adults with T1DM.
Patients and methods: Eight-five (mean age 14.67±4.8 years (range 329)) patients were enrolled. Forty-six were treated with CSII and 43 with MDI (glargine as basal insulin). Basal insulin used was either downloaded from the insulin pump or taken as the dose registered in the chart. Glucose data were downloaded from patients glucometers. Mean time between data download and HbA1c determination was 0.9±0.78 months. We divided patients by quartiles according to HbA1c and determined the average basal insulin for each quartile. The second and third quartiles were joined and are presented together in the graph.
Results: With lower basal insulin levels lower HbA1C was achieved despite a similar total daily bolus dose (see graph). The optimal basal dose as determined by this study for 18 patients who had the lowest HbA1c (average 6.49% 0.34) (0.28±0.08 u/kg/d) is similar to that shown for fasting individuals of similar age (0.2±0.16 u/kg/d).
Conclusion: This study provides evidenced for a recommendation to optimize treatment by relying mainly on alterations in the bolus while keeping a low rate of basal insulin since patients with lower basal insulin doses did better in their overall control.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology