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

Elena Castellano, R Attanasio, V A Giagulli, A Boriano, M Terzolo, E Papini, E Guastamacchia, S Monti, A Aglialoro, D Agrimi, E Ansaldi, A C Babini, A Blatto, D Brancato, C Casile, S Cassibba, C Crescenti, M L De Feo, A Del Prete, O Disoteo, F Ermetici, V Fiore, A Fusco, D Gioia, A Grassi, D Gullo, F Lo Pomo, A Miceli, M Nizzoli, M Pellegrino, B Pirali, C Santini, S Settembrini, E Tortato, V Triggiani, A Vacirca, G Borretta, all on behalf of Associazione Medici Endocrinologi (AME), Elena Castellano, R Attanasio, V A Giagulli, A Boriano, M Terzolo, E Papini, E Guastamacchia, S Monti, A Aglialoro, D Agrimi, E Ansaldi, A C Babini, A Blatto, D Brancato, C Casile, S Cassibba, C Crescenti, M L De Feo, A Del Prete, O Disoteo, F Ermetici, V Fiore, A Fusco, D Gioia, A Grassi, D Gullo, F Lo Pomo, A Miceli, M Nizzoli, M Pellegrino, B Pirali, C Santini, S Settembrini, E Tortato, V Triggiani, A Vacirca, G Borretta, all on behalf of Associazione Medici Endocrinologi (AME)

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.

Conflict of interest statement

Compliance with ethical standardsC.E., A.R., B.A., T.M., P.E., G.E., B. A.C., B.A., B.D., C.C., D.F.M.L., D.P.A.,E.F., F.A., G.D., L.P. F., M.A., N.M., P.B., P.M., S.C., T.E., T.V., V.A. and B.G. have nothing to disclose. G.V.A. has participated in advisory panels for Bayer. A.D. has participated in advisory panels for Novartis. C.S. has received research support from Eli-Lilly. D.O. has received research support from Boehringer, Eli-Lilly,Merck Serono, Novartis, Novo Nordisk,Takeda. G.D. is consultant for Boehringer, Sanofi, Takeda. F.V. has received research support from Astra-Zeneca, Eli-Lilly, Novo Nordisk, Bayer, Novartis and Merck Serono. S.S. is on the speakers’ bureau for Boehringer-Ingelheim, Astra-Zeneca, Eli-Lilly,Takeda and Sanofi-Aventis.

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