In the Journals

Insulin dose increase smaller with basal-bolus therapy vs. other regimens

Adults with type 2 diabetes assigned to basal-bolus therapy require a smaller increase in insulin dose after 1 year compared with adults assigned to long-acting insulin or biphasic insulin, according to findings published in the Journal of Diabetes Investigation.

Satoru Tsujii, MD, PhD, of the department of endocrinology at Tenri Hospital in Japan, and colleagues evaluated data from the Diabetes Distress and Care Registry on 757 adults (mean age, 65.7 years) with type 2 diabetes (mean HbA1c level, 7.8%; mean duration of insulin therapy, 11.3 years) who presented to Tenri Hospital to determine the association between four insulin regimens and increases in HbA1c and insulin dose.

Participants were assigned to one of four insulin regimens: long-acting insulin once per day (regimen 1; n = 79), biphasic insulin twice per day (regimen 2; n = 448), biphasic insulin three times per day (regimen 3; n = 147) or basal-bolus therapy (regimen 4; n = 83).

An increase in HbA1c of more than 0.5% was observed in 22.8% of participants on regimen 1, 24.9% of participants on regimen 2, 20.7% of participants on regimen 3 and 29.3% of participants on regimen 4. After 1 year, daily insulin doses were increased in 62.3% of participants on regimen 1, 68.8% of participants on regimen 2, 65.3% of participants on regimen 3 and 38.6% of participants on regimen 4 (P < .001).

Increased HbA1c at the end of follow-up was significantly associated with age (adjusted OR = 0.76; 95% CI, 0.63-0.91) and higher HbA1c level at baseline (aOR = 0.68; 95% CI, 0.57-0.8). Odds of increasing daily insulin units 1 year later were significantly lower in participants on regimen 4 compared with participants on regimen 2 (aOR = 0.24; 95% CI, 0.14-0.41).

“Regardless of the insulin regimen used, a considerable number of patients treated with insulin therapy showed increases in both HbA1c levels and insulin doses at the end of follow-up,” the researchers wrote. “These findings indicate the limitations and unmet needs of current insulin regimens. Multivariable regression analysis showed that patients who received regimen 4 had smallest odds of requiring future insulin dose increases. This may be because a basal-bolus therapy has largest number of injections, which enables precise and subtle adjustment of insulin doses supported by and based on results of [self-monitoring blood glucose], eventually little increase in total daily doses. The current study provides insights on real life clinical scenario and reminds us of the importance of the basal-bolus therapy.” – by Amber Cox

Disclosure: The researchers report no relevant financial disclosures.

Adults with type 2 diabetes assigned to basal-bolus therapy require a smaller increase in insulin dose after 1 year compared with adults assigned to long-acting insulin or biphasic insulin, according to findings published in the Journal of Diabetes Investigation.

Satoru Tsujii, MD, PhD, of the department of endocrinology at Tenri Hospital in Japan, and colleagues evaluated data from the Diabetes Distress and Care Registry on 757 adults (mean age, 65.7 years) with type 2 diabetes (mean HbA1c level, 7.8%; mean duration of insulin therapy, 11.3 years) who presented to Tenri Hospital to determine the association between four insulin regimens and increases in HbA1c and insulin dose.

Participants were assigned to one of four insulin regimens: long-acting insulin once per day (regimen 1; n = 79), biphasic insulin twice per day (regimen 2; n = 448), biphasic insulin three times per day (regimen 3; n = 147) or basal-bolus therapy (regimen 4; n = 83).

An increase in HbA1c of more than 0.5% was observed in 22.8% of participants on regimen 1, 24.9% of participants on regimen 2, 20.7% of participants on regimen 3 and 29.3% of participants on regimen 4. After 1 year, daily insulin doses were increased in 62.3% of participants on regimen 1, 68.8% of participants on regimen 2, 65.3% of participants on regimen 3 and 38.6% of participants on regimen 4 (P < .001).

Increased HbA1c at the end of follow-up was significantly associated with age (adjusted OR = 0.76; 95% CI, 0.63-0.91) and higher HbA1c level at baseline (aOR = 0.68; 95% CI, 0.57-0.8). Odds of increasing daily insulin units 1 year later were significantly lower in participants on regimen 4 compared with participants on regimen 2 (aOR = 0.24; 95% CI, 0.14-0.41).

“Regardless of the insulin regimen used, a considerable number of patients treated with insulin therapy showed increases in both HbA1c levels and insulin doses at the end of follow-up,” the researchers wrote. “These findings indicate the limitations and unmet needs of current insulin regimens. Multivariable regression analysis showed that patients who received regimen 4 had smallest odds of requiring future insulin dose increases. This may be because a basal-bolus therapy has largest number of injections, which enables precise and subtle adjustment of insulin doses supported by and based on results of [self-monitoring blood glucose], eventually little increase in total daily doses. The current study provides insights on real life clinical scenario and reminds us of the importance of the basal-bolus therapy.” – by Amber Cox

Disclosure: The researchers report no relevant financial disclosures.