In Japanese adults with type 1 diabetes, body weight should be used to calculate total daily insulin dose, and the portion of total basal insulin dose to total daily insulin dose should be set at 30% to achieve an optimal HbA1c concentration of 7.5% or less, according to published results.
Yamada, MD, PhD, of the department of medicine and molecular science at Gunma University Graduate School of Medicine, Japan, and colleagues evaluated 92 adults (mean age, 47 years) with type 1 diabetes to determine the insulin dose required to achieve an HbA1c concentration of 7.5% or less. Researchers compared body parameters and demographic factors in 39 participants with HbA1c 7.5% or less (well-controlled group) and 53 with HbA1c greater than 7% (poorly controlled group) to determine which factors contribute to optimal glycemic control.
There were no significant differences between the well-controlled group and poorly controlled group for age, duration of diabetes, stages of diabetic kidney disease, insulin pump use, body weight, BMI or total daily insulin dose. The well-controlled group had a lower percentage of total basal insulin dose to total daily dose compared with the poorly controlled group (P < .05) after adjustment for age, sex and duration of diabetes. According to the researchers, this finding suggests that optimal glycemic control may not depend on total daily insulin dose, but on the appropriate ratio of basal and basal bolus insulin.
Researchers also evaluated the relationship between various body parameters and insulin dose. Body weight, BMI and body surface area were strongly correlated with total daily insulin dose (P < .01 for all). Researchers observed a weak correlation between total basal insulin dose and body weight (P < .01, whereas there was no relationship between total basal insulin dose and BMI or body surface area. According to the researchers, this finding suggests that the amount of bolus and total basal insulin dose required by a patient may be influenced by body weight. Further, researchers found that the optimal percentage of total basal insulin dose in total daily insulin dose was 30% to achieve HbA1c 7.5% or less.
“When the [total basal insulin dose] is very low, clinicians should consider a more precise method of insulin delivery, such as an insulin pump rather than pens,” the researchers wrote. “Our assessment of insulin dosing yielded useful findings for our optimal control of type 1 diabetes, but further studies with larger cohorts using the continuous glucose monitoring system are needed to confirm our findings regarding the design of therapeutic strategies.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.