Correlation between basal insulin glargine dose required in achieving target fasting blood glucose and various clinical and laboratory parameters in hospitalized noncritical patients

Abstract

Aims:The primary objective was to study the interrelationship between the basal insulin glargine dose and baseline clinical and laboratory parameters in noncritically ill hospitalized patients who have achieved the stable fasting blood glucose in the target range of 100–140 mg/dl.Patients and Methods:This was retrospective, cross-sectional, observational study. Consenting, nonpregnant, adult patients on basal-bolus insulin who had fasting capillary blood glucose in the range of 100–140 mg/dl as measured by glucometer for 3 consecutive days were included in this study. Patient receiving any basal insulin other than insulin glargine were excluded from this study. The data collected for these patients included age, sex, glycated hemoglobin (HBA1c) at the time of admission, timing of basal insulin, basal insulin dose (BID), BID/kg, weight, and serum creatinine. BID/kg was correlated with other parameters using regression analysis (Pearson's). Comparison of BID/kg in various subgroups was analyzed using Student's t- test. Parametric data of more than three groups were compared using ANOVA. The P < 0.05 was considered as statistically significant. Results:A total of 180 patients were included in the study. On correlating the BID/kg with various parameters, we found statistically significant correlation between BID/kg and glycated hemoglobin (HbA1c) at the time of admission (P = 0.044). Patients with HbA1c ≥8.0% had higher BID/kg compared to those with HbA1c <8.0% (P = 0.004). The mean BID in patients with renal failure was significantly higher compared to those without renal failure.Conclusion:HbA1c at the time of admission is the most important parameter for determining the appropriate BID in hospitalized patients. Patients with renal failure may require a higher dose of basal insulin than those not having renal failure.

Insulin Therapy in Type-II Diabetes Mellitus – Is it Feasible and Acceptable?

“…12,13 Patients having renal dysfunction may have insulin resistance and may require a higher dose of basal insulin. 14,15 Insulin therapy thus becomes an important treatment option in patients of diabetic kidney disease. A myth which prevailed in our study patients was that, if insulin is taken, patients may have to undergo hemodialysis in future, while the fact is that it slows the progression of CKD.…”