Excess weight gain during insulin pump therapy is associated with higher basal insulin doses

Abstract

BackgroundWhile higher total daily dose (TDD) of insulin has been associated with excess weight gain on insulin pump therapy, the role of higher total basal dose (TBD) of insulin on weight gain has not been studied. We evaluated the impact of higher TBD on weight gain in relationship to glycosylated hemoglobin (HbA1c), hypoglycemic episodes, and change in body mass index (BMI) z score in a group of pediatric patients with type 1 diabetes mellitus (T1DM).MethodsOne-year data from 91 (54 Female/37 Male) patients (2.3–17.8 years of age), transitioned from basal-bolus regimen to insulin pump therapy were reviewed. Patients were divided into two groups based on changes in BMI z score: Group 1 (no change or decrease) and Group 2 (increase).ResultsThirty-three patients in Group 1 and 58 patients in Group 2. The two groups had similar TDD (0.9 ± 0.2 vs. 0.8 ± 0.2 U/kg/day), however Group 1 had a higher bolus: basal insulin ratio (1.8 ± 0.6 vs. 1.5 ± 0.6, p < 0.05). While Groups 1 and 2 had similar HbA1c values (7.7 ± 0.7 vs. 7.70 ± 0.6 %; p = 0.79) and activity levels (2.2 ± 0.6 vs. 2.2 ± 0.7; p = 0.15), Group 2 had higher rates of hypoglycemic episodes (1.0 ± 0.4 vs. 1.5 ± 0.9, p < 0.01).ConclusionExcess weight gain was associated with lower bolus to basal insulin ratios independent of glycemic control and activity level. Evaluation of bolus and basal insulin doses during insulin therapy is warranted in order to avoid excess weight gain.Electronic supplementary materialThe online version of this article (doi:10.1186/s40200-016-0271-5) contains supplementary material, which is available to authorized users.

Non‐severe hypoglycaemia is associated with weight gain in patients with type 1 diabetes: Results from the Diabetes Control and Complication Trial

“…Jacob et al found no significant correlation between the frequency of non‐severe hypoglycaemic episodes and weight gain in 21 subjects with T1D with a baseline HbA1c of 10%; however, the short follow‐up period of 6 months and the small sample size were clear limitations . Consistent with our results, a recent study on 1‐year insulin pump therapy in T1D showed that the cohort that gained more weight during follow‐up reported more frequent episodes of non‐severe hypoglycaemia …”

Obesity and diabetes—Not only a simple link between two epidemics

“…A 1‐year‐long observation of 91 patients, who started insulin pump treatment, revealed increased weight gain in case of higher basal rate and lower bolus to basal insulin ratios. This result was independent from glycaemic control as well as physical activity level …”

Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps

“…The amount of insulin needed to maintain glycemic control increases in puberty [6] and with longer T1D duration and older age [7]. The DCCT—Epidemiology of Diabetes Interventions and Complications (EDIC) study also demonstrated that increased insulin needs are associated with more T1D complications [8, 9] and weight gain and higher weight status across time in individuals with T1D [10–12, 13••] because of the anabolic and lipogenic actions of insulin [14]. These findings further highlight the need to decrease insulin needs, which can be accomplished through engagement in physical activity [15].…”

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