Lower dose basal insulin infusion has positive effect on glycaemic control for children with type I diabetes on continuous subcutaneous insulin infusion therapy

Schulten, Ron J; Piet, Jessica; Bruijning, Patricia; Waal, Wouter J. de

doi:10.1111/pedi.12352

Cited by 11 publications

(10 citation statements)

References 24 publications

(37 reference statements)

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“…Most diabetes guidelines recommend that the BI rate should be programmed in hourly intervals, according to the patient's circadian variation of insulin requirement [ 16 ] and based on their individual fasting tests over a period of 6–10 h [ 14 ]. They also suggest that a %BI range of between 30% and 50% should be used [ 1 – 5 , 15 , 17 ]. We found that while this recommendation on %BI was followed in more than two-third of patients with T1DM, there was a substantial proportion of individuals using a %BI outside the recommended range.…”

Section: Discussionmentioning

confidence: 99%

“…Continuous subcutaneous insulin infusion (CSII) therapy by insulin pumps has become a widely used treatment in patients with type 1 diabetes mellitus (TIDM). CSII is currently the most physiological method of insulin delivery available [ 1 ]. This mode of insulin therapy includes two components: basal insulin (BI) infusion that mimics physiological hormone secretion during the night and between meals, and boluses of insulin substituting acute postprandial insulin secretion [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The proper BI dosing is crucial for achieving glycemic control [ 1 , 13 ]. Some studies suggest that BI rate variability might be associated with severe hypoglycemic episodes or even with chronic diabetic complications [ 8 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, both daily basal insulin requirement and circadian profile have been shown to be age-specific in patients with T1DM [ 15 ]. In addition, lower BI infusion was associated with a decreased HbA1c level in pediatric patients with T1DM [ 1 , 13 ], although there are currently only limited data confirming this observation in adult patients. Similarly, the diurnal BI rate profile also remains insufficiently defined in adult patients with T1DM.…”

Section: Introductionmentioning

confidence: 99%

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Basal Insulin Dose in Adults with Type 1 Diabetes Mellitus on Insulin Pumps in Real-Life Clinical Practice: A Single-Center Experience

Matejko

Kukułka

Kieć‐Wilk

et al. 2018

Advances in Medicine

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Introduction Basal insulin (BI) infusion in pump therapy of type 1 diabetes (T1DM) mimics physiological secretion during the night and between meals. The recommended percentage of the total BI to daily insulin dose (termed the %BI) ranges between 30 and 50%. We analyzed whether this recommendation was followed in adults with T1DM from a university center, and whether BI doses were linked with glycemic control. Materials and Methods We included 260 consecutive patients with T1DM (159 women and 101 men) treated with continuous subcutaneous insulin infusion at the Department of Metabolic Diseases, Krakow, Poland. Data were downloaded from patients' pumps and collected from medical records. We analyzed the settings of BI and the association of %BI with HbA1c level. Linear regression was performed. Results The mean age of T1DM individuals was 26.6 ± 8.2 years, BMI was 23.1 ± 3.0 kg/m2, T1DM duration was 13.3 ± 6.4 years, and HbA1c level was 7.4%. There were 69.6% (n=181) of T1DM patients with %BI in the recommended range. The T1DM duration and HbA1c level of patients with a %BI <30% (n=23) was 9.5 years and 6.4%, respectively; for a %BI of 30–50%, it was 13.2 years and 7.4%; and for a %BI >50% (n=56), it was 15.8 years and 7.8% (p < 0.001 for both three-group comparisons). Multiple regression identified %BI among independent predictors of the HbA1c level. Conclusion In this real-life analysis, the recommendations concerning %BI dosing were not followed by almost one-third of adult T1DM patients. Low %BI was associated with better glycemic control; however, this requires further confirmation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Basal Insulin Dose in Adults with Type 1 Diabetes Mellitus on Insulin Pumps in Real-Life Clinical Practice: A Single-Center Experience

Matejko

Kukułka

Kieć‐Wilk

et al. 2018

Advances in Medicine

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“…Shulten et al demonstrate that low‐dose basal insulin infusion as a percentage of total insulin dose has a positive effect on metabolic outcome as expressed in HbA1c levels. They confirm that a change of 10% in basal insulin dose results in a decrease or increase of HbA1c by 0.22% . This result is consistent with the research of Strich et al, who demonstrate a significant correlation between injection of less total daily basal insulin and lower HbA1c level.…”

Section: Discussionmentioning

confidence: 99%

Physiological factors influencing diabetes control in type 1 diabetes children with insulin pumps from diagnosis

Piechowiak

Szypowska

2018

Diabetes Metabolism Res

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Background The aim of this study was to identify the physiological factors influencing diabetes control in children with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) from diabetes diagnosis. Methods This study focused on 163 children (81 boys) initiated with CSII within 2 weeks after T1D recognition and treated for at least 3 years. We analysed fasting C‐peptide, GADA, ICA, IA2A, BMI z‐score, total daily dose, and basal insulin. Patients were divided into groups according to their metabolic control: 7.5% > HbA1c ≥ 7.5% at the end of the study. Results At the end of the follow‐up, patients with HbA1c <7.5%, had a lower HbA1c level at diagnosis (11.7% vs 12.6%; P = 0.018), lower HbA1c level at both the first‐year (6.7% vs 7.3%; P = 0.000) and the second‐year (6.8% vs.7.7%; P = 0.000) follow‐up, and a lower GADA level (P = 0.001). A multiple logistic regression analysis showed that HbA1c at diagnosis (P = 0.012), HbA1c at first year (P = 0.000), HbA1c at second year (P = 0.000), age at diagnosis (P = 0.047), GADA (P = 0.031), and basal insulin at third year (P = 0.032), influenced HbA1c <7.5% at the third year of follow‐up. At the end of the study, 76% of patients started with CSII at the age <10 years and 49% of subjects initiated with CSII at the age ≥10 years achieved HbA1c ≤7.5%. Conclusions This study shows that for those who initiated CSII at T1D onset, younger age, less intense autoimmune process, a low HbA1c at recognition, and good diabetes control during the first year of treatment were associated with long‐term optimal glycaemic control.

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Improvement of continuous subcutaneous insulin infusion on patients with type 2 diabetes mellitus by 3-dimensional speckle tracking echocardiography

Luo

Zhou

Kou

et al. 2017

Int J Cardiovasc Imaging

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Three-dimensional speckle tracking echocardiography (3D-STE) was used to evaluate the improvement of continuous subcutaneous insulin infusion on the left ventricular (LV) systolic function of patients with type 2 diabetes mellitu (T2DM). We recruited T2DM patients (38 cases, diabetic group) and healthy volunteers (35 cases, control group) to collect LV full volume imaging. TomTec software was used for calculating LV global longitudinal strain (LVGLS), global circumferential strain (LVGCS), peak twist (LVTW), peak apical rotation (LVPAR), ejection fraction (LVEF), and torsion (LVT). All indices were re-tested 2 weeks later after intensive treatment of insulin pump. LVGLS, LVGCS, LVTW and LVPAR in diabetic group were significantly decreased than control group. LVGLS and LVGCS in pre-treatment diabetic group were significantly increased than post-treatment. LVGLS, LVGCS, LVTW and LVPAR had correlations among control, pre-treatment and post-treatment diabetic groups. There were no significant differences in LVEDV, LVESV, LVEF, LVT and R-R. LV systolic function of patients with T2DM complicated with microangiopathy was improved after treatment of continuous subcutaneous insulin infusion. In addition, therapeutic effect could be accurately evaluated by 3D-STE which had vital clinical application.

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Lower dose basal insulin infusion has positive effect on glycaemic control for children with type I diabetes on continuous subcutaneous insulin infusion therapy

Cited by 11 publications

References 24 publications

Basal Insulin Dose in Adults with Type 1 Diabetes Mellitus on Insulin Pumps in Real-Life Clinical Practice: A Single-Center Experience

Basal Insulin Dose in Adults with Type 1 Diabetes Mellitus on Insulin Pumps in Real-Life Clinical Practice: A Single-Center Experience

Physiological factors influencing diabetes control in type 1 diabetes children with insulin pumps from diagnosis

Improvement of continuous subcutaneous insulin infusion on patients with type 2 diabetes mellitus by 3-dimensional speckle tracking echocardiography

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