Insulin treatment intensification to basal-bolus in diabetic patients
Juan Garcia-Quiros, Monica Tome, Ignacio Fernandez, Clara Garcia, Cristobal Morales, Isabel Serrano & Angel Sendon
Objectives: To valuate the insulin treatment intensification efficacy (from three premixed insulin doses to basal-bolus therapy) in type 1 and 2 diabetic patients wrongly controlled.
Material and methods: The 61 patients were included. 29 (47.5%) type 1 diabetes mellitus (DM) and 32 (52.5%) type 2 DM, attended in the Day Diabetes Hospital (DDH) during 2008. 50.8% were females and 49.2% were males. Mean age was 34.2±14.4 in type1 DM and 63.6±8.6 in type 2 DM. Illness mean duration was 15.6 years in type 1 DM and 17.0 years in type 2 DM.
HbA1c was analyzed before and 2 months after the new treatment. Other issues studied were weight, insulin doses, mean glycemia and glycemic variability. The insulin treatment intensification meant to change from three premixed insulin doses to basal-bolus therapy. All patients were re-educated on their condition. Data were analyzed with a Wilcoxon test for related data using SPSS version 15.0.
Results: In type 1 DM there was a reduction in the mean HbA1c of 1.94±1.1% (from 9.94±2.14 to 8.0±1.4%; P<0.01), an improvement in the mean glycemia (from 194.1 to 172.9 mg/dl; P<0.01) and in the glycemic variability (from 79.73 to 76.60; P<0.01). There was a light increase on weight (from 79.3 to 79.4 kg) and insulin doses (0.76±0.2 to 0.83±0.2 UI/kg) non statistically relevant.
In type 2 DM there was an improvement in HbA1c of 1.45±1.26% (from 9.26±1.0 to 7.8±1.3%; P<0.01), mean glycemia (from 224.1 to 184.7 mg/dl; P<0.01) and glycemic variability (from 63.5 to 54.9; NS). Weight worsened (from 78.9 to 79.9 kg; NS). There was also an increase in insulin requirements (from 0.92±0.4 to 1.6±1.1 UI/kg; P<0.01).
Patients whose HbA1c before treatment intensification was under 8% had a modification from 7.45±0.6 to 7.12±1.2% (NS), patients whose HbA1c before the new treatment was between 8 and 10% changed from 9.03±0.5 to 7.38±1.0% (P<0.05) and those whose initial HbA1c was over 10% improved from 11.26±1.4 to 8.8±1.2%.
Conclusions: Insulin treatment intensification to basal-bolus therapy in non controlled diabetic patients showed a significant improvement in HbA1c.
HbA1c values improved more in those patients whith higher initial levels.
There was a weight gain but non statistically significant.