Endocrine Abstracts

Introduction: Glycemic control in type 2 diabetics on insulin is a real therapeutic challenge. The aim of this study was to determine the clinical profile of type 2 diabetic patients on high doses of insulin and to assess their glycemic control after a reduction in insulin doses.

Method: It was a prospective study conducted in the Diabetology Department of the National Institute of Nutrition in Tunis with type 2 diabetic patients (T2DM) hospitalized on a high dose of insulin (≧ 0.5 IU/kg/d). Insulin dose reduction and dietary education were performed in all patients included in the study. Insulin doses were subsequently adjusted according to pre- and postprandial capillary blood glucose levels.

Results: We included 48 patients with a mean age of 59±11 years [22;78] and a sex ratio (M/F) of 0.37. The mean age of diabetes was 19±8 years. The mean time of permanent insulin therapy initiation was 12±8 years. Metformin was prescribed in 56% of T2DM patients. Poor adherence to dietary rules was found in the majority of T2DM patients (91%), most of whom were sedentary (82%). Obesity was present in 67% of diabetics: it was abdominal in 75% of cases. Hypertension, dyslipidaemia and hypothyroidism affected 67%, 81% and 19% of diabetics, respectively. The mean glycated haemoglobin level was 10.4±1.9%. The mean insulin dose at admission was 1.14±0.26 IU/kg [0.8;2.21]. A mean rate of insulin dose reduction was 30.6±14.2%. At the end of the hospitalization period: a statistically significant decrease in preprandial (P=0.007) and postprandial (P=0.002) blood glucose levels was noted.

Conclusion: Insulin overdose is common in insulin-requiring type 2 diabetics without any real benefit for glycemic control, but with a risk of aggravating the often present overweight.