Basal insulin dose in 40 type 1 diabetic patients remains stable 1 year after educational training in flexible insulin therapy

• Published in: Diabetes & metabolism 2010-11, Vol.36 (5), p.369-374
• Main Authors: Benhamou, P.-Y, Garnier, C, Debaty, I, Rueff, A, Gilbert, C, Ressel, M, Siaud, C, Boudrot, E, Carpentier, B, Boizel, R, Nasse, L, Halimi, S
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Basal insulin; Biological and medical sciences; Blood Glucose Self-Monitoring; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 1 - drug therapy; Diabetes. Impaired glucose tolerance; Diabète de type 1; Endocrine pancreas. Apud cells (diseases); Endocrinology & Metabolism; Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Flexible insulin therapy; Food; Glycated Hemoglobin A - analysis; Humans; Hypoglycemia - epidemiology; Insulin - administration & dosage; Insuline basale; Insulinothérapie fonctionnelle; Internal Medicine; Male; Medical sciences; Middle Aged; Patient Education as Topic; Retrospective Studies; Self Administration - methods; Therapeutic education; Type 1 diabetes; Weight Gain; Éducation thérapeutique
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2010.03.006

Abstract Aim Basal insulin dose (BID) determination is the key to successful flexible insulin therapy (FIT). As our hypothesis was that BID changes over time, the primary objective of the present study was to determine the changes in BID 1 year after a therapeutic educational programme on FIT. Methods This single-centre retrospective study recruited the first 40 type 1 adult diabetic patients undergoing an educational FIT programme, which was conducted over a 4-day hospital stay and included a carbohydrate-fasting test. Results Patients’ BIDs decreased between Day 0 and Day 4 after the programme (0.31 ± 0.11 IU/kg/day vs 0.27 ± 0.09 IU/kg/day; P < 0.0001), and was increased at 1 year (0.29 ± 0.09 IU/kg/day; P = 0.004). There was no significant variation in prandial insulin requirements. A tendency toward a reduction in HbA1c was observed at 1 year (8.3 ± 1.4% vs 8.1 ± 1.6%; P = 0.075), with a decrease by more than 0.5% in 37.5% of patients. Body weight increased at 1 year (66.9 ± 10.4 kg vs 68.1 ± 10.7 kg; P = 0.003), and the gain was greater than 5% in 7.5% of patients. Frequency of mild hypoglycaemia either remained stable (40%) or decreased (30%). Only nine patients (baseline HbA1c 8.03 ± 1.7%, baseline BID 0.27 ± 0.09 IU/kg/day) had BID increases more than 20%, with no changes in prandial insulin requirements and no distinctive phenotype. Baseline HbA1c , and BID have an impact on the BID at 1 year of approximately 0.3 IU/kg/day in most patients. Conclusion The stability of BID over 1 year, with values close to 0.3 IU/kg/day associated with a trend towards improvement in HbA1c , reduction in the frequency of mild hypoglycaemic episodes and absence of major weight gain, supports the relevance of FIT educational training.