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Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus

Optimal glycemic control is required to lower the risk of complications in type 1 diabetes mellitus (T1DM). This can be achieved with multiple daily insulin injections (MDI) or with continuous subcutaneous insulin infusion (CSII). Most diabetes guidelines recommend a proportion of basal insulin (bas...

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Autores principales: Pozos-Varela, Francisco Javier, Mena-Ureta, Tania Sofía, Lam-Chung, César Ernesto, Ibarra-Salce, Raúl, Martínez-Zavala, Néstor, Janka-Zires, Marcela, Almeda-Valdes, Paloma
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089725/
http://dx.doi.org/10.1210/jendso/bvab048.942
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author Pozos-Varela, Francisco Javier
Mena-Ureta, Tania Sofía
Lam-Chung, César Ernesto
Ibarra-Salce, Raúl
Martínez-Zavala, Néstor
Janka-Zires, Marcela
Almeda-Valdes, Paloma
author_facet Pozos-Varela, Francisco Javier
Mena-Ureta, Tania Sofía
Lam-Chung, César Ernesto
Ibarra-Salce, Raúl
Martínez-Zavala, Néstor
Janka-Zires, Marcela
Almeda-Valdes, Paloma
author_sort Pozos-Varela, Francisco Javier
collection PubMed
description Optimal glycemic control is required to lower the risk of complications in type 1 diabetes mellitus (T1DM). This can be achieved with multiple daily insulin injections (MDI) or with continuous subcutaneous insulin infusion (CSII). Most diabetes guidelines recommend a proportion of basal insulin (basal proportion of total insulin dose; %B/T) around 50% of the total daily dose (TDD), although there is scarce evidence that suggests that a lower %B/T is associated with lower HbA1c levels. Our objective was to evaluate the association of the %B/T with glycemic and microvascular outcomes. We included 132 T1DM adults of the Diabetes Clinic in a tertiary care center, 117 (88.6%) using MDI and 15 (11.4%) using CSII. Data from the medical records and insulin pumps software during outpatient visits were retrospectively collected. Individuals with end-stage renal disease, solid-organ transplant, pregnancy, and glucocorticoid use were excluded. A positive correlation between %B/T and HbA1c levels was found, r=0.26 (p=0.002). Three groups were analyzed according to the %B/T: ≤40%, 41–59% and ≥60%, observing differences in HbA1c concentrations: 7.1% (6.7–8.0%), 7.8% (7.2–9.1%) and 8.7% (7.6–10.2%), respectively (p=0.003). Regarding microvascular complications, the cases of nephropathy were 0 (0%), 23 (30.7%) and 18 (40%) across those groups (p=0.029) even though there was no difference in T1DM duration across groups. There were also no differences in body mass index, TDD, TDD/weight (units/kg/day), nor in the rates of retinopathy or neuropathy. Multiple regression analysis identified %B/T as an independent predictor of the HbA1c concentration. A difference in the rates of hypoglycemic episodes per month was found among individuals with a %B/T ≤50%: 2 (1–5) versus 6 (2.5–12) episodes per month in those having a higher %BT (p=0.002). There are limitations in our study, including the retrospective nature of the analysis, no data about meal content and a low usage of CGM (thus relying on variable self-monitoring of blood glucose). Therefore, we cannot asseverate that lowering the %B/T would improve glycemic and microvascular outcomes. Nevertheless, our findings indicate that the %B/T correlates with HbA1c levels and are consistent with those previously described. It also suggests a relationship with hypoglycemia and to the best of our knowledge, it is the first time that an association between %B/T and nephropathy has been noted.
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spelling pubmed-80897252021-05-06 Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus Pozos-Varela, Francisco Javier Mena-Ureta, Tania Sofía Lam-Chung, César Ernesto Ibarra-Salce, Raúl Martínez-Zavala, Néstor Janka-Zires, Marcela Almeda-Valdes, Paloma J Endocr Soc Diabetes Mellitus and Glucose Metabolism Optimal glycemic control is required to lower the risk of complications in type 1 diabetes mellitus (T1DM). This can be achieved with multiple daily insulin injections (MDI) or with continuous subcutaneous insulin infusion (CSII). Most diabetes guidelines recommend a proportion of basal insulin (basal proportion of total insulin dose; %B/T) around 50% of the total daily dose (TDD), although there is scarce evidence that suggests that a lower %B/T is associated with lower HbA1c levels. Our objective was to evaluate the association of the %B/T with glycemic and microvascular outcomes. We included 132 T1DM adults of the Diabetes Clinic in a tertiary care center, 117 (88.6%) using MDI and 15 (11.4%) using CSII. Data from the medical records and insulin pumps software during outpatient visits were retrospectively collected. Individuals with end-stage renal disease, solid-organ transplant, pregnancy, and glucocorticoid use were excluded. A positive correlation between %B/T and HbA1c levels was found, r=0.26 (p=0.002). Three groups were analyzed according to the %B/T: ≤40%, 41–59% and ≥60%, observing differences in HbA1c concentrations: 7.1% (6.7–8.0%), 7.8% (7.2–9.1%) and 8.7% (7.6–10.2%), respectively (p=0.003). Regarding microvascular complications, the cases of nephropathy were 0 (0%), 23 (30.7%) and 18 (40%) across those groups (p=0.029) even though there was no difference in T1DM duration across groups. There were also no differences in body mass index, TDD, TDD/weight (units/kg/day), nor in the rates of retinopathy or neuropathy. Multiple regression analysis identified %B/T as an independent predictor of the HbA1c concentration. A difference in the rates of hypoglycemic episodes per month was found among individuals with a %B/T ≤50%: 2 (1–5) versus 6 (2.5–12) episodes per month in those having a higher %BT (p=0.002). There are limitations in our study, including the retrospective nature of the analysis, no data about meal content and a low usage of CGM (thus relying on variable self-monitoring of blood glucose). Therefore, we cannot asseverate that lowering the %B/T would improve glycemic and microvascular outcomes. Nevertheless, our findings indicate that the %B/T correlates with HbA1c levels and are consistent with those previously described. It also suggests a relationship with hypoglycemia and to the best of our knowledge, it is the first time that an association between %B/T and nephropathy has been noted. Oxford University Press 2021-05-03 /pmc/articles/PMC8089725/ http://dx.doi.org/10.1210/jendso/bvab048.942 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Diabetes Mellitus and Glucose Metabolism
Pozos-Varela, Francisco Javier
Mena-Ureta, Tania Sofía
Lam-Chung, César Ernesto
Ibarra-Salce, Raúl
Martínez-Zavala, Néstor
Janka-Zires, Marcela
Almeda-Valdes, Paloma
Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus
title Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus
title_full Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus
title_fullStr Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus
title_full_unstemmed Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus
title_short Reconsidering the Basal Proportion of Insulin Dose: Glycemic and Microvascular Outcomes in Type 1 Diabetes Mellitus
title_sort reconsidering the basal proportion of insulin dose: glycemic and microvascular outcomes in type 1 diabetes mellitus
topic Diabetes Mellitus and Glucose Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089725/
http://dx.doi.org/10.1210/jendso/bvab048.942
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