Insulin requirement profiles in Japanese hospitalized subjects with type 2 diabetes treated with basal-bolus insulin therapy

• Published in: Endocrine Journal Vol. 62; no. 2; pp. 209 - 216
• Main Authors: Shimoda, Seiya, Okubo, Mina, Koga, Kotaro, Sekigami, Taiji, Kawashima, Junji, Kukidome, Daisuke, Igata, Motoyuki, Ishii, Norio, Shimakawa, Akiko, Matsumura, Takeshi, Motoshima, Hiroyuki, Furukawa, Noboru, Nishida, Kenro, Araki, Eiichi
• Format: Journal Article
• Language: English
• Published: Japan The Japan Endocrine Society 2015
• Subjects: Aged; Basal-bolus insulin therapy (BBT); Basal/total daily insulin ratio (B/TD ratio); Blood Glucose - analysis; Combined Modality Therapy; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diet therapy; Diabetes Mellitus, Type 2 - drug therapy; Diet, Diabetic; Drug Administration Schedule; Drug Therapy, Combination - adverse effects; Female; Glycated Hemoglobin A - analysis; Hospitalization; Humans; Hyperglycemia - prevention & control; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Insulin Resistance; Insulin, Long-Acting - administration & dosage; Insulin, Long-Acting - adverse effects; Insulin, Long-Acting - therapeutic use; Insulin, Short-Acting - administration & dosage; Insulin, Short-Acting - adverse effects; Insulin, Short-Acting - therapeutic use; Japan - epidemiology; Male; Middle Aged; Retrospective Studies; Risk; Total daily insulin dose (TDD)
• ISSN: 0918-8959; 1348-4540
• DOI: 10.1507/endocrj.EJ14-0487

To assess the total daily inulin dose (TDD) and contribution of basal insulin to TDD and to identify the predictive factors for insulin requirement profiles in subjects with type 2 diabetes, we retrospectively examined insulin requirement profiles of 275 hospitalized subjects treated with basal-bolus insulin therapy (BBT) (mean age, 60.1 ± 12.9 years; HbA1c, 10.2 ± 4.5%). Target plasma glucose level was set between 80 and 129 mg/dL before breakfast and between 80 and 179 mg/dL at 2-hour after each meal without causing hypoglycemia. We also analyzed the relationship between the insulin requirement profiles (TDD and basal/total daily insulin ratio [B/TD ratio]) and insulin-associated clinical parameters. The mean TDD was 0.463 ± 0.190 unit/kg/day (range, 0.16-1.13 unit/kg/day). The mean B/TD ratio was 0.300 ± 0.099 (range, 0.091-0.667). A positive correlation of TDD with B/TD ratio was revealed by linear regression analysis (r=0.129, p=0.03). Stepwise multiple regression analysis identified post-breakfast glucose levels before titrating insulin as an independent determinant of the insulin requirement profile [Std β (standard regression coefficient) = 0.228, p<0.01 for TDD, Std β = -0.189, p<0.01 for B/TD ratio]. The TDD was <0.6 unit/kg/day and the B/TD ratio was <0.4 in the majority (70.2%) of subjects in the present study. These findings may have relevance in improving glycemic control and decreasing the risk of hypoglycemia and weight gain in subjects with type 2 diabetes treated with BBT.