Insulin doses requirements in patients with type 1 diabetes using glargine U300 or degludec in routine clinical practice

There are not many real-world studies evaluating daily insulin doses requirements (DIDR) in patients with type 1 diabetes (T1D) using second-generation basal insulin analogs, and such comparison is necessary. The aim of this study was to compare DIDR in individuals with T1D using glargine 300 UI/mL (IGlar-300) or degludec (IDeg) in real clinical practice. An observational, retrospective study was designed in 412 patients with T1D (males: 52%; median age 37.0±13.4 years, diabetes duration: 18.7±12.3 years) using IDeg and IGla-300 ≥6 months to compare DIDR between groups. Patients using IGla-300 (n=187) were more frequently males (59% vs 45.8%; p=0.004) and had lower glycosylated hemoglobin (HbA1c) (7.6±1.2 vs 8.1%±1.5%; p<0.001) than patients using IDeg (n=225). Total (0.77±0.36 unit/kg/day), basal (0.43±0.20 unit/kg/day) and prandial (0.33±0.23 unit/kg/day) DIDR were similar in IGla-300 and IDeg groups. Patients with HbA1c ≤7% (n=113) used significantly lower basal (p=0.045) and total (p=0.024) DIDR, but not prandial insulin (p=0.241), than patients with HbA1c between 7.1% and 8% and >8%. Patients using IGla-300 and IDeg used similar basal, prandial and total DIDR regardless of metabolic control subgroup. No difference in basal, prandial and total DIDR was observed between patients with T1D using IGla-300 or IDeg during at least 6 months in routine clinical practice.

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A multicentre, UK, retrospective, observational study to assess the effectiveness of insulin glargine 300 units/ml in treating people with Type 1 diabetes mellitus in routine clinical practice (SPARTA)

Diabetic Medicine ◽

10.1111/dme.13847 ◽

2018 ◽

Vol 36 (1) ◽

pp. 110-119 ◽

Cited By ~ 3

Author(s):

T. Pang ◽

S. C. Bain ◽

R. Neil A. Black ◽

J. G. Boyle ◽

J. Elliott ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Clinical Practice ◽

Observational Study ◽

Insulin Glargine ◽

Type 1 Diabetes Mellitus ◽

Routine Clinical Practice ◽

Retrospective Observational Study

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Predicting the Effectiveness of Insulin Pump Therapy on Glycemic Control in Clinical Practice: A Retrospective Study of Patients with Type 1 Diabetes from 10 Outpatient Diabetes Clinics in Sweden over 5 Years

Diabetes Technology & Therapeutics ◽

10.1089/dia.2014.0139 ◽

2015 ◽

Vol 17 (1) ◽

pp. 21-28 ◽

Cited By ~ 15

Author(s):

Mark Clements ◽

Viktorija Matuleviciene ◽

Stig Attvall ◽

Magnus Ekelund ◽

Aldina Pivodic ◽

...

Keyword(s):

Type 1 Diabetes ◽

Clinical Practice ◽

Retrospective Study ◽

Glycemic Control ◽

Insulin Pump ◽

Insulin Pump Therapy ◽

Pump Therapy

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Serum Insulin Bioassay Reflects Insulin Sensitivity and Requirements in Type 1 Diabetes

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2017-00892 ◽

2017 ◽

Vol 102 (10) ◽

pp. 3814-3821 ◽

Cited By ~ 2

Author(s):

Joseph A M J L Janssen ◽

Gemma Llauradó ◽

Aimee J Varewijck ◽

Per-Henrik Groop ◽

Carol Forsblom ◽

...

Keyword(s):

Insulin Resistance ◽

Type 1 Diabetes ◽

Insulin Sensitivity ◽

Serum Insulin ◽

Glycosylated Hemoglobin ◽

Insulin Dose ◽

Biologically Active ◽

Insulin Analogs ◽

Insulin Requirements

Abstract Context Insulin resistance could increase insulin requirements in type 1 diabetes (T1D). Current insulin immunoassays do not detect insulin analogs. Kinase insulin receptor (IR) activation (KIRA) bioassays specific for human IR isoforms A (IR-A) and B (IR-B) permit assessment of all circulating insulin bioactivity. We studied whether IR-A and IR-B KIRA assays are related to direct measures of insulin sensitivity or insulin doses in T1D. Design We evaluated 31 adult patients with T1D (age 45.7 ± 1.6 years, body mass index 28.8 ± 0.7 kg/m2). Serum IR-A and IR-B bioactivities were measured by KIRA bioassays. Insulin sensitivity of glucose production (Ra) was measured by the euglycemic hyperinsulinemic clamp technique in which a low insulin dose (0.4 mU/kg/min for 240 minutes) was combined with D-[3-3H] glucose infusion to measure rates of Ra and utilization and insulin action on antilipolysis from suppression of serum free fatty acids. Results Baseline circulating IR-A bioactivity was 53 ± 7 pmol/L, and IR-B bioactivity was 81 ± 11 pmol/L. Compared with baseline, insulin infusion significantly increased IR-A (P < 0.001) and IR-B (P < 0.001) bioactivities. Fasting IR-A and IR-B bioactivities were positively related to endogenous Ra (r = 0.44, P = 0.01 and r = 0.38, P < 0.05). Fasting IR-A (r = 0.43, P = 0.02) and IR-B (r = 0.47, P = 0.01) bioactivities were significantly correlated with insulin requirements and glycosylated hemoglobin (IR-A: r = 0.52, P = 0.002; IR-B: r = 0.48, P = 0.006). Conclusions Circulating IR-A and IR-B bioactivities are associated with insulin resistance, high insulin requirements, and poor glycemic control in T1D. Measurement of IR bioactivity by KIRA assays provides a tool to assess the amount of biologically active insulin in groups of T1D patients treated with insulin analogs.

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