Basal Insulin Requirement Is  30% of the Total Daily Insulin Dose in Type 1 Diabetic Patients Who Use the Insulin Pump

Abstract Background: SGLT2 inhibitor combined with insulin therapy is a novel therapy for patients with type 1 diabetes mellitus. Without the reduction of basal insulin, hypoglycemia could occur frequently in this therapy. But diabetic ketoacidosis is an undesirable adverse effect in case with basal insulin reduction. The aim of this study is to explore whether the reduction of the basal insulin dose combined with SGLT2 inhibitor in patients with type 1 diabetes mellitus can reduce the frequency of hypoglycemia and be used safely. We hypothesized that with an adequate basal insulin dose, the frequency of hypoglycemia is higher if the basal insulin dose is not reduced when combined with SGLT2 inhibitor.Methods and Analysis: The study has a two-arm design; 60 subjects with type 1 diabetes mellitus are being recruited from 7 hospitals. The basal insulin dose before the start of the SGLT2 inhibitor combination therapy is the reference. Study subjects are stratified into two groups based on the ratio of basal insulin daily dose (Basal) to total daily insulin dose (TDD). The subjects are instructed to reduce the basal insulin dose by 10% or 0% for Basal to TDD ratio of <0.4 and > 0.4, respectively.The primary outcome is the frequency of hypoglycemia per day during the intervention period (administration of SGLT2 inhibitor) as determined by self-monitoring of blood glucose (SMBG). The secondary outcome is the frequency of ketosis before and after the intervention. Discussion: 10% basal insulin reduction could reduce hypoglycemia as well as could not increase ketosis in case that the ratio of basal insulin daily dose to total daily insulin dose is 0.4 or higher, which improve the efficacy and safety of SGLT2 inhibitor treatment patients with type 1 diabetes mellitus.Ethics and Dissemination: The study was approved by Kyoto Prefectural University of Medicine, Clinical Research Review Board (CRB5180001). The results will be disseminated through presentations at appropriate conferences and meetings, and published in peer-reviewed journals.Trial registration: Registered with Japan Registry of Clinical Trials (jRCTs051190114) on 2 March, 2020. https://rctportal.niph.go.jp/detail/jr?trial_id=jRCTs051190114)

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Carbohydrate-to-Insulin Ratio Is Estimated from 300–400 Divided by Total Daily Insulin Dose in Type 1 Diabetes Patients Who Use the Insulin Pump

Diabetes Technology & Therapeutics ◽

10.1089/dia.2012.0109 ◽

2012 ◽

Vol 14 (11) ◽

pp. 1077-1080 ◽

Cited By ~ 6

Author(s):

Akio Kuroda ◽

Tetsuyuki Yasuda ◽

Mitsuyoshi Takahara ◽

Fumie Sakamoto ◽

Ryuichi Kasami ◽

...

Keyword(s):

Type 1 Diabetes ◽

Insulin Pump ◽

Insulin Dose ◽

Daily Insulin ◽

Daily Insulin Dose ◽

Diabetes Patients

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Correlations of cholecalciferol-levels, daily insulin dose and clinical features in patients with Type 1 diabetes mellitus

Diabetologie und Stoffwechsel ◽

10.1055/s-0033-1341860 ◽

2013 ◽

Vol 8 (S 01) ◽

Author(s):

D Bogdanou ◽

M Penna-Martinez ◽

F Shioghi ◽

M Sandler ◽

K Badenhoop

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Clinical Features ◽

Insulin Dose ◽

Daily Insulin ◽

Daily Insulin Dose

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Are fast insulin analogues fast enough? Switching to faster aspart may reduce glycemic variability and the risk of hypoglycemia in type 1 diabetic patients on sensor-augmented insulin pump therapy

Endocrine Abstracts ◽

10.1530/endoabs.63.p971 ◽

2019 ◽

Author(s):

Manuel Esteban Nivelo-Rivadeneira ◽

Agnieszka Kuzior ◽

Paula Maria Fernandez-Trujillo-Comenge ◽

Ana Delia Santana-Suarez ◽

Carmen Acosta-Calero ◽

...

Keyword(s):

Insulin Pump ◽

Glycemic Variability ◽

Insulin Analogues ◽

Insulin Pump Therapy ◽

Diabetic Patients ◽

Pump Therapy ◽

Type 1 Diabetic Patients ◽

Fast Insulin

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Partial remission in children and adolescents with type 1 diabetes: an analysis based on the insulin dose-adjusted hemoglobin A1c

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0048 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Emine Ayça Cimbek ◽

Aydın Bozkır ◽

Deniz Usta ◽

Nazım Ercüment Beyhun ◽

Ayşenur Ökten ◽

...

Keyword(s):

Type 1 Diabetes ◽

Partial Remission ◽

Hemoglobin A1c ◽

Insulin Dose ◽

Age At Onset ◽

Insulin Requirement ◽

C Peptide ◽

Factors Associated ◽

Daily Insulin

Abstract Objectives Most patients with type 1 diabetes (T1D) experience a transient phase of partial remission (PR). This study aimed to identify the demographic and clinical factors associated with PR. Methods This was a longitudinal retrospective cohort study of 133 children and adolescents with T1D. PR was defined by the gold standard insulin dose-adjusted hemoglobin A1c (HbA1c) (IDAA1c) of ≤9. Results Remission was observed in 77 (57.9%) patients. At diagnosis, remitters had significantly higher pH (7.3 ± 0.12 vs. 7.23 ± 0.15, p=0.003), higher C-peptide levels (0.45 ± 0.31 ng/mL vs. 0.3 ± 0.22, p=0.003), and they were significantly older (9.3 ± 3.6 years vs. 7.3 ± 4.2, p=0.008) compared with non-remitters. PR developed more frequently in patients without diabetic ketoacidosis (DKA) (p=0.026) and with disease onset after age 5 (p=0.001). Patients using multiple daily insulin regimen were more likely to experience PR than those treated with a twice daily regimen (63.9 vs. 32%, p=0.004). Only age at onset was an independent predictor of PR (OR: 1.12, 95% CI: 1-1.25; p=0.044). Remitters had lower HbA1c levels and daily insulin requirement from diagnosis until one year after diagnosis (p<0.001). PR recurred in 7 (9%) patients. The daily insulin requirement at three months was lower in remitters with PR recurrence compared to those without (0.23 ± 0.14 vs. 0.4 ± 0.17 U/kg/day, p=0.014). Conclusions Addressing factors associated with the occurrence of PR could provide a better comprehension of metabolic control in T1D. The lack of DKA and higher C-peptide levels may influence PR, but the main factor associated with PR presence was older age at onset. PR may recur in a small proportion of patients.

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