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. 2015 Aug;32(8):1071-6.
doi: 10.1111/dme.12806. Epub 2015 May 28.

Twice- rather than once-daily basal insulin is associated with better glycaemic control in Type 1 diabetes mellitus 12 months after skills-based structured education in insulin self-management

H E Hopkinson  1 , R M Jacques  2 , K J Gardner  3 , S A Amiel  4 , P Mansell  5
Affiliations

Twice- rather than once-daily basal insulin is associated with better glycaemic control in Type 1 diabetes mellitus 12 months after skills-based structured education in insulin self-management

H E Hopkinson et al. Diabet Med. 2015 Aug.

Abstract

Aim: This study investigates the relationship between basal insulin regimen and glycaemic outcomes 12 months after skills-based structured education in the UK Dose Adjustment for Normal Eating (DAFNE) programme for Type 1 diabetes mellitus.

Method: Retrospective analysis of data from 892 DAFNE participants from 11 UK centres.

Results: Mean HbA1c 12 months after DAFNE was lower in those using twice- rather than once-daily basal insulin after correcting for differences in baseline HbA1c , age and duration of diabetes; difference -2 (95% CI -3 to -1) mmol/mol [-0.2 (-0.3 to -0.1)%], P = 0.009. The greatest fall in HbA1c of -5 (-7 to -3) mmol/mol [-0.4 (-0.6 to -0.3)%], P < 0.001 occurred in those with less good baseline control, HbA1c ≥ 58 mmol/mol, who switched from once- to twice-daily basal insulin. There was no difference in the 12-month HbA1c between users of glargine, detemir and NPH insulin after correcting for other variables. Relative risk of severe hypoglycaemia fell by 76% and ketoacidosis by 63% 12 months after DAFNE. The rate of severe hypoglycaemia fell from 0.82 to 0.23 events/patient year in twice-daily basal insulin users. In the group with greatest fall in HbA1c , the estimated relative risk for severe hypoglycaemia in twice-daily basal insulin users versus once daily at 12 months was 1.72 (0.88-3.36, P = 0.110).

Conclusion: After structured education in adults with Type 1 diabetes mellitus, use of basal insulin twice rather than once daily was associated with lower HbA1c , independent of insulin type, with significant reductions in severe hypoglycaemia and ketoacidosis in all groups.

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Figures

Figure 1
Figure 1
Mean HbA1c at baseline and 12 months after structured education in DAFNE shown for the reduced cohort (baseline HbA1c ≥ 58 mmol/mol, ≥ 7.5%) and subgroups of participants analysed according to basal insulin regimen at 12 months, with 95% confidence intervals and P values derived from paired t‐tests. The 12‐month HbA1c is significantly lower than baseline in all subgroups.
See this image and copyright information in PMC

References

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