Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 1;17(2):393-399.
doi: 10.1007/s40200-018-0358-2. eCollection 2018 Dec.

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen

Elena Castellano  1 , R Attanasio  2 , V A Giagulli  3 , A Boriano  4 , M Terzolo  5 , E Papini  6 , E Guastamacchia  7 , S Monti  8 , A Aglialoro  9 , D Agrimi  10 , E Ansaldi  11 , A C Babini  12 , A Blatto  13 , D Brancato  14 , C Casile  15 , S Cassibba  16 , C Crescenti  17 , M L De Feo  18 , A Del Prete  19 , O Disoteo  20 , F Ermetici  21 , V Fiore  22 , A Fusco  23 , D Gioia  24 , A Grassi  25 , D Gullo  26 , F Lo Pomo  27 , A Miceli  15 , M Nizzoli  28 , M Pellegrino  1 , B Pirali  29 , C Santini  30 , S Settembrini  31 , E Tortato  32 , V Triggiani  7 , A Vacirca  33 , G Borretta  1 ; all on behalf of Associazione Medici Endocrinologi (AME)
Affiliations

The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen

Elena Castellano et al. J Diabetes Metab Disord. .

Erratum in

  • Correction to: The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.
    Castellano E, Attanasio R, Giagulli VA, Boriano A, Terzolo M, Papini E, Guastamacchia E, Monti S, Aglialoro A, Agrimi D, Ansaldi E, Babini AC, Blatto A, Brancato D, Casile C, Cassibba S, Crescenti C, De Feo ML, Del Prete A, Disoteo O, Ermetici F, Fiore V, Fusco A, Gioia D, Grassi A, Gullo D, Lo Pomo F, Miceli A, Nizzoli M, Pellegrino M, Pirali B, Santini C, Settembrini S, Tortato E, Triggiani V, Vacirca A, Borretta G; all on behalf of Associazione Medici Endocrinologi (AME). Castellano E, et al. J Diabetes Metab Disord. 2018 Dec 17;17(2):401-402. doi: 10.1007/s40200-018-0370-6. eCollection 2018 Dec. J Diabetes Metab Disord. 2018. PMID: 30919831 Free PMC article.

Abstract

Objective: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia.

Methods: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031.

Results: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1.

Conclusion: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

Keywords: Basal bolus; Hypoglycemia; Insulin therapy; Type 1 diabetes; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

Compliance with ethical standardsC.E., A.R., B.A., T.M., P.E., G.E., B. A.C., B.A., B.D., C.C., D.F.M.L., D.P.A.,E.F., F.A., G.D., L.P. F., M.A., N.M., P.B., P.M., S.C., T.E., T.V., V.A. and B.G. have nothing to disclose. G.V.A. has participated in advisory panels for Bayer. A.D. has participated in advisory panels for Novartis. C.S. has received research support from Eli-Lilly. D.O. has received research support from Boehringer, Eli-Lilly,Merck Serono, Novartis, Novo Nordisk,Takeda. G.D. is consultant for Boehringer, Sanofi, Takeda. F.V. has received research support from Astra-Zeneca, Eli-Lilly, Novo Nordisk, Bayer, Novartis and Merck Serono. S.S. is on the speakers’ bureau for Boehringer-Ingelheim, Astra-Zeneca, Eli-Lilly,Takeda and Sanofi-Aventis.

References

    1. American Diabetes Association Standards of medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S1–S27. - PubMed
    1. Umpierrez GE, Smiley D, Jacobs S, et al. Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery) Diabetes Care. 2011;34:256–261. doi: 10.2337/dc10-1407. - DOI - PMC - PubMed
    1. Garber AJ, Abrahamson MJ, Barzilay JI, et al. Consensus statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the comprehensive type 2 diabetes management algorithm - 2018 executive summary. Endocr Pract. 2018;24(1):91–120. doi: 10.4158/CS-2017-0153. - DOI - PubMed
    1. Kidney disease Improving global outcomes (KDIGO) CKD work group. 2013 KDIGO clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. 2013;3:1–150. doi: 10.1038/kisup.2012.73. - DOI
    1. Giugliano D, Chiodini P, Maiorino MI, Bellastella G, Esposito K. Intensification of insulin therapy with basal-bolus or premixed insulin regimens in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Endocrine. 2016;51:417–428. doi: 10.1007/s12020-015-0718-3. - DOI - PubMed

Associated data