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. 2023 Nov 27;15(1):243.
doi: 10.1186/s13098-023-01193-9.

Efficacy and safety of basal-bolus insulin at 1:1.5 ratio compared to 1:1 ratio using a weight-based initiation and titration (WIT2) algorithm in hospitalized patients with type 2 Diabetes: a multicenter, randomized, clinical study

Xiaodan Zhang  1 , Dewen Yan  2 , Tao Du  1 , Yunjuan Zhao  1 , Jiangong Zhang  1 , Tong Zhang  3 , Mingrun Lin  4 , Yanli Li  5 , Wangen Li  6
Affiliations

Efficacy and safety of basal-bolus insulin at 1:1.5 ratio compared to 1:1 ratio using a weight-based initiation and titration (WIT2) algorithm in hospitalized patients with type 2 Diabetes: a multicenter, randomized, clinical study

Xiaodan Zhang et al. Diabetol Metab Syndr. .

Abstract

Background: Most studies initiated basal-bolus insulin in a ratio of 1:1 and titrated based on glucose. This study aimed to investigate the effectiveness and safety of a weight-based and ratio of 1:1.5 basal-bolus insulin using an algorithm for both initiation and titration in hospitalized patients with type 2 diabetes (T2D).

Methods: Hospitalized patients with T2D were randomly assigned to two groups in equal numbers to receive 1:1.5 and 1:1 ratios of basal-bolus insulin using a weight-based algorithm for both initiation and titration. The primary outcome was the time taken to reach the fasting blood glucose (FBG) target and 2-h postprandial blood glucose (2hBG) targets after three meals. The secondary outcome included insulin dosage to achieve glycemic control and the incidence of hypoglycemia during hospitalization.

Results: 250 patients were screened between October 2021 and June 2022, 220 were randomly grouped, and 182 completed the trial (89 in the 1:1.5 and 93 in the 1:1 groups). The time taken to reach FBG targets was comparable between the two groups (3.4 ± 1.7 vs. 3.0 ± 1.3 days, p = 0.137) within about 3 days. The 2hBG after three meals was shorter in the 1:1.5 group than in the 1:1group (2.9 ± 1.5 vs. 3.4 ± 1.4 days, p = 0.015 for breakfast, 3.0 ± 1.6 vs. 3.6 ± 1.4 days, p = 0.005 for lunch, and 3.1 ± 2.1 vs. 4.0 ± 1.5 days, p = 0.002 for dinner). No significant difference in insulin dosages was found between the two groups at the end of the study. The incidence of hypoglycemia was similar in both groups.

Conclusions: We demonstrated that fixed dose-ratio basal-bolus insulin at 1:1.5 calculated using a weight-based initiation and titration algorithm was simple, as effective, and safe as ratio at 1:1 in managing T2D in hospitalized patients. Trial Registration ChiCTR 2,100,050,963. Date of registration: September 8, 2021.

Keywords: Basal-bolus; Diabetes; Initiation; Insulin; Titration.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Patients’ selection.  ALT, alanine aminotransferase; AST, aspartate aminotransferase; BG, blood glucose; OHA, oral hypoglycemic agent
Fig. 2
Fig. 2
A The number of days taken to reach FBG and 2hBG target levels.  B, breakfast; L, lunch; D, dinner. The time taken to reach the FBG target level was not significant between the two groups. The time taken to reach three 2hBG target levels was significant between the two groups. B Insulin dosage at the end of treatment.  B, breakfast; L, lunch; D, dinner. The dosage of glargine, pre-breakfast, pre-lunch, and pre-dinner aspart were not significant between the two groups. C The percentage of hypoglycemia episode in the 1:1.5 and 1:1 basal-bolus groups
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