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. Issue 8 (28th May 2015)

• Record Type: Journal Article
• Authors: Hopkinson, H. E.; Jacques, R. M.; Gardner, K. J.; Amiel, S. A.; Mansell, P.
• Is Part Of: Diabetic medicine. Volume 32:Issue 8(2015:Aug.)
• Page Start: 1071
• Page End: 1076
• Publication Date: 2015-05-28
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12806
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" id="dme12806-abs-0001"> <title>Abstract</title> <sec id="dme12806-sec-0001" sec-type="section"> <title>Aim</title> <p>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.</p> </sec> <sec id="dme12806-sec-0002" sec-type="section"> <title>Method</title> <p>Retrospective analysis of data from 892 DAFNE participants from 11 UK centres.</p> </sec> <sec id="dme12806-sec-0003" sec-type="section"> <title>Results</title> <p>Mean HbA<sub>1c</sub> 12 months after DAFNE was lower in those using twice‐ rather than once‐daily basal insulin after correcting for differences in baseline HbA<sub>1c</sub>, age and duration of diabetes; difference –2 (95% CI –3 to –1) mmol/mol [–0.2 (–0.3 to –0.1)%], <italic>P</italic> = 0.009. The greatest fall in HbA<sub>1c</sub> of –5 (–7 to –3) mmol/mol [–0.4 (–0.6 to –0.3)%], <italic>P</italic> < 0.001 occurred in those with less good baseline control, HbA<sub>1c</sub> ≥ 58 mmol/mol, who switched from once‐ to twice‐daily basal insulin. There was no difference in the 12‐month HbA<sub>1c</sub> 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 HbA<sub>1c</sub>, 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, <italic>P</italic> = 0.110).</p> </sec> <sec id="dme12806-sec-0004" sec-type="section"> <title>Conclusion</title> <p>After structured education in adults with Type 1 diabetes mellitus, use of basal insulin twice rather than once daily was associated with lower HbA<sub>1c</sub>, independent of insulin type, with significant reductions in severe hypoglycaemia and ketoacidosis in all groups.</p> </sec> </abstract>