Principles of self-adjustment of insulin dose in people with diabetes type 2 and flexible insulin therapy. (June 2016)

• Record Type: Journal Article
• Authors: Kramer, G.; Kuniss, N.; Kloos, C.; Lehmann, T.; Müller, N.; Sanow, B.; Lorkowski, S.; Wolf, G.; Müller, U.A.
• Is Part Of: Diabetes research and clinical practice. Volume 116(2016)
• Page Start: 165
• Page End: 170
• Publication Date: 2016-06
• Subjects: T2DM type 2 diabetes mellitus -- HbA1c glycated haemoglobin; Self-adjustment of insulin dose -- Type 2 diabetes mellitus -- Flexible insulin therapy; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2016.04.017
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Sophisticated rules were used only by a minority of the participants. Only 22% adjust their insulin dose using factor for correction. There were no differences in HbA1c and hypoglycaemia between both groups. Abstract: Aims: Structured treatment and education programmes for people with type 2 diabetes mellitus (T2DM) and flexible insulin therapy provide rules for self-adjustment of insulin dose, that are extensively trained. The aim of this cohort study was to register current principles and the frequency of self-adjustment of insulin dose and their association with metabolic control in people with T2DM. Methods: Details of insulin dose adjustment were assessed by a structured interview in 149 people with T2DM on flexible insulin therapy (mean HbA1c 7.1%/53.8 mmol/mol, age 65 y, diabetes duration 19.0 y, BMI 33.8 kg/m 2 ) in a tertiary care centre. The frequency of insulin dose adjustments was obtained from the last 28 days of the patients' diaries. Results: Insulin dose adjustment by adjustment rules was used by 33 people (22.1%) and by personal experience/feeling in 111 participants (74.5%). People adjusting by rules were younger (60.9 ± 9.8 vs. 65.7 ± 9.2, p = 0.011) and did more insulin dose adjustments per 28 days (50.0 ± 31.0 vs. 33.4 ± 23.5, p = 0.016). HbA1c and incidence of hypoglycaemia were comparable. There were no differences in satisfaction of treatment, quality of life as well as current well-being between the groups. Conclusions: Only a fifth of the participants used the rule trained within the education programme to adjust their insulin dose. The majority adjusted their insulin dose by personal experience/feeling. However, people in both groups were able to adjust their insulin dose. Although people using adjustment rules adjust their insulin dose more frequently, HbA1c and the incidence of hypoglycaemia was similar compared to those using personal experience/feeling.