A Large Difference in Dose Timing of Basal Insulin Introduces Risk of Hypoglycemia and Overweight: A Cross-Sectional Study

Diabetes Therapy, Feb 2017

Introduction Basal insulin should be injected at the same time each day, but people with diabetes sometimes mistime their injections. It is not known whether irregular daily dose timing affects diabetes-related factors. We report here our evaluation of the effects of deviations from a regular dosing schedule on glycemic control and hypoglycemia on patients treated with long-acting insulin (insulin glargine U100). We also consider the effects of ultra-long-acting insulin (insulin degludec) in this context. Methods Nineteen individuals with type 1 diabetes and 58 with type 2 diabetes were enrolled. Demographic data on all participants were retrieved from their medical records. Variation in dose timing was determined as the difference between the time of the earliest mistimed dose and the time of the latest mistimed dose, for each participant, over a 2-week period. All participants completed the Summary of Diabetes Self-Care Activities questionnaire, Problem Areas in Diabetes scale and 5-Item World Health Organization Well-being Index. Glargine U100 was switched to degludec in those individuals with type 2 diabetes who achieved inadequate glycemic control or suffered from frequent hypoglycemic episodes or who required two injections per day, and changes in hemoglobin A1c level and frequency of hypoglycemic episodes during the 12-week period were compared. Results A greater difference in dose timing was related to a higher frequency of hypoglycemic episodes and overweight in persons with type 2 diabetes. Smoking, drinking and living alone were independently associated with a greater difference in dose timing. Insulin degludec decreased the frequency of hypoglycemia and improved glycemic control in participants whose dose mistiming was >120 min. Conclusion Fixed dose timing should be employed for basal insulin, as a larger difference in dose timing worsens diabetes-related factors. Insulin degludec improved glycemic control and lowered the hypoglycemia rate in persons with more irregular dose timing.

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A Large Difference in Dose Timing of Basal Insulin Introduces Risk of Hypoglycemia and Overweight: A Cross-Sectional Study

Diabetes Ther A Large Difference in Dose Timing of Basal Insulin Introduces Risk of Hypoglycemia and Overweight: A Cross-Sectional Study Akiko Nishimura . Shin-ichi Harashima . Haruna Fukushige . 0 1 2 3 Yu Wang . Yanyan Liu . Kiminori Hosoda . Nobuya Inagaki 0 1 2 3 0 H. Fukushige Department of Foundation of Nursing, Kobe City College of Nursing , Kobe , Japan 1 S. Harashima (&) Y. Wang Y. Liu N. Inagaki Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University , Kyoto , Japan 2 A. Nishimura H. Fukushige K. Hosoda Department of Human Health Sciences, Graduate School of Medicine, Kyoto University , Kyoto , Japan 3 K. Hosoda Division of Endocrinology and Metabolism, Department of Lifestyle-Related Diseases, National Cerebral and Cardiovascular Center , Suita , Japan Introduction: Basal insulin should be injected at the same time each day, but people with diabetes sometimes mistime their injections. It is not known whether irregular daily dose timing affects diabetes-related factors. We report here our evaluation of the effects of deviations from a regular dosing schedule on glycemic control and hypoglycemia on patients treated with long-acting insulin (insulin glargine U100). We also consider the effects of ultra-long-acting insulin (insulin degludec) in this context. - Methods: Nineteen individuals with type 1 diabetes and 58 with type 2 diabetes were enrolled. Demographic data on all participants were retrieved from their medical records. Variation in dose timing was determined as the difference between the time of the earliest mistimed dose and the time of the latest mistimed dose, for each participant, over a 2-week period. All participants completed the Summary of Diabetes Self-Care Activities questionnaire, Problem Areas in Diabetes scale and 5-Item World Health Organization Well-being Index. Glargine U100 was switched to degludec in those individuals with type 2 diabetes who achieved inadequate glycemic control or suffered from frequent hypoglycemic episodes or who required two injections per day, and changes in hemoglobin A1c level and frequency of hypoglycemic episodes during the 12-week period were compared. Results: A greater difference in dose timing was related to a higher frequency of hypoglycemic episodes and overweight in persons with type 2 diabetes. Smoking, drinking and living alone were independently associated with a greater difference in dose timing. Insulin degludec decreased the frequency of hypoglycemia and improved glycemic control in participants whose dose mistiming was [120 min. Conclusion: Fixed dose timing should be employed for basal insulin, as a larger difference in dose timing worsens diabetes-related factors. Insulin degludec improved glycemic control and lowered the hypoglycemia rate in persons with more irregular dose timing. INTRODUCTION Basal insulin is frequently used to treat all types of diabetes mellitus. The position statement of the American Diabetes Association and the European Association for the Study of Diabetes on the management of hyperglycemia in persons with type 2 diabetes states that basal insulin should be considered an essential component of the treatment strategy for any persons not achieving an agreed-upon glycated hemoglobin (HbA1c) target [1]. Basal insulin is also indispensable for persons with type 1 diabetes to maintain glycemic control within the target range and participate in normal daily activities [2]. During the last decade, long-acting insulin (glargine U100 and detemir) has become the main basal insulin in both type 1 and type 2 diabetes, as it contributes to better glycemic control and fewer hypoglycemic episodes when compared to intermediate-acting insulins [3–5]. A recent study also reported that patient-led insulin glargine titration achieved near-target blood glucose levels in uncontrolled type 1 [6] and type 2 diabetes [7]. The treatment of most patients with type 1 and type 2 diabetes consists of injections of long-acting insulins once a day; these insulins should be injected at the same time each day because the effectiveness of each dose is close to 24 h [8–14]. However, it is sometimes difficult and inconvenient for people with diabetes to follow clinical practice guidelines and inject themselves with long-acting insulin at the same time each day. Indeed, it has been reported that 27.6% of people with type 1 or type 2 diabetes have difficulty maintaining a regular daily dose schedule (i.e. injecting themselves with insulin at the same time each day). Physicians have generally considered that 81.4% of people with diabetes fail to take basal insulin at the same time each day and that 71.1% fail to take basal insulin due to a busy lifestyle or travel commitments [15]. In general, most people with diabetes find it difficult to incorporate basal insulin injections into their daily life, partly due to changing daily routines [16]. It is as yet unknown whether differences in the i (...truncated)


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Akiko Nishimura, Shin-ichi Harashima, Haruna Fukushige, Yu Wang, Yanyan Liu, Kiminori Hosoda, Nobuya Inagaki. A Large Difference in Dose Timing of Basal Insulin Introduces Risk of Hypoglycemia and Overweight: A Cross-Sectional Study, Diabetes Therapy, 2017, pp. 385-399, Volume 8, Issue 2, DOI: 10.1007/s13300-017-0238-7