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.
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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)