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2. The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

Author

Castellano, Elena, Attanasio, R., Giagulli, V. A., Boriano, A., Terzolo, M., Papini, E., Guastamacchia, E., Monti, S., Aglialoro, A., Agrimi, D., Ansaldi, E., Babini, A. C., Blatto, A., Brancato, D., Casile, C., Cassibba, S., Crescenti, C., De Feo, M. L., Del Prete, A., and Disoteo, O.

Subjects
TREATMENT of diabetes, INSULIN, OUTPATIENT medical care
Abstract

Objective To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. Methods Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. Results Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 inDM1 and 0.44 inDM2; Glargine, 0.44 inDM1 and 0.43 inDM2; Detemir, 0.45 inDM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. Conclusion The b/T ratio was independent of glycemic control and incidence of hypoglycemia. [ABSTRACT FROM AUTHOR]

Published
2018
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3. Quality of life and treatment satisfaction in adults with Type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections

Author

A. Nicolucci, A. Maione, M. Franciosi, R. Amoretti, E. Busetto, F. Capani, D. Bruttomesso, P. Di Bartolo, A. Girelli, F. Leonetti, L. Morviducci, P. Ponzi, E. Vitacolonna, L. V. Cassano, N. Tota, V. Cherubini, A. Iannilli A. Corsi, P. Ponzani, V. Montani, P. Di Berardino, M. Velussi, F. Giorgino, V. Gigantelli, G. Beltramello, A. Pianta, R. Trevisan, G. Lepore, G. Forlani, G. Marchesini, D. Crazzolara, M. Marchesi, E. Zarra, B. Agosti, G. Careddu, L. Tomaselli, R. Vigneri, M. Agrusta, V. Di Blasi, S. Tumini, M. T. Anzellotti, P. Ruggeri, P. Foglini, M. Rossana, A Murri, S. Toni, M. F. Reali, M. Nizzoli, S. Aquati, G. d’Annunzio, N. Minuto, L. Cataldi, C. Bordone, R. Iannarelli, F. Sciarretta, M. Tagliaferri, M. A. Lezzi, L. Sciangula, A. Ciucci, M. Bonomo, E. Meneghini, G. Mariani, P. Colapinto, G. Testori, P. Rampini, R. Bonfanti, F. Meschi, G. Galimberti, A. Laurenzi, A. Veronelli, C. Mauri, C. Tortul, A. M. Cernigoi, M. E. De Feo, M. Piscopo, G. Annuzzi, L. Bozzetto, A. Franzese, P. Buono, S. Turco, A. Turco, F. Prisco, D. Iafusco, M. Trovati, P. Massucco, S. Costa, M, V. Provenzano, L. Strazzera, G. Ridola, E. Torlone, M. Orsini Federici, A. Bertolotto, M. Aragona, F. Pellicano, V. Manicardi, M. Michelini, M. Parenti, A. C. Babini, P. Borboni, A. Di Flaviani, M. L. Manca Bitti, S. Piccinini, A. Clementi, C. Tubili, C. Suraci, S. Carletti, A. Moretti, M. Maiello, V. C. Iannucci, N. Sulli, B. Shashaj, D. Fava, F. Massimiani, P. Pozzilli, S. Manfrini, C. Landi, I. Tanganelli, G. Grassi, M. Tomelini, R. De Luca, L. Corgiat Mansin, R. Candido, E. Manca, L. Tonutti, C. Noacco, I. Franzetti, P. Marnini., Nicolucci, A., Maione, A., Franciosi, M., Amoretti, R., Busetto, E., Capani, F., Bruttomesso, D., Di Bartolo, P., Girelli, A., Leonetti, F., Morviducci, L., Ponzi, P., Vitacolonna, E., Cassano, L. V., Tota, N., Cherubini, V., Corsi, A. Iannilli A., Ponzani, P., Montani, V., Di Berardino, P., Velussi, M., Giorgino, F., Gigantelli, V., Beltramello, G., Pianta, A., Trevisan, R., Lepore, G., Forlani, G., Marchesini, G., Crazzolara, D., Marchesi, M., Zarra, E., Agosti, B., Careddu, G., Tomaselli, L., Vigneri, R., Agrusta, M., Di Blasi, V., Tumini, S., Anzellotti, M. T., Ruggeri, P., Foglini, P., Rossana, M., Murri, A, Toni, S., Reali, M. F., Nizzoli, M., Aquati, S., D’Annunzio, G., Minuto, N., Cataldi, L., Bordone, C., Iannarelli, R., Sciarretta, F., Tagliaferri, M., Lezzi, M. A., Sciangula, L., Ciucci, A., Bonomo, M., Meneghini, E., Mariani, G., Colapinto, P., Testori, G., Rampini, P., Bonfanti, R., Meschi, F., Galimberti, G., Laurenzi, A., Veronelli, A., Mauri, C., Tortul, C., Cernigoi, A. M., De Feo, M. E., Piscopo, M., Annuzzi, G., Bozzetto, L., Franzese, A., Buono, P., Turco, S., Turco, A., Prisco, F., Iafusco, D., Trovati, M., Massucco, P., Costa, S., M, Provenzano, V., Strazzera, L., Ridola, G., Torlone, E., Orsini Federici, M., Bertolotto, A., Aragona, M., Pellicano, F., Manicardi, V., Michelini, M., Parenti, M., Babini, A. C., Borboni, P., Di Flaviani, A., Manca Bitti, M. L., Piccinini, S., Clementi, A., Tubili, C., Suraci, C., Carletti, S., Moretti, A., Maiello, M., Iannucci, V. C., Sulli, N., Shashaj, B., Fava, D., Massimiani, F., Pozzilli, P., Manfrini, S., Landi, C., Tanganelli, I., Grassi, G., Tomelini, M., De Luca, R., Corgiat Mansin, L., Candido, R., Manca, E., Tonutti, L., Noacco, C., Franzetti, I., and Marnini., P.

Subjects
multiple daily injections, Insulin pump, Adult, Male, medicine.medical_specialty, Continuous subcutaneous insulin infusion, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Injections, Subcutaneous, Insulin Glargine, Endocrinology, Patient satisfaction, Insulin Infusion Systems, Quality of life, Internal medicine, Diabetes mellitus, Internal Medicine, medicine, Humans, Hypoglycemic Agents, Insulin, Multiple daily injection, continuous subcutaneous insulin infusion, quality of life, questionnaires, type 1 diabetes, Type 1 diabetes, Questionnaire, Insulin glargine, business.industry, Middle Aged, medicine.disease, Obesity, Surgery, Insulin, Long-Acting, Diabetes Mellitus, Type 1, Patient Satisfaction, Quality of Life, Female, business, Epidemiologic Methods, medicine.drug
Abstract

Aims The aim of this case–control study was to compare quality of life (QoL) and treatment satisfaction in adults with Type 1 diabetes (T1DM) treated with either continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Methods Consecutive patients aged between 18 and 55 years, and attending diabetes clinics for a routine visit, completed the Diabetes-Specific Quality-of-Life Scale (DSQOLS), the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the SF-36 Health Survey (SF-36). Case (CSII) and control subjects (MDI) were recruited in a 1 : 2 ratio. Results Overall, 1341 individuals were enrolled by 62 diabetes clinics; 481 were cases and 860 control subjects. Cases had a longer diabetes duration and were more likely to have eye and renal complications. Age, school education, occupation and HbA 1c were similar. Of control subjects, 90% followed glargine-based MDI regimens and 10% used NPH-based MDI regimens. On multivariate analysis, after adjusting for socioeconomic and clinical characteristics, scores in the following areas of the DSQOLS were higher in cases than control subjects: diet restrictions ( β = 5.96; P < 0.0001), daily hassles ( β = 3.57; P = 0.01) and fears about hypoglycaemia ( β = 3.88; P = 0.006). Treatment with CSII was also associated with a markedly higher DTSQ score ( β = 4.13; P < 0.0001) compared with MDI. Results were similar when CSII was compared separately with glargine- or NPH-based MDI regimens. Conclusions This large, non-randomized, case–control study suggests quality of life gains deriving from greater lifestyle flexibility, less fear of hypoglycaemia, and higher treatment satisfaction, when CSII is compared with either glargine-based or NPH-based MDI regimens. Diabet. Med. 25, 213–220 (2008)

Published
2008

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