Insulin Dose And Characteristics Of Short-term Insulin Replacement Therapy In Chinese Patients With Type2Diabetes

ObjectiveThe study was to determine whether insulin replacement therapy in differentinjections by preferential adjustment basal insulin can achieve glycemic control with alower total daily dose of insulin in people with type2diabetes(T2DM).MethodsWe studied509Chinese subjects with T2DM (256men and253women). Allpatients were hospitalized between January2010and July2012in the Department ofEndocrinology at Linyi People’s Hospital, Linyi, China. The diagnosis of T2DM wasestablished on the basis of the1999diabetes diagnostic criteria of the World HealthOrganization. Patients with acute complications (such as Diabetic ketoacidosis andDiabetic nonketotic hyperosmolar coma and Diabetic lactic acidosis), severe orsignificant hepatic or renal impairment, pregnancy or malignancy, and acute infectionwere excluded. A total of509subjects with T2DM were randomly treated withcontinuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) ofinsulin therapy. We preferentially adjusted the basal insulin dose to control fasting andpremeal blood glucose, and analyzed the characteristics of insulin dose. Comparision withdays to reach glycemic goals、the mean total daily insulin dose、the dose per unit bodyweight、the total daily basal and bolus dose accounted for the proportion of the meantotal daily insulin dose, Comparision with the insulin dose distribution among thedifferent BMI and the course of diabetes subgroups.Results1.There were no significant differences between the MDI group and CSII group interms of age, sex, HbA1c, blood glucose, fasting serum C-peptide or other clinical data.(p ＞0.05)2.①A total of203subjects received MDI. Good glycemic control was achieved after7.00±2.24days. The mean total daily insulin dose was37.47±9.98IU, and the dose perunit body weight was0.59±0.18IU/kg/day. The total daily basal and bolus doses were19.78±7.88IU and17.69±3.39IU, respectively (i.e., about51.29±8.26%and48.71±8.26%of the total daily dose). The incidence of hypoglycemia was5.94%. A total of306subjects received CSII. Good glycemic control was achieved after5.44±2.22days. Themean total daily insulin dose was32.58±8.78IU, and the dose per unit body weight was0.48±0.17IU/kg/day. The total daily basal and bolus doses were22.79±7.55IU and9.81±2.64IU, respectively (i.e., about69.03±7.00%and30.97±7.00%of the total dailydose). The incidence of hypoglycemia was1.63%.②There were obviously significantdifference in the insulin dose between the MDI group and CSII group（P<0.001）.③In thegroups (MDI vs.CSII) with BMI of <23kg/m2, the insulin dose of per kilogram of bodyweight (0.68±0.19IU/kg/day vs.0.59±0.19IU/kg/day) were significantly higher than in theother two groups (P＜0.001), while We did not observe any significant difference in totaldose of insulin or basal and bolus doses of insulin per day among different groups dividedby BMI（P＞0.05）.There was no relationship between the insulin dose and the course ofthe disease.Conclusions(1) In individuals with T2DM on short-term insulin therapy, the total dose of insulinon CSII therapy was significantly reduced compared to MDI therapy, and lower incidenceof hypoglycemia compared to the MDI group(2) On CSII therapy, increases in basal dose of insulin and reductions in bolus dosemay be an effective method to achieve good glycemic control with a lower total daily doseof insulin.