Abstract
Background:
It has been reported that most pump-treated patients with type 2 diabetes require only two or fewer basal rates. Using daily continuous glucose monitoring (CGM)-directed titration, this premise was re-evaluated at near-normal glycemic control.
Patients and Methods:
Thirty subjects who were insulin-naive (n=10), on basal insulin (n=10), or on basal-bolus insulin therapy (n=10) ate a fixed diet. The basal rate was started as a single rate and then adjusted to a basal glucose goal of 70–130 mg/dL. The insulin-to-carbohydrate ratio (ICR) (in g/U) was adjusted to 2–4-h postmeal CGM glucose goal of 80–120% of premeal glucose.
Results:
The mean (SE) CGM basal glucose was 99.9 (4.9) mg/dL, and 4.5% (1.4%) of the readings were <70 mg/dL. The mean 2–4-h postmeal glucose was 113.3% (4.8%) of the premeal glucose. Only six subjects (20%) required two basal rates, while the remainder needed only one. The mean (SE) dosing relationships were as follows: total basal dose (TBD) (in U/day)=0.226(0.018)×weight (in kg); TBD (in U/day)=0.339(0.012)×total daily dose (TDD) (in U/day); ICR (in g/U)=126(8)/TBD (in U/day); and ICR (in g/U)=365(14)/TDD (in U/day).
Conclusions:
This study confirms that one basal rate is adequate for the majority of subjects with type 2 diabetes. The mathematical proportionality between dosing factors closely agrees with those obtained in CGM-titrated pump-treated type 1 diabetes but differs from those derived from clinical studies in which insulin titration was based on infrequent self-monitored plasma glucose testing and while on an unstructured diet.
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