Determinants of daily insulin use in Type 1 diabetes.
OBJECTIVE
Insulin need for a given degree of glucose control varies markedly among individuals. We examined which factors determine daily insulin use in patients with Type 1 diabetes.


METHODS
A cross-sectional study was performed in 416 patients. Clinical parameters, medication use, physical activity, smoking, alcohol consumption, and laboratory parameters were determined.


RESULTS
Body mass index and waist circumference were positively related to daily insulin use (2.3 U/kg/m(2), 95% CI=1.9-2.7 and 0.8 U/cm, 95% CI=0.6-0.9, adjusted for age and sex). Age, female sex, and duration of diabetes were inversely related to daily insulin dose. There was an increase of 3.6 U of insulin per mmol/l triglycerides (95% CI=1.04-6.2) and a decrease of 5.9 U of insulin per mmol/l high-density lipoprotein cholesterol (95% CI=-10.0 to -1.8), adjusted for age, sex, and weight. For blood pressure-lowering drugs, the strongest relation was found for thiazide diuretics (difference of 7.1 U insulin/day, 95% CI=0.2-14.2, adjusted for age, sex, and weight). The use of an insulin pump and physical activity were related to lower daily insulin need: -8.7 U/day (95% CI=-11.8 to -5.5) and -1.7 U/day per activity score unit (95% CI=-3.2 to -0.2), respectively, adjusted for age, sex, and weight. Smoking was related to an increased need of 5.3 U/day (95% CI=1.5-9.0), adjusted for age, sex, and weight.


CONCLUSIONS
Our results show that components of the metabolic syndrome are positively related to daily insulin use. Also, decreased physical activity, smoking, and the use of blood pressure-lowering drugs, which influence insulin sensitivity, are associated with an increased insulin need. These findings suggest that the presence of insulin resistance in Type 1 diabetes or "double diabetes" plays a key role in determining daily insulin need.
Muis
Marian J
MJ
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Bots
Michiel L
ML
Bilo
Henk J G
HJ
Hoogma
Roel P L M
RP
Hoekstra
Joost B L
JB
Grobbee
Diederick E
DE
Stolk
Ronald P
RP
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D015992:Body Mass Index; D001835:Body Weight; D008076:Cholesterol, HDL / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000008:administration & dosage*; D007333:Insulin Resistance; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000378:metabolism; D008875:Middle Aged; D009043:Motor Activity; D012907:Smoking; D049629:Waist-Hip Ratio
D001786:Blood Glucose; D008076:Cholesterol, HDL; D007328:Insulin