title: Factors that influence basal insulin requirement in type 2 diabetes.
abstract: In clinical practice, basal insulin dosage (BID) for the treatment for type 2 diabetes given as slow-acting analogues or NPH insulin varies widely when adjusted for body weight (UI/kg). In this study, we investigated the interrelationship between BID and anthropometric, laboratory and clinical parameters. A total of 681 type 2 diabetic patients, treated with bedtime insulin in association with other antidiabetic drugs (preprandial insulin and/or oral agents), were studied. Anthropometric, clinical and biochemical parameters, as well as micro- and macrovascular complications, were evaluated. Non-alcoholic fatty liver disease (NAFLD) was assessed by liver ultrasound. BID was titrated to achieve a fasting blood glucose target of ≤6.7 mmol/L (120 mg/dL). In the multivariate analysis, BID was significantly associated with waist circumference (p = 0.04) and the insulin treatment duration (p = 0.004) as the type of insulin treatment ("basal-bolus" regimen vs. basal insulin only, p < 0.0001), the use of lipid-lowering drugs (p = 0.0003) and insulin sensitizers (p = 0.005). Several glycometabolic parameters were strongly associated with BID (HbA1c p = 0.01, FPG p < 0.0001, HDL p = 0.02, triglycerides p = 0.03). Moreover, the presence of severe NAFLD resulted in a higher BID (p = 0.03). We concluded that when starting and titrating the basal insulin in type 2 diabetes, certain anthropometric, laboratory and clinical factors can be useful to find optimal BID more quickly and appropriately.
authors.affiliation: Unit of Metabolic and Endocrine Diseases, "Centro Catanese di Medicina e Chirurgia" Clinic, Catania, Italy. gpapa_98@yahoo.com
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Papa
authors.forename: Roberto
authors.initials: R
authors.lastname: Baratta
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Calì
authors.forename: Claudia
authors.initials: C
authors.lastname: Degano
authors.forename: Maria Pierangela
authors.initials: MP
authors.lastname: Iurato
authors.forename: Carmelo
authors.initials: C
authors.lastname: Licciardello
authors.forename: Raffaella
authors.initials: R
authors.lastname: Maiorana
authors.forename: Concetta
authors.initials: C
authors.lastname: Finocchiaro
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D001835:Body Weight; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007328:Insulin