title: Physical characteristics that predict final basal insulin dose in type 2 diabetes mellitus, with a special focus on BMI.
abstract: OBJECTIVE
  The possibility to predict final insulin dose based on patient's characteristics would allow for efficient titration for patients with higher dose needs. The primary aim of this post-hoc analysis of the L2T3 study was to determine predictors for final dose. Specifically, we focused on the relationship between BMI and dose. The secondary aims were to investigate (i) the predictive value of BMI and age on final dose and (ii) the possibility to tailor the starting dose of insulin based on BMI and age.
  
  
  RESULTS
  We performed two stepwise regression analyses, one using all baseline characteristics, and one using physical characteristics and FPG which can be assessed "at the bedside" only. Furthermore, median [min, max] final doses of groups stratified according to BMI and age were calculated. BMI clearly correlated with final dose in IU (Pearson correlation 0.42 [0.37; 0.48], p < 0.001). Characteristics which can be assessed "at the bedside" that predict high final dose were allocation to detemir, absence or discontinuation of insulin secretagogues, high BMI, low age, male gender and high FPG. Final dose varied among strata (BMI ≥30 kg/m(2): 64 IU; BMI <30 kg/m(2): 38 IU, p < 0.001 and age <59 years: 52 IU; age ≥59 years: 44 IU, p < 0.001). All groups stratified for both BMI and age showed similarly low minimal final dose (5-17 IU).
  
  
  CONCLUSIONS
  Our data showed a high predictive value of BMI on final dose. However, it does not seem possible to tailor starting dose based on BMI and age.
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: a.c.simon@amc.uva.nl.
authors.forename: A C R
authors.initials: AC
authors.lastname: Simon
authors.affiliation: Department of Internal Medicine, University of Perugia, Perugia, Italy.
authors.forename: G B
authors.initials: GB
authors.lastname: Bolli
authors.affiliation: Sanofi, Paris, France.
authors.forename: M-P
authors.initials: MP
authors.lastname: Dain
authors.affiliation: Sanofi, Bridgewater, NJ, USA.
authors.forename: E
authors.initials: E
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Holleman
mesh_terms: D000375:Aging / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting / Q000008:administration & dosage* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D057285:Precision Medicine; D012737:Sex Factors
chemical_list: D007004:Hypoglycemic Agents; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine
keywords: Body mass index; Diabetes mellitus; Insulin; Long-acting; Regression analysis; Type 2