title: Twice- rather than once-daily basal insulin is associated with better glycaemic control in Type 1 diabetes mellitus 12 months after skills-based structured education in insulin self-management.
abstract: OBJECTIVE
  This study investigates the relationship between basal insulin regimen and glycaemic outcomes 12 months after skills-based structured education in the UK Dose Adjustment for Normal Eating (DAFNE) programme for Type 1 diabetes mellitus.
  
  
  METHODS
  Retrospective analysis of data from 892 DAFNE participants from 11 UK centres.
  
  
  RESULTS
  Mean HbA1c 12 months after DAFNE was lower in those using twice- rather than once-daily basal insulin after correcting for differences in baseline HbA1c , age and duration of diabetes; difference -2 (95% CI -3 to -1) mmol/mol [-0.2 (-0.3 to -0.1)%], P = 0.009. The greatest fall in HbA1c of -5 (-7 to -3) mmol/mol [-0.4 (-0.6 to -0.3)%], P < 0.001 occurred in those with less good baseline control, HbA1c  ≥ 58 mmol/mol, who switched from once- to twice-daily basal insulin. There was no difference in the 12-month HbA1c between users of glargine, detemir and NPH insulin after correcting for other variables. Relative risk of severe hypoglycaemia fell by 76% and ketoacidosis by 63% 12 months after DAFNE. The rate of severe hypoglycaemia fell from 0.82 to 0.23 events/patient year in twice-daily basal insulin users. In the group with greatest fall in HbA1c , the estimated relative risk for severe hypoglycaemia in twice-daily basal insulin users versus once daily at 12 months was 1.72 (0.88-3.36, P = 0.110).
  
  
  CONCLUSIONS
  After structured education in adults with Type 1 diabetes mellitus, use of basal insulin twice rather than once daily was associated with lower HbA1c , independent of insulin type, with significant reductions in severe hypoglycaemia and ketoacidosis in all groups.
authors.affiliation: New Victoria Hospital, Glasgow, UK.
authors.forename: H E
authors.initials: HE
authors.lastname: Hopkinson
authors.affiliation: University of Sheffield, UK.
authors.forename: R M
authors.initials: RM
authors.lastname: Jacques
authors.affiliation: University of Dundee, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Gardner
authors.affiliation: King's College London, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Amiel
authors.affiliation: Nottingham University Hospitals NHS Trust, UK.
authors.forename: P
authors.initials: P
authors.lastname: Mansell
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D016883:Diabetic Ketoacidosis / Q000517:prevention & control; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000069057:Insulin Detemir / Q000008:administration & dosage / Q000009:adverse effects; D000069036:Insulin Glargine / Q000008:administration & dosage / Q000009:adverse effects; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000009:adverse effects; D049528:Insulin, Long-Acting / Q000008:administration & dosage* / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D012189:Retrospective Studies; D012648:Self Care; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D007336:Insulin, Isophane; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human