Principles of self-adjustment of insulin dose in people with diabetes type 2 and flexible insulin therapy.
OBJECTIVE
Structured treatment and education programmes for people with type 2 diabetes mellitus (T2DM) and flexible insulin therapy provide rules for self-adjustment of insulin dose, that are extensively trained. The aim of this cohort study was to register current principles and the frequency of self-adjustment of insulin dose and their association with metabolic control in people with T2DM.


METHODS
Details of insulin dose adjustment were assessed by a structured interview in 149 people with T2DM on flexible insulin therapy (mean HbA1c 7.1%/53.8mmol/mol, age 65y, diabetes duration 19.0y, BMI 33.8kg/m(2)) in a tertiary care centre. The frequency of insulin dose adjustments was obtained from the last 28days of the patients' diaries.


RESULTS
Insulin dose adjustment by adjustment rules was used by 33 people (22.1%) and by personal experience/feeling in 111 participants (74.5%). People adjusting by rules were younger (60.9±9.8 vs. 65.7±9.2, p=0.011) and did more insulin dose adjustments per 28days (50.0±31.0 vs. 33.4±23.5, p=0.016). HbA1c and incidence of hypoglycaemia were comparable. There were no differences in satisfaction of treatment, quality of life as well as current well-being between the groups.


CONCLUSIONS
Only a fifth of the participants used the rule trained within the education programme to adjust their insulin dose. The majority adjusted their insulin dose by personal experience/feeling. However, people in both groups were able to adjust their insulin dose. Although people using adjustment rules adjust their insulin dose more frequently, HbA1c and the incidence of hypoglycaemia was similar compared to those using personal experience/feeling.
Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany. Electronic address: guido.kramer@med.uni-jena.de.
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Kramer
Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
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Kuniss
Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
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Kloos
Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
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Lehmann
Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
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Müller
Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
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Sanow
Institute of Nutrition, Friedrich Schiller University Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Halle-Jena-Leipzig, Germany.
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Lorkowski
Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
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Wolf
Endocrinology and Metabolic Diseases, Department of Internal Medicine III, Jena University Hospital, Jena, Germany.
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Müller
D000368:Aged; D015190:Blood Glucose Self-Monitoring / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D012648:Self Care
D007004:Hypoglycemic Agents; D007328:Insulin
Flexible insulin therapy; Self-adjustment of insulin dose; Type 2 diabetes mellitus