Audit of the change from twice daily to basal-bolus insulin regimens in insulin-dependent diabetes.

ABSTRACT

Basal-bolus insulin regimens have become popular with patients, but clinicians' enthusiasm for their use has been tempered by a number of reports that suggest that these regimens do not improve overall glycemic control when compared with conventional, twice daily, regimens. Indeed, it has been suggested that basal-bolus regimens may be abused by certain patients leading to an increase in body weight and deterioration in glycemic control. This paper reports the results of a retrospective audit of 145 insulin-dependent diabetic patients changed from conventional insulin therapy to a basal-bolus insulin regimen. After 3 months on the basal-bolus regimen, a small but significant fall in total insulin (10%; p < 0.001) and intermediate-acting insulin (50%; p < 0.001) dose was recorded. During this time period serum fructosamine measurements also fell by 10% (p < 0.001) indicating a small but significant improvement in glycemic control. Body-mass index (BMI) and body weight data did not support the view that basal-bolus regimens lead to an increase in body weight. Analysis of the data by gender did not support the view that the basal-bolus insulin regimen is prone to abuse by female patients.