The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

OBJECTIVE: To evaluate the basal/total ratio of daily insulin dose (b/T) in outpatients with diabetes type 1 (DM1) and type 2 (DM2) on basal-bolus regimen, by investigating whether there is a relationship with HbA1c and episodes of hypoglycemia. METHODS: Multicentric, observational, cross-sectional study in Italy. Adult DM1 (n = 476) and DM2 (n = 541) outpatients, with eGFR >30 mL/min/1.73 m2, on a basal-bolus regimen for at least six months, were recruited from 31 Italian Diabetes services between March and September 2016. Clinicaltrials.govID: NCT03489031. RESULTS: Total daily insulin dose was significantly higher in DM2 patients (52.3 ± 22.5 vs. 46 ± 20.9 U/day), but this difference disappeared when insulin doses were normalized for body weight. The b/T ratio was lower than 0.50 in both groups: 0.46 ± 0.14 in DM1 and 0.43 ± 0.15 in DM2 patients (p = 0.0011). The b/T was significantly higher in the patients taking metformin in both groups, and significantly different according to the type of basal insulin (Degludec, 0.48 in DM1 and 0.44 in DM2; Glargine, 0.44 in DM1 and 0.43 in DM2; Detemir, 0.45 in DM1 and 0.39 in DM2). The b/T ratio was not correlated in either group to HbA1c or incidence of hypoglycemia (<40 mg/dL, or requiring caregiver intervention, in the last three months). In the multivariate analysis, metformin use and age were independent predictors of the b/T ratio in both DM1 and DM2 patients, while the type of basal insulin was an independent predictor only in DM1. CONCLUSION: The b/T ratio was independent of glycemic control and incidence of hypoglycemia.

Correction to: The basal to total insulin ratio in outpatients with diabetes on basal-bolus regimen.

[This corrects the article DOI: 10.1007/s40200-018-0358-2.].

[Comparison of dietary intake of type I diabetic patients and nutritional recommendations]. / Confronto tra introito alimentare di diabetici tipo I con le raccomandazioni nutrizionali.

BACKGROUND: The management of type I diabetes mellitus requires a careful balance between nutrient intake, energy expenditure and dose and timing of insulin. According to the recommendations of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) the calories should be prescribed according to energy needs to achieve and maintain a desirable body weight. Many studies have shown that diets in which carbohydrates provide 50-60% of total energy are associated with improved blood glucose control and lower levels of LDL cholesterol. Whenever acceptable to the patients, natural foods containing unrefined carbohydrate should be substituted for the highly refined carbohydrates that are low in fiber. The high risk of macrovascular disease in patients with diabetes dictates a need to restrict total fat (25-30% of total energy) and cholesterol intake (300 mg/day). ADA and EASD suggest that reduction of protein intake (0.8 g/kg/day) may reduce proteinuria and progression to renal failure during the earliest stages of diabetic nephropathy. METHODS: The goal of this study was to describe macronutrient intakes in type I diabetic patients of our Centre by a validated 3 day record. RESULTS: Mean energy intake was 2022+/-427 Kcal/die (vs 2596+/-501 recommended intake). Average protein intake was well above the level of 0.8 g/kg/day required to ensure an adequate protein intake in type I diabetes mellitus. Total fats contributed 29.8+/-7.4 of total energy (vs 27% recommended intake) and saturated fat provided significantly more than 10% of energy. Carbohydrates intake was above 50% of total energy but fiber intakes was substantially lower than the recommendation (12.7+/-5.5 vs 20.1+/-6.6 g/day). CONCLUSIONS: These data indicate current problems in the nutritional intake of type I diabetes mellitus; in fact the majority of our group of patients are not meeting the recommended dietary intakes for protein, total fat, saturated fat and fiber.