BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).Howeve...BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.展开更多
基金Supported by the National Key R and D Program of China,No.2021YFC2501700 and No.2021YFC2501705and the National Natural Science Foundation of China,No.82171580 and No.81672646.
文摘BACKGROUND Studies have shown that patients with type 1 diabetes mellitus on continuous subcutaneous insulin infusion(CSII)require a lower dose of insulin than those treated with multiple daily injections(MDIs).However,it is unclear whether this is also the case for patients with type 2 diabetes mellitus(T2DM).AIM To compare insulin dosage requirements between CSII and MDI in T2DM,iden-tifying influencing factors associated with both therapeutic modalities.METHODS A total of 954 patients with T2DM were divided into two groups:CSII and MDI groups.The total daily insulin dose(TDD),TDD per kilogram per day(TDD/kg),and ratio of total basal insulin dose to TDD(%TBa)required to achieve the target blood glucose levels were compared between the two groups.In addition,factors affecting insulin dosage were analyzed in both groups of patients.RESULTS Compared to the CSII group,the MDI group required a higher TDD[median(interquartile)]:30.00(24.00,38.00)U/day vs 26.40(21.60,32.40)U/day;P<0.01,TDD/kg and%TBa.In the MDI group and CSII groups,an increase in TDD was independently associated with an increase in body mass index(BMI),waist circumference(WC),fasting plasma glucose(FPG),and glycated hemoglobin(HbA1c).The pathophysiology of type 2 diabetes mellitus(T2DM)mainly involves insulin resistance and progressiveβ-cell failure,which leads to increased blood glucose levels(hyperglycemia)[1-3].Treatment for T2DM includes antidiabetic medications and insulin therapy[4,5].Patients with T2DM withβ-cell failure usually require insulin therapy[6-8].Continuous subcutaneous insulin infusion(CSII)and multiple daily injections(MDIs)are two major insulin therapies for controlling hyperglycemia in these patients.However,excessive insulin therapies may cause problems such as hypoglycemia,weight gain,and iatrogenic hyperinsulinemia[9].Therefore,attention should be paid to the dosage of insulin used.The establishment of insulin regimens for CSII and MDI therapies is primarily guided by physicians’empirical judgment.To date,there have been few clear guidelines or recommendations on the appropriate insulin dose during CSII and MDI treatment for T2DM[10].Yang et al[11]studied insulin doses and related factors in the CSII treatment of patients with T2DM[12].However,these studies did not cover the dose setting and related factors in MDI treatment.Previous studies have shown that patients with type 1 diabetes mellitus treated with CSII require less insulin than those treated with MDIs[13-15].However,it is unclear whether patients with T2DM on CSII also require less insulin than patients on MDI.Therefore,the present study determined the difference in insulin dosages between CSII and MDI therapies and evaluated the related factors in patients with T2DM.It also systematically analyzed the insulin dose characteristics of MDI and CSII in 954 hospitalized patients with T2DM,aiming to optimize the insulin dosage regimen and provide clinical references for guiding the application of CSII and MDI in patients with T2DM.
