Anna M Lindmeyer1, Juris J Meier1, Michael A Nauck1,2. 1. Diabetes Division, Katholisches Klinikum Bochum, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Germany. 2. Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany.
Abstract
BACKGROUND: Pump-treated patients with type 1 diabetes have widely differing basal insulin infusion profiles. We analyzed consequences of such heterogeneity for glycemic control under fasting conditions. METHODS: Data from 339 adult patients with type 1 diabetes on insulin pump therapy undergoing a 24-hour fast (basal rate test) were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations as well as their proportions within, below, or above arbitrarily defined target ranges were assessed for specific periods of the day (eg, 1-7 hours, "dawn" period, 16-19 hours, "dusk" period, reference period 20-1 hours/10-14 hours), by tertiles of a predefined "dawn" index (mean basal insulin infusion rate during the "dawn" divided by the reference periods). RESULTS: The "dawn" index varied interindividually from 0.7 to 4.4. Basal insulin infusion profiles exhibited substantial differences (P = .011), especially overnight. Despite higher insulin infusion rates at 4 and 6.45 hours, patients with the most pronounced "dawn" phenomenon exhibited higher plasma glucose concentrations at those time points (P < .012). Patients with a marked "dawn" phenomenon exhibited a lower probability for low (<4.4 mmol/L) and a higher probability of high values (>7.2 mmol/L) during the dawn period (all P values <.01). CONCLUSIONS: We observe substantial interindividual heterogeneity in the "dawn" phenomenon. However, widely different empirically derived basal insulin infusion profiles appear appropriate for individual patients, as indicated by similar plasma glucose concentrations, mainly in the target range, during a 24-hour fasting period.
BACKGROUND: Pump-treated patients with type 1 diabetes have widely differing basal insulin infusion profiles. We analyzed consequences of such heterogeneity for glycemic control under fasting conditions. METHODS: Data from 339 adult patients with type 1 diabetes on insulin pump therapy undergoing a 24-hour fast (basal rate test) were retrospectively analyzed. Hourly programmed basal insulin infusion rates and plasma glucose concentrations as well as their proportions within, below, or above arbitrarily defined target ranges were assessed for specific periods of the day (eg, 1-7 hours, "dawn" period, 16-19 hours, "dusk" period, reference period 20-1 hours/10-14 hours), by tertiles of a predefined "dawn" index (mean basal insulin infusion rate during the "dawn" divided by the reference periods). RESULTS: The "dawn" index varied interindividually from 0.7 to 4.4. Basal insulin infusion profiles exhibited substantial differences (P = .011), especially overnight. Despite higher insulin infusion rates at 4 and 6.45 hours, patients with the most pronounced "dawn" phenomenon exhibited higher plasma glucose concentrations at those time points (P < .012). Patients with a marked "dawn" phenomenon exhibited a lower probability for low (<4.4 mmol/L) and a higher probability of high values (>7.2 mmol/L) during the dawn period (all P values <.01). CONCLUSIONS: We observe substantial interindividual heterogeneity in the "dawn" phenomenon. However, widely different empirically derived basal insulin infusion profiles appear appropriate for individual patients, as indicated by similar plasma glucose concentrations, mainly in the target range, during a 24-hour fasting period.
Entities:
Keywords:
basal rate profiles; continuous subcutaneous insulin infusion; dawn phenomenon; dusk phenomenon; insulin pump; type 1 diabetes
Authors: Lalantha Leelarathna; Hood Thabit; Sara Hartnell; Malgorzata E Willinska; Sibylle Dellweg; Carsten Benesch; Julia K Mader; Manuel Holzer; Harald Kojzar; Mark L Evans; Sabine Arnolds; Thomas R Pieber; Roman Hovorka Journal: J Diabetes Sci Technol Date: 2016-07-09
Authors: Jun Yoshino; Paloma Almeda-Valdes; Bruce W Patterson; Adewole L Okunade; Shin-ichiro Imai; Bettina Mittendorfer; Samuel Klein Journal: J Clin Endocrinol Metab Date: 2014-05-30 Impact factor: 5.958
Authors: Martin Tauschmann; Hood Thabit; Lia Bally; Janet M Allen; Sara Hartnell; Malgorzata E Wilinska; Yue Ruan; Judy Sibayan; Craig Kollman; Peiyao Cheng; Roy W Beck; Carlo L Acerini; Mark L Evans; David B Dunger; Daniela Elleri; Fiona Campbell; Richard M Bergenstal; Amy Criego; Viral N Shah; Lalantha Leelarathna; Roman Hovorka Journal: Lancet Date: 2018-10-03 Impact factor: 202.731