BACKGROUND: Basal rate profiles in patients with type 1 diabetes on insulin pump therapy are subject to enormous inter-individual heterogeneity. Tools to predict basal rates based on clinical characteristics may facilitate insulin pump therapy. METHODS: Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy were collected. Basal rate tests were performed over 24 hours. A mathematical algorithm to predict individual basal rate profiles was generated by relating the individual insulin demand to selected clinical characteristics in an exploratory cohort of 170 patients. The predicted insulin pump profiles were validated in a confirmatory cohort of 169 patients. FINDINGS: Basal rates (0.27 ± 0.01 IU.d-1.kg-1) showed circadian variations with peaks corresponding to the "dawn" and "dusk" phenomena. Age, gender, duration of pump treatment, body-mass-index, HbA1c, and triacylglycerol concentrations largely predicted the individual basal insulin demand per day (IU/d; exploratory vs prospective cohorts: r2 = 0.518, P < .0001). Model-predicted and actual basal insulin rates were not different (exploratory cohort: Δ 0.1 (95% CI -0.9; 1.0 U/d; P = .95; prospective cohort: Δ -0.5 (95% CI -1.5; 0.6 IU/d; P = .46). Similarly, precise predictions were possible for each hour of the day. Actual and predicted "dawn" index correlated significantly in the exploratory but not in the confirmatory cohort. INTERPRETATION: Clinical characteristics predict 52% of the variation in individual basal rate profiles, including their diurnal fluctuations. The multivariate regression model can be used to initiate or optimize insulin pump treatment in patients with type 1 diabetes.
BACKGROUND: Basal rate profiles in patients with type 1 diabetes on insulin pump therapy are subject to enormous inter-individual heterogeneity. Tools to predict basal rates based on clinical characteristics may facilitate insulin pump therapy. METHODS: Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy were collected. Basal rate tests were performed over 24 hours. A mathematical algorithm to predict individual basal rate profiles was generated by relating the individual insulin demand to selected clinical characteristics in an exploratory cohort of 170 patients. The predicted insulin pump profiles were validated in a confirmatory cohort of 169 patients. FINDINGS: Basal rates (0.27 ± 0.01 IU.d-1.kg-1) showed circadian variations with peaks corresponding to the "dawn" and "dusk" phenomena. Age, gender, duration of pump treatment, body-mass-index, HbA1c, and triacylglycerol concentrations largely predicted the individual basal insulin demand per day (IU/d; exploratory vs prospective cohorts: r2 = 0.518, P < .0001). Model-predicted and actual basal insulin rates were not different (exploratory cohort: Δ 0.1 (95% CI -0.9; 1.0 U/d; P = .95; prospective cohort: Δ -0.5 (95% CI -1.5; 0.6 IU/d; P = .46). Similarly, precise predictions were possible for each hour of the day. Actual and predicted "dawn" index correlated significantly in the exploratory but not in the confirmatory cohort. INTERPRETATION: Clinical characteristics predict 52% of the variation in individual basal rate profiles, including their diurnal fluctuations. The multivariate regression model can be used to initiate or optimize insulin pump treatment in patients with type 1 diabetes.
Entities:
Keywords:
basal rate profiles; continuous subcutaneous insulin infusion; dawn phenomenon; dusk phenomenon; insulin pump; type 1 diabetes
Authors: Lalantha Leelarathna; Hood Thabit; Malgorzata E Willinska; Lia Bally; Julia K Mader; Sabine Arnolds; Carsten Benesch; Thomas R Pieber; Viral N Shah; Anders L Carlson; Richard M Bergenstal; Mark L Evans; Roman Hovorka Journal: Diabetes Care Date: 2020-01-16 Impact factor: 19.112
Authors: Mario Siervo; Clio Oggioni; Jose Lara; Carlos Celis-Morales; John C Mathers; Alberto Battezzati; Alessandro Leone; Anna Tagliabue; Angela Spadafranca; Simona Bertoli Journal: Maturitas Date: 2015-01-08 Impact factor: 4.342
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