Twice‐ rather than once‐daily basal insulin is associated with better glycaemic control in Type 1 diabetes mellitus 12 months after skills‐based structured education in insulin self‐management

Abstract

AimThis study investigates the relationship between basal insulin regimen and glycaemic outcomes 12 months after skills‐based structured education in the UK Dose Adjustment for Normal Eating (DAFNE) programme for Type 1 diabetes mellitus.MethodRetrospective analysis of data from 892 DAFNE participants from 11 UK centres.ResultsMean HbA1c 12 months after DAFNE was lower in those using twice‐ rather than once‐daily basal insulin after correcting for differences in baseline HbA1c, age and duration of diabetes; difference –2 (95% CI –3 to –1) mmol/mol [–0.2 (–0.3 to –0.1)%], P = 0.009. The greatest fall in HbA1c of –5 (–7 to –3) mmol/mol [–0.4 (–0.6 to –0.3)%], P < 0.001 occurred in those with less good baseline control, HbA1c ≥ 58 mmol/mol, who switched from once‐ to twice‐daily basal insulin. There was no difference in the 12‐month HbA1c between users of glargine, detemir and NPH insulin after correcting for other variables. Relative risk of severe hypoglycaemia fell by 76% and ketoacidosis by 63% 12 months after DAFNE. The rate of severe hypoglycaemia fell from 0.82 to 0.23 events/patient year in twice‐daily basal insulin users. In the group with greatest fall in HbA1c, the estimated relative risk for severe hypoglycaemia in twice‐daily basal insulin users versus once daily at 12 months was 1.72 (0.88–3.36, P = 0.110).ConclusionAfter structured education in adults with Type 1 diabetes mellitus, use of basal insulin twice rather than once daily was associated with lower HbA1c, independent of insulin type, with significant reductions in severe hypoglycaemia and ketoacidosis in all groups.

A review of the NG17 recommendations for the use of basal insulin in type 1 diabetes

“…This recommendation was consistent with recommendations from the national UK Dose Adjustment for Normal Eating (DAFNE) structured education programme, which recommends twice‐daily basal insulin . This approach was supported by observational data from graduates of the DAFNE programme, which found that those on twice‐daily basal regimens had better HbA 1c outcomes than those on once‐daily basal insulin .…”

Insulin Therapy in Adults with Type 1 Diabetes Mellitus: a Narrative Review

“…Similar glycemic control was seen with the administration of detemir either in the morning and before dinner or in the morning and at bedtime [39], and the risk of overall and nighttime hypoglycemia was found to be the same in either timing regimen [38]. Some reports indicate that the twice-daily administration of detemir is more common than once-daily dosing [40].…”

Diagnosis and management of type 1 diabetes in adults: summary of updated NICE guidance

“…• Reduction of the HbA 1c target from 53 mmol/mol to 48 mmol/mol, with an audit standard of the proportion of people achieving 53 mmol/mol rather than 58 mmol/mol, based on evidence that achieved glycated haemoglobin is always higher than the target set 15 4 • Twice daily detemir as the basal insulin regimen of choice, based on a network meta-analysis, 5 audit data, 16 and original economic analysis 5 showing its effectiveness and cost effectiveness, especially with structured education programmes…”