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Total daily dose method safe for estimating starting basal insulin pump rates
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A currently used method for estimating starting basal insulin rates for pump initiation is effective in type 1 and type 2 diabetes, according to recent findings.
Hugh D. Tildesley, MD, clinical professor in the division of endocrinology at the University of British Columbia, and colleagues evaluated patients on continuous subcutaneous insulin infusion therapy: 61 with type 1 diabetes and 34 with type 2 diabetes. Researchers compared the four following methods for accuracy in estimating starting basal insulin rates and the potential risk for hypoglycemia: weight-based method, total daily dose of insulin method, a flat empiric value and a new formula developed by regression analysis of clinical data.
Final basal rates were linked to patient weight and total daily dose of long-acting insulin in type 1 diabetes. Compared with the weight-based method and empirical estimates, the total daily dose method and regression formula were safer. Final basal rates in type 2 diabetes were linked to the patient total daily dose of long-acting insulin. Although the regression formula was more accurate in type 2 diabetes, the total daily dose method estimate was safer.
“The observation of frequent basal rate overestimations in all methods and major inaccuracies in a small number of outliers underscores the importance of expert judgement when determining initial basal rates,” the researchers wrote. “Basal insulin rate estimators are provided only as a tool; with knowledge of each estimate method’s strengths and weaknesses, trained health care professionals are better equipped to safely bridge the gap between old and new insulin therapies.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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