Effects of Basal Doses of Insulin Treatment in Type 1 Diabetes Evaluated by Continuous Glucose Monitoring on Glucose Variability

Background: This study compared the effects of insulin glargine and insulin detemir or degludec on glucose variability with CGM technology in real-life condition of patients with T1D.

Methods: This was a paralell trial in 81 T1D patients: 27 men and 51 women, with an average age of 31.33 years, and hemoglobin A1c (HbA1c) level of 8.4%. 56 patients were treated with glargine and 25 with detemir/degludec. The primary end point was the coefficient of variation (CV) of blood glucose. Secondary end points included HbA1c, mean amplitude of glycemic excursions (MAGE) and total doses of basal insulin and rapid analogs.

Results: insulin degludec/detemir was not different to insulin glargine with respect to CV (39.42±7.64 vs. 40.37±7.38, p=0.95) and HbA1c (8.03±1.42 vs. 8.47±1.68, p=0.26). There were also no significant differences between treatment groups with respect to MAGE (305.77±7.50 vs. 300.83±10.64, p=0.71) and rapids analogs (17.92±1.34 vs. 17.50±1.88, p=0.85). Only significantly higher doses were found with insulin detemir/degludec vs. insulin glargine (33.30±5.60 vs. 21.70±1.53, p=0.01). In multiple regression analyses, the total dose of basal insulin was the only parameter positively associated with levels of HbA1c (p = 0.01).

Conclusion: the increased doses of insulin determir/degludec related to insulin glargine do not lead to a better metabolic control regarding CV or HbA1c levels.