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A randomized controlled trial of transition from insulin pump to multiple daily injections using insulin degludec
Author(s) -
Shah Viral N.,
Akturk Halis K.,
Joseph Hal,
Schneider Nicole,
SnellBergeon Janet K.
Publication year - 2021
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.14423
Subject(s) - insulin degludec , insulin pump , medicine , insulin , basal (medicine) , randomized controlled trial , diabetes mellitus , randomization , type 1 diabetes , adverse effect , basal insulin , anesthesia , type 2 diabetes , endocrinology
Aim To evaluate two methods of transition from an insulin pump to multiple daily injections (MDI) using long‐acting insulin degludec (IDeg). Materials and Methods After a 1‐week run‐in period, adults with type 1 diabetes for longer than 1 year and HbA1c 48‐69 mmol/mol (6.5%‐8.5%), who had been using an insulin pump at least for 6 months, were randomly transitioned to either standard of care (discontinued insulin pump and started IDeg in 1:1 dose) or overlap (IDeg 1:1 at pump basal dose, but pump continued for the first 48 hours with a gradual basal reduction; 50% from 0‐24 hours, 75% from 24‐48 hours and then pump discontinued). Participants used blinded Dexcom G6 and the IDeg dose was not changed during the trial. Primary (% time above 180 mg/dL) and secondary (% time in 70‐180 mg/dL and below 70 mg/dL) outcomes were compared between the two groups during 7 days of randomization. Results Age, gender, diabetes duration and basal/bolus insulin doses were similar between patients randomized to standard of care ( n = 17) or overlap ( n = 13) transition. Compared with overlap transition, the standard of care group spent 4.8% more time in hyperglycaemia (least square mean 4.8% [95% CI –3.3%, 12.9%]) and 5.3% less time in range (−5.3% [−12.6%, −2.0%]), without a significant difference in hypoglycaemia (0.5% [−2.3%,3.4%]). No treatment‐related adverse events were noted in either group. Conclusion The overlap transition method may result in a significant improvement in time‐in‐range without increasing hypoglycaemia during the first week of transition from an insulin pump to MDI using IDeg in adults with type 1 diabetes.