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Clinical care/education/nutrition/psychosocial research
Determining starting basal rates of insulin infusion for insulin pump users: a comparison between methods
  1. Nelson Chow1,
  2. Daniel Shearer2,
  3. Hamish G Tildesley3,
  4. Jessica Aydin Plaa4,
  5. Betty Pottinger4,
  6. Monika Pawlowska5,
  7. Adam White6,
  8. Anne Priestman5,
  9. Stuart A Ross7,
  10. Hugh D Tildesley6
  1. 1Department of Biochemistry, University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Dartmouth College, Hanover, New Hampshire, USA
  4. 4Endocrine Research Society, Vancouver, British Columbia, Canada
  5. 5Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  6. 6Department of Endocrinology and Metabolism, St. Paul's Hospital, Vancouver, British Columbia, Canada
  7. 7Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Hugh D Tildesley; hdtildesley{at}gmail.com

Abstract

Objective We aimed to assess the accuracy and safety of presently available methods of estimating starting basal insulin rates for patients with type 1 and 2 diabetes, and to compare them against an empirically derived standard basal rate and a newly developed regression formula.

Research design and methods Data on 61 patients with type 1 diabetes on continuous subcutaneous insulin infusion (CSII) therapy and 34 patients with type 2 diabetes on CSII were reviewed. Patient data were first analyzed for correlations between initial patient parameters and final basal rates. Starting basal rates were then retrospectively calculated for these patients according to the weight-based method (WB-M), the total daily dose (TDD) of insulin method (TDD-M), a flat empiric value, and a new formula developed by regression analysis of clinical data. These 4 methods were subsequently compared in their accuracy and potential risk of hypoglycemia.

Results For type 1 diabetes, patient weight and TDD of long-acting insulin correlated with final basal rates. Both the regression formula and the TDD-M appeared safer than the WB-M and empirical estimates. For type 2 diabetes, only patient TDD of long-acting insulin correlated with final basal rates. The regression formula was significantly more accurate for patients with type 2 diabetes overall, but the TDD-M estimate was marginally safer.

Conclusions The pre-existing TDD-M was found to be the safest presently recommended estimate of initial basal rates for pump initiation in both type 1 and 2 diabetes. The best-fit regression was found to have potential use for type 2 CSII initiation.

  • Insulin Pump
  • Insulin Treatment in Type 2 Diabetes
  • Basal
  • Insulin Dose Management

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjdrc-2015-000145

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