Insulin requirement profiles and related factors of insulin pump therapy in patients with type 2 diabetes

Hand grip strength is inversely associated with total daily insulin dose requirement in patients with type 2 diabetes mellitus: a cross-sectional study

Background

Short-term (2 weeks to 3 months) insulin intensive therapy using continuous subcutaneous insulin infusion (CSII) can improve islet beta cell function and prolong glycemic remission in patients with newly diagnosed type 2 diabetes mellitus (T2DM). However, the total daily insulin dose (TDD, IU/kg/d) required to achieve near-normoglycemic control with CSII still needs to be frequently adjusted based on blood glucose monitoring. Although real-time continuous glucose monitoring (rtCGM), which measures the interstitial fluid glucose concentration continuously without much difficulty, facilitates the adjustment of insulin dosage, its adoption in the T2DM population is strictly limited by insurance coverage and lack of awareness of rtCGM among clinicians. Thus, it is of clinical significance to identify easy-to-use parameters that may allow a more rapid and accurate prediction of TDD requirement. This study aimed to explore the association between hand grip strength (HGS) and TDD requirement in patients with T2DM receiving CSII therapy.

Methods

A total of 180 eligible patients with T2DM were enrolled in the study and divided into three groups based on their HGS: low (L), medium (M), and high (H). The TDD requirement was calculated on day 7 or 8 of CSII treatment. Anthropometric parameters, including HGS, skeletal muscle mass, skeletal muscle index (SMI) and 6-m gait speed, and laboratory data, were collected on the morning of the second day after admission, within the first 24 h of CSII therapy. These parameters were used to identify significant predictors of TDD requirement using Pearson or Spearman correlation test, and stepwise multiple regression analysis.

Results

There were no significant differences in age, duration of T2DM, waist-to-hip ratio (WHR), body mass index (BMI), blood pressure, liver function, estimated glomerular filtration rate, triglyceride, total cholesterol, glycosylated hemoglobin A1c (HbA1c), homeostatic model assessment of insulin resistance (HOMA-IR), and homeostasis model assessment of beta cell function (HOMA-β) among the groups. The H group had higher body muscle mass-to-fat ratio (BMFR), skeletal muscle mass-to-fat ratio (SMFR), SMI, 6-m gait speed, and lower TDD requirement than the M and L groups. The HGS negatively correlated with TDD requirement (r = -0.33, p < 0.001) after adjusting for sex, age, BMI, WHR, HbA1c, Ln (HOMA-β), Ln (HOMA-IR), Ln (BMFR), Ln (SMFR), SMI, and 6-m gait speed. Multivariate stepwise regression analysis indicated that HGS was an independent predictor of TDD requirement in patients with T2DM (β = -0.45, p < 0 001).

Conclusion

Lower HGS is associated with an increased TDD requirement in T2DM patients. HGS may facilitate the prediction of TDD requirement in T2DM patients receiving CSII therapy.

The relationship between different C-peptide level and insulin dose of insulin pump

Background

This study aims to explore the insulin requirement profiles, and analyze the related factors of type-2 diabetes mellitus (T2DM) with different C-peptide levels on insulin pump therapy.

Methods

A retrospective study was conducted on 271 T2DM patients treated with insulin pumps from 2016 to 2018. These patients were divided into groups according to the ratio of C-peptide at 2 h after meals to fasting C-peptide (C₂h/C₀), and the dosage of insulin and influencing factors were analyzed.

Results

In comparing group A (C_2h/C₀ < 2.5) with group B (C_2h/C₀ ≥ 2.5), the percentage of the base amount in total (%TBa, 0.50 ± 0.06) in group A was higher than that in group B (0.48 ± 0.05) (P < 0.05). Furthermore, there was a correlation between C_2h/C₀ and waist circumference, HbA1c, Fasting Plasma Glucose (FPG) and Blood glucose 2 h after meal (2hPG) (r = −0.137, −0.154, −0.471, and −0.172; all, P < 0.05). The multiple linear regression analysis revealed that BMI and FPG were independent factors of %TBa (β′ = 0.124 and 0.144; all, P < 0.05), and BMI and FPG were independent factors of C_2h/C₀ (β′ = −0.134 and −0.502; all, P < 0.05).

Conclusions

The basal premeal dose ratio of T2DM with different C-peptide levels differs during intensive insulin pump therapy. Parameters that indicate the glycemic control and β-cell function should be taken into consideration for total insulin requirements.