A study has shown that twice-daily administration of basal insulin leads to better glycaemic control than once-daily administration in people with type 1 diabetes who undergo the Dose Adjustment for Normal Eating (DAFNE) education programme.
The efficacy of the DAFNE programme, which is widely used in the UK, has previously been demonstrated in randomised controlled trials in which participants exclusively used twice-daily neutral protamine Hagedorn insulin; however, long-acting insulin analogues are now increasingly being prescribed in practice. Thus, a group led by Helen Hopkinson at New Victoria Hospital, Glasgow, sought to determine whether there was any relationship between basal insulin regimen and glycaemic outcomes 1 year after DAFNE training in 892 people with type 1 diabetes.
After 1 year, adjusting for baseline HbA1c, age and diabetes duration, the mean HbA1c was 2 mmol/mol (0.2%) lower in the twice-daily basal insulin group overall. The greatest improvement occurred in participants with worse baseline glycaemic control (HbA1c, >58 mmol/mol [>7.5%]) who switched from once-daily to twice-daily insulin; these participants had a decline in HbA1c of 5 mmol/mol (0.4%). However, the relative risk of severe hypoglycaemia was 1.85 (95% confidence interval, 1.01–3.42) in the twice-daily group compared with the once-daily group, although the absolute risk was low as a result of the DAFNE training. The risk of diabetic ketoacidosis was not affected.
The study can be read in full here.
