ArticleAACE endocrinology and diabetes
A Novel Approach to Treating Adults With Type 1 Diabetes and Recurrent Diabetic Ketoacidosis: Once-Daily Subcutaneous Basal Insulin With Hybrid Closed-Loop Insulin Pump Therapy.
Article in AACE endocrinology and diabetes. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: We assessed the impact of adding subcutaneous basal insulin to hybrid closed-loop insulin pump therapy on diabetic ketoacidosis (DKA) rates and glycemic outcomes in adults with type 1 diabetes (T1D) and recurrent DKA. Methods: We conducted a retrospective review of electronic health records from adults with T1D and recurrent DKA who received concurrent treatment with subcutaneous basal insulin and hybrid closed-loop insulin pump therapy at an academic health system in the United States. We performed an as-treated analysis using descriptive statistics. Results: Our cohort included 5 adults (3 women, 2 men; mean age 39.4 ± 10.8 years) with T1D and recurrent DKA. Due to elevated DKA risk, all 5 adults were initiated on once-daily subcutaneous basal insulin (degludec or glargine, mean dose 0.14 units/kg/d, range 0.07-0.22 units/kg/d) in addition to insulin pump therapy (Omnipod 5 with automated insulin delivery). Mean HbA1c decreased from 9.3% (79 mmol/mol) (days -360 to -1) to 8.2% (66 mmol/mol) (days 0 to 360) following the intervention. The frequency of DKA-related hospitalizations decreased from a mean of 2.0 events per person (days -360 to -1) to 0.75 events per person (days 0 to 360). One individual discontinued subcutaneous basal insulin due to recurrent level 1 hypoglycemia. Conclusion: Adding once-daily subcutaneous basal insulin to hybrid closed-loop therapy may have the potential to reduce DKA-related hospitalizations and improve glycemic outcomes in adults with T1D and recurrent DKA. However, given this was a retrospective study with a small cohort, further research is needed to rigorously evaluate this approach.
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