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Chung, Cho, Chung, and Chung: Determining the Factors that Influence the Insulin Requirements in Type 2 Diabetic Patients
Original Article
Endocrinology and Metabolism

Endocrinology and Metabolism 2010; 25(2): 110-118.

Published online: 30 June 2010

DOI: https://doi.org/10.3803/EnM.2010.25.2.110

Determining the Factors that Influence the Insulin Requirements in Type 2 Diabetic Patients

Jin Ook Chung, Dong Hyeok Cho, Dong Jin Chung, Min Young Chung

Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.

Corresponding author: Min Young Chung. Department of Internal Medicine, Chonnam National University Medical School, 8 Hak-dong, Dong-gu, Gwangju 501-757, Korea. Tel: +82.62-220-6500, Fax: +82.62-225-8578, mychung@chonnam.ac.kr

Received 4 September 2009       Accepted 27 January 2010

Copyright © 2010 Korean Endocrine Society

Abstract

Background

The initial insulin dose is often determined by clinical experience or with a formula using the body weight. However, it may be difficult to determine the initial insulin dose because various factors such as insulin sensitivity and the glycemic status can influence the insulin requirement. The purpose of this study was to assess the factors that influence the initial insulin requirement in insulin naive patients with type 2 diabetes mellitus.

Methods

A total 128 patients who were admitted for glycemic control were investigated. The patients were managed with long-acting insulin glargine and rapid-acting insulin lispro.

Results

The basal insulin requirement was positively correlated with waist circumference, body mass index (BMI), the HbA1C, AST, ALT, fasting plasma glucose and 2-hour postprandial glucose levels and the homeostasis model assessment of insulin resistance (HOMA-IR), but it was negatively correlated with age and the stimulated C-peptide level. The daily insulin requirement was positively correlated with waist circumference, BMI, the HbA1C, AST, ALT, triglyceride, fasting plasma glucose and 2-hour postprandial glucose level and HOMA-IR, but it was negatively correlated with age. On the multiple linear regression analysis, the basal insulin requirement was independently associated with BMI (β = 0.507, p < 0.001), the 2-hour postprandial glucose level (β = 0.307, p < 0.001), the ALT level (β = 0.214, P = 0.015) and the meal-stimulated C-peptide level (β = -0.209, P = 0.010). The daily insulin requirement was independently associated with BMI (β = 0.508, p < 0.001) and the 2-hour postprandial glucose level (β = 0.404, p < 0.001).

Conclusion

Our results show that the BMI and 2-hour postprandial glucose level are useful predictors of the initial insulin requirement in insulin naive type 2 diabetic patients. It may be prudent to consider the other various factors that influence the insulin requirement together when insulin therapy is required.

Keywords: Body mass index, Diabetes mellitus, Insulin

Figures and Tables

Fig. 1
Insulin protocol. The algorithm shows initiation and titration of insulin regimens.
enm-25-110-g001
Table 1
Clinical characteristics of study population
enm-25-110-i001

Data are median (interquartile range).

BMI, body mass index; DBP, diastolic blood pressure; DM, diabetes mellitus; FBS, fasting blood glucose; FFA, free fatty acid; HDL-C, high density lipoprotein cholesterol; HOMA-IR, homeostasis model assessment: insulin resistance; hs-CRP, high sensitivity C reactive protein; LDL-C, low density lipoprotein cholesterol; OHA, oral hypoglycemic agent; PP2hr glucose, 2-hour postprandial glucose; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; UAE, urinary albumin excretion rate; WC, waist circumference.

*P < 0.05, men vs. women.

Table 2
Insulin requirements for plasma glucose control in type 2 diabetic patients
enm-25-110-i002

Data are median (interquartile range). BB, before breakfast; BL, before lunch; BS, before supper.

Data were analyzed by Mann-Whitney U-test. There were no significant difference between men and women.

Table 3
Simple correlation between insulin dosage and other parameters in type 2 diabetic patients
enm-25-110-i003

*p < 0.05, †p < 0.01, ‡p < 0.001, §Prandial insulin before breakfast.

BMI, body mass index; BW, body weight; DBP, diastolic blood pressure; DM, diabetes mellitus; FBS, fasting blood glucose; FFA, free fatty acid; HDL-C, high density lipoprotein cholesterol; HOMA-IR, homeostasis model assessment: insulin resistance; hs-CRP, high sensitivity C reactive protein; LDL-C, low density lipoprotein cholesterol; PP2hr glucose, 2-hour postprandial glucose; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; UAE, urinary albumin excretion rate; WC, waist circumference; NS, not significant.

Table 4
Multivariate linear regression analysis with basal insulin dose as the dependent variable
enm-25-110-i004

The log transformed variables were used for analysis.

BMI, body mass index; PP2hr glucose, 2-hour postprandial glucose.

Table 5
Multivariate linear regression analysis with prandial insulin does as the dependent variable
enm-25-110-i005

*Prandial insulin before breakfast.

The log transformed variables were used for analysis.

HOMA-IR, homeostasis model assessment: insulin resistance; PP2hr glucose, 2-hour postprandial glucose.

Table 6
Multivariable linear regression analysis with total daily insulin dose as the dependent variable
enm-25-110-i006

The log transformed variables were used for analysis.

BMI, body mass index; PP2hr glucose, 2-hour postprandial glucose.

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