Pauta óptima de administración de insulina detemir en sujetos diabéticos tipo 1 con mal control metabólico / Optimal timing of insulin detemir injection in patients with type 1 diabetes and poor metabolic control

Objetivo El objetivo de este estudio fue comparar diversos regímenes de administración de la insulina detemir (IDet) en pacientes con diabetes tipo I y mal control metabólico.Material y métodosEstudio abierto aleatorizado de 24 semanas de duración. Se incluyeron 39 pacientes con diabetes mellitus (DM) tipo I aleatorizados a una inyección de IDet antes de la comida (14,24±00,36[±SD]h) o IDet antes de acostarse (23,19±0,42h). Si no se alcanzaban los objetivos de glucemia, se cambió a la pauta con 2 inyecciones (IDet-12h). En las comidas se administró insulina aspart.ResultadosEn la semana 24 solamente un 12,2% de los pacientes permanecían en el grupo IDet antes de acostarse y un 30,3% en el grupo IDet antes de la comida. El 57,5% restantes pasaron al grupo de IDet-12h. No hubo diferencias entre el grupo de IDet antes de la comida e IDet antes de acostarse. Un subanálisis incluyendo los 3 grupos demostró un mejor control metabólico en el grupo IDet antes de la comida (hemoglobina glicosilada (HbA1c) 7,1±0,2 vs. 7,6±0,4 y 8,1±0,2%, en IDet antes de la comida, IDet antes de acostarse e IDet-12h, respectivamente; p<0,05). El valor de HbA1c inferior a 7%, fue alcanzado en un 30,3% de los pacientes, un 15,2% en el grupo IDet antes de la comida, un 3,3% en el grupo IDet antes de acostarse y 11,5% en grupo IDet-12h. No se encontraron diferencias entre los grupos del tratamiento respecto a la calidad de vida.ConclusiónUna inyección de IDet administrada antes de la comida podría mejorar el control metabólico. Sin embargo, la mayoría de pacientes requiere 2 inyecciones de IDet (AU)

Aim To compare different administration times of insulin detemir (IDet) in patients with type 1 diabetes and poor metabolic control.Material and MethodsThis 24-week open study included 39 people with type 1 diabetes mellitus (DM) randomized to one injection of IDet before lunch (mean 14.24±00.36 (±SD) h) or at bedtime (23.19±0.42h). Whenever target glycemia levels were not reached, the regimen was switched to insulin therapy with two injections (IDet-12h). Insulin aspart was used before main meals.ResultsAt week 24, only 12.2% of patients remained in the IDet bedtime group and 30.3% in the IDet before lunch group. The remaining 57.5% joined the IDet-12h group. There were no differences between the IDet before lunch and IDet bedtime groups. A subanalysis including the three groups demonstrated better metabolic control in the IDet before lunch group (glycosylated hemoglobin (HbA1c) 7.1±0.2 vs. 7.6±0.4 and 8.1±0.2% in IDet before-lunch, IDet bedtime and IDet-12h, respectively; p<0.05). An HbA1c value below 7% was achieved in 30.3% of the patients: 15.2% in the IDet before-lunch group, 3.3% in the IDet bedtime group and 12.2% in IDet-12h group. Quality of life did not differ among treatment groups.ConclusionsOne injection of IDet administered before lunch could improve metabolic control. However, most patients required two injections of IDet(AU)

[Optimal timing of insulin detemir injection in patients with type 1 diabetes and poor metabolic control]. / Pauta óptima de administración de insulina detemir en sujetos diabéticos tipo 1 con mal control metabólico.

AIM: To compare different administration times of insulin detemir (IDet) in patients with type 1 diabetes and poor metabolic control. MATERIAL AND METHODS: This 24-week open study included 39 people with type 1 diabetes mellitus (DM) randomized to one injection of IDet before lunch (mean 14.24 + or - 00.36 (+ or - SD) h) or at bedtime (23.19 + or - 0.42 h). Whenever target glycemia levels were not reached, the regimen was switched to insulin therapy with two injections (IDet-12h). Insulin aspart was used before main meals. RESULTS: At week 24, only 12.2% of patients remained in the IDet bedtime group and 30.3% in the IDet before lunch group. The remaining 57.5% joined the IDet-12h group. There were no differences between the IDet before lunch and IDet bedtime groups. A subanalysis including the three groups demonstrated better metabolic control in the IDet before lunch group (glycosylated hemoglobin (HbA1c) 7.1 + or - 0.2 vs. 7.6 + or - 0.4 and 8.1 + or - 0.2% in IDet before-lunch, IDet bedtime and IDet-12h, respectively; p<0.05). An HbA1c value below 7% was achieved in 30.3% of the patients: 15.2% in the IDet before-lunch group, 3.3% in the IDet bedtime group and 12.2% in IDet-12h group. Quality of life did not differ among treatment groups. CONCLUSIONS: One injection of IDet administered before lunch could improve metabolic control. However, most patients required two injections of IDet.