[Optimal timing of insulin detemir injection in patients with type 1 diabetes and poor metabolic control].

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.