Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
Division of Biomedical Sciences, Warwick Medical School, Coventry, UK.
J Diabetes. 2018 Feb;10(2):140-147. doi: 10.1111/1753-0407.12572. Epub 2017 Jun 28.
Establishing an optimal insulin regimen is crucial for maintaining glycemic control in patients with type 1 diabetes (T1D). The aim of the present study was to determine the insulin dose required to achieve an HbA1c concentration ≤7.5% in Japanese patients with T1D.
The present multicenter cross-sectional study was performed at three institutes in Japan. Information was collected regarding patient age, sex, body weight, body mass index (BMI), HbA1c, total daily insulin dose (TDD), and total basal insulin dose (TBD), and the effects of these factors on achieving HbA1c ≤7.5% were investigated.
Of 107 patients with T1D, 92 had no detectable endogenous insulin secretion: 39 had HbA1c ≤7.5% (well-controlled group) and 53 had HbA1c >7.5% (poorly controlled group). No significant differences in age, sex, height, body weight, BMI, diabetes duration, stage of diabetic kidney disease, treatment, or TDD were noted between the poorly and well-controlled groups. The TBD as a percentage of TDD (%TBD) was lower in patients with well-controlled diabetes ( P < 0.05) after adjustment for age, gender, and diabetes duration. In the well-controlled group, TDD was correlated with body weight ( R = 0.51), BMI ( R = 0.44), body surface area ( R = 0.41), and TBD ( R = 0.73; P < 0.01 for all), but TBD was not correlated with BMI or body surface area. In our population, a %TBD of approximately 30% was appropriate, without considering BMI.
To achieve HbA1c ≤7.5 in patients with T1D, TDD should be calculated based on body weight, and the %TBD should be set at 30% in the Japanese population.
对于 1 型糖尿病（T1D）患者来说，建立最佳的胰岛素方案对于维持血糖控制至关重要。本研究旨在确定日本 T1D 患者达到 HbA1c≤7.5%所需的胰岛素剂量。
本多中心横断面研究在日本的三个机构进行。收集了患者年龄、性别、体重、体重指数（BMI）、HbA1c、总日胰岛素剂量（TDD）和总基础胰岛素剂量（TBD）等信息，并探讨了这些因素对达到 HbA1c≤7.5%的影响。
在 107 例 T1D 患者中，92 例无可检测的内源性胰岛素分泌：39 例 HbA1c≤7.5%（控制良好组），53 例 HbA1c>7.5%（控制不佳组）。两组在年龄、性别、身高、体重、BMI、糖尿病病程、糖尿病肾病分期、治疗方法或 TDD 方面无显著差异。校正年龄、性别和糖尿病病程后，控制良好组的 TBD 占 TDD 的百分比（%TBD）较低（P<0.05）。在控制良好组中，TDD 与体重（R=0.51）、BMI（R=0.44）、体表面积（R=0.41）和 TBD（R=0.73；均 P<0.01）呈正相关，但 TBD 与 BMI 或体表面积无关。在我们的人群中，不考虑 BMI，%TBD 约为 30%是合适的。
对于 T1D 患者，要达到 HbA1c≤7.5%，TDD 应根据体重计算，日本人群的%TBD 应设定为 30%。
