Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-8

which impairs the person’s ability to engage in appropriate self-care decisions, is unclear, but appears significant (8). • In 1993, the DCCT reported that IT is accompanied by a three-fold increase in severe hypoglycemia (10). This statistic is often quoted as a reason not to intensify therapy for many individuals. However, with the use of newer insulin analogues since the publication of the DCCT, IT is able to achieve similar A1C levels without the same rate of hypoglycemia (15,16-18). • Chase et al. reported on the reduced rates of severe hypoglycemia observed since the introduction of rapid-acting insulin to the IT regimen (19). When a rapid-acting insulin was used, the number of severe hypoglycemic events did not increase, despite a lowering of A1C to a mean for adults of 7.98% compared with 8.14% when short-acting insulin was used. • IT is both a cause of hypoglycemia and a preventive treatment. With adequate SME and SMS, appropriate BG targets, and professional support, IT may result in less hypoglycemia than previously reported (20). See Chapter 7: Monitoring for more information about hypoglycemia. IT in type 1 diabetes The results of the DCCT demonstrated that BBI therapies (three or more insulin injections or the use of an insulin pump) with type 1 diabetes significantly delayed the onset and progression of microvascular complications (10). The DCCT cohort continues to be followed in the Epidemiology of Diabetes Interventions and Complications (EDIC) study (21). It has reported long-term benefits of reduction in microvascular complication and significant reduction in macrovascular complications supporting the earliest possible adoption of IT to achieve an A1C <7% (10). IT in type 2 diabetes NOTE: In this chapter, IT refers to basal-bolus insulin therapy, not intensified therapy with oral and injectable agents. • IT for type 2 diabetes is increasingly accepted by both health-care professionals and patients (22). As Hirsch points out, patients with an A1C of >9% are likely to need basal and prandial insulin, and IT is an option for these patients (17).