Switching from Twice-Daily Basal Insulin Injections to Once-Daily Insulin Degludec Injection for Basal-Bolus Insulin Regimen in Japanese Patients with Type 1 Diabetes: A Pilot Study

The aim of this study was to investigate the efficacy of insulin degludec used for basal-bolus insulin regimen after switching from twice-daily basal insulin in Japanese patients with type 1 diabetes mellitus. The subjects were 22 type 1 diabetes patients treated with basal-bolus insulin regimen with twice-daily basal insulin. Basal insulin was switched to once-daily injection of insulin degludec with 10% dose reduction. HbA1c and fasting plasma glucose (FPG) were measured before and 12 weeks after switching. The frequency of hypoglycemic episodes, standard deviation (SD) of blood glucose, and mean of daily difference (MODD) were evaluated by continuous glucose monitoring (CGM) before and 4 weeks after switching. HbA1c and FPG before and 12 weeks after switching were comparable (HbA1c 8.5 ± 1.4 versus 8.7 ± 1.6%, P=0.28; FPG 203.2 ± 81.2 versus 206.5 ± 122.4 mg/dL, P=0.91). The frequency of hypoglycemia during nighttime was not significantly different at 4 weeks after switching (14.4 ± 17.0 versus 11.1 ± 15.0%, P=0.45). In addition, SD and MODD before and 4 weeks after switching were also comparable. In conclusion, glycemic control under once-daily insulin degludec injection was almost comparable to that under twice-daily basal insulin injections in Japanese type 1 diabetes patients. This study was registered with ID: UMIN000010474

One year follow-up after a randomized controlled trial of a 130 g/day low-carbohydrate diet in patients with type 2 diabetes mellitus and poor glycemic control

<div><p>Background & aims</p><p>Recently, we conducted a prospective randomized controlled trial (RCT) showing that a 6-month 130g/day low-carbohydrate diet (LCD) reduced HbA1c and BMI more than a calorie restricted diet (CRD). [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188892#pone.0188892.ref001" target="_blank">1</a>] To assess whether the benefits of the LCD persisted after the intensive intervention, we compared HbA1c and BMI between the LCD and CRD groups at 1 year after the end of the 6-month RCT.</p><p>Methods</p><p>Following the end of the 6-month RCT, patients were allowed to manage their own diets with periodic outpatient visits. One year later, we analyzed clinical and nutrition data.</p><p>Results</p><p>Of the 66 participants in the original study, 27 in the CRD group and 22 in the LCD group completed this trial. One year after the end of the original RCT, the carbohydrate intake was comparable between the groups (215 [189–243]/day in the CRD group and 214 (176–262) g/day in the LCD group). Compared with the baseline data, HbA1c and BMI were decreased in both groups (CRD: HbA1c -0.4 [-0.9 to 0.3] % and BMI -0.63 [-1.20 to 0.18] kg/m²; LCD: HbA1c -0.35 [-1.0 to 0.35] % and BMI -0.77 [-1.15 to -0.12] kg/m²). There were no significant differences in HbA1c and BMI between the groups.</p><p>Conclusions</p><p>One year after the diet therapy intervention, the beneficial effect of the LCD on reduction of HbA1c and BMI did not persist in comparison with CRD. However, combining the data of both groups, significant improvements in HbA1c and BMI from baseline were observed. Although the superiority of the LCD disappeared 1 year after the intensive intervention, these data suggest that well-constructed nutrition therapy programs, both CRD and LCD, were equally effective in improving HbA1c for at least 1 year.</p><p>Trial registration</p><p>University Hospital Medical Information Network (UMIN) <a href="https://clinicaltrials.gov/ct2/show/ID000010663" target="_blank">ID000010663</a></p></div

Characteristics of 49 patients at the RCT baseline, and changes in medication dosages at the end of 1-year follow-up.

<p>Characteristics of 49 patients at the RCT baseline, and changes in medication dosages at the end of 1-year follow-up.</p

Study flow chart.

<p>The baseline data of the study subjects are shown in Tables <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188892#pone.0188892.t001" target="_blank">1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188892#pone.0188892.t002" target="_blank">2</a>. Except for age and fat intake, other data were well-matched.</p

Data at baseline, 6 months, and 18 months for 49 patients in the calorie-restricted diet (CRD) group and the low-carbohydrate diet (LCD) group.

<p>Data at baseline, 6 months, and 18 months for 49 patients in the calorie-restricted diet (CRD) group and the low-carbohydrate diet (LCD) group.</p