Quantifying the Presence of Insulin Overbasalization in a Family Medicine Practice

Voiceover

Presenter(s)

Rebekah Meyers

Abstract or Description

Objectives: Although basal insulin is effective in the treatment of Type 2 Diabetes Mellitus (T2DM), insulin overbasalization may prevent patients from attaining hemoglobin A1c targets and increase the risk of high glucose variability, weight gain and hypoglycemia. Overbasalization may be suspected in patients with basal insulin doses >0.5 IU/kg/day, postprandial glucose > 180mg/dL, bedtime to AM (BeAM) glucose differentials >50mg/dL, and/or A1c not at goal despite reaching fasting glucose targets. This study is intended to quantify the frequency of overbasalization in a family medicine practice.

Methods: This retrospective, observational study included adult patients with a diagnosis of T2DM prescribed any basal insulin product between June 1, 2018 and June 30, 2021 at a family medicine practice located in southwestern Pennsylvania. Data were analyzed using descriptive statistics and Chi-squared test comparing A1c goal attainment and weight gain with presence of overbasalization.

Results: A total of 105 patients met the study’s inclusion and exclusion criteria. Overbasalization (>0.5 units/kg/day) was identified in 17 (16%) patients. The average most recent A1c was 8.8%. The mean A1c among patients taking ≥0.5 units/kg/day was 9.4%.

Conclusions: The prevalence of overbasalization was lower than expected from a previous report in the literature of 40%. Lack of glycemic control and higher than average A1c among overbasalized patients supports current literature identifying overbasalization as a barrier to achieving glycemic control in T2DM. This literature may be used as a method to overcome clinical inertia in the future.

Mentor

Dr. Autumn Stewart-Lynch