Challenging the 50‐50 rule for the basal‐bolus insulin ratio in patients with type 2 diabetes who maintain stable glycaemic control
Authors' conclusion
Our data show that a 50-50 ratio of basal-to-bolus insulin does not generally apply to patients with T2D who successfully maintain stable glycemia. Therefore, the 50-50 ratio should not serve as an ongoing treatment guide. Moreover, our results emphasize the importance of at least weekly insulin titrations.
Study context
- Population
- Patients with T2D on basal-bolus insulin therapy >80% of the time, on d-Nav >6 months, no data gap >3 months; Diabetes Centre of Ulster Hospital
- Participants
- 306 patients
- Outcome
- Average basal insulin fraction of total daily insulin (assessment of the 50-50 basal-bolus rule)
Methodological detailsreal-world, AI-driven insulin titration (d-Nav)
- Real-world
- AI-driven insulin titration (d-Nav)
Main finding
As reported in the abstract
Average basal insulin fraction
- Patients with average basal insulin fraction <50%
- just over three-quarters of the cohort
- Median average basal insulin fraction (half of cohort below)
- <41.2%
- Basal insulin fraction in one-quarter of cohort
- <33.6%
Observational data: associations, not effects.
Further findings
Variation of basal insulin fraction over time
- Basal insulin fraction varied by ≥1.9× in half of patients
- Basal insulin fraction varied by ≥2.5× in 25% of patients
Glycaemic control (HbA1c) · after initial run-in period
- Mean HbA1c maintained close to 7%
Follow-up by d-Nav service
- Follow-up duration (mean ± SD)
- 3.4 ± 1.8 years
- Autonomous insulin dose titrations per patient
- about 180
- Autonomous individual dose recommendations per patient
- about 5000
Original publication
Challenging the 50‐50 rule for the basal‐bolus insulin ratio in patients with type 2 diabetes who maintain stable glycaemic control. Diabetes Obes Metab. Published 2 December 2022. doi:10.
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