Type 1 Diabetes: When Basal-Bolus Injection Therapy Has Not Achieved Glycemic Targets

For adults with type 1 diabetes who remain above glycemic targets despite basal-bolus injection therapy, an evidence-based next-line protocol exists. The approach is distinct from multiple daily injections and is directed at improving A1C.

Previous treatment — failure condition

Targets not achieved

Prior therapy: Basal-bolus injection therapy — a basal long-acting insulin analogue given subcutaneously once or twice daily, combined with a prandial rapid-acting insulin analogue injected before or at each meal.

Goals that were not reached: Adequate lowering of fasting plasma glucose, adequate lowering of postprandial blood glucose, and avoidance of hypoglycemia.

Next-line approach

This protocol

When basal-bolus injection therapy fails, the next step involves a continuous subcutaneous method of insulin delivery — fundamentally different from multiple daily injections — which may be used alongside continuous glucose monitoring. The complete protocol specifies which insulin and monitoring options apply.

Clinical goal: Improvement in A1C (glycated hemoglobin).

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jcjd.2017.10.012

In adults with type 1 diabetes on basal-bolus injection therapy who are not achieving glycemic targets, CSII with or without CGM may be used to improve A1C.

The 3 rapid-acting insulin analogues approved for CSII are insulin lispro, aspart and glulisine.

CSII may be used instead of basal-bolus injection therapy to improve treatment satisfaction.

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