EFFECT OF BMI, INSULIN DOSE AND NUMBER OF INJECTIONS ON GLYCEMIC CONTROL IN INSULIN-USING DIABETIC-PATIENTS

Background: Strict glucose control is essential to the prevention of d iabetic complications. The level of glycaemic control in insulin-treat ed patients with diabetes mellitus (DM) in a routine clinical setting is not known. Methods: In a cross-sectional survey comprising 8 hospit als in the Rijnmond area, The Netherlands, age, body mass index (BMI), insulin dose, number of injections, and HbA1(c) were scored in 712 pa tients with insulin-dependent DM (IDDM) and 462 patients with non-insu lin-dependent DM (NIDDM). Results: In IDDM and NIDDM patients, respect ively, age (mean +/- SD) was 40 +/- 17 and 65 +/- 12 years, BMI was 24 .1 +/- 3.5 and 27.3 +/- 4.1 kg/m(2), daily insulin dose was 49 +/- 18 and 44 +/- 18 U (P < 0.001). Intensive therapy (greater than or equal to 4 injections or continuous subcutaneous insulin infusion) was used in 59% of IDDM and 13% of NIDDM patients. HbA1(c) below the upper norm al limit was achieved in 11% of the patients, and within 20% above the upper normal limit in 37%. Obesity was positively associated with HbA 1(c) in NIDDM patients (P < 0.01). A higher insulin dose was associate d with higher HbA1(c) in both IDDM and NIDDM patients (P < 0.01). Conc lusions: Good glycaemic control was established in 37% of our patients . Intensive insulin treatment and higher insulin dose did not improve glucose regulation. Obesity is a risk factor for poor glycaemic contro l. (C) 1997 Elsevier Science B.V.