ORIGINAL RESEARCH ARTICLE
Basal and Bolus Insulin Dose Changes after Switching Basal
Insulin to Insulin Degludec in Patients with Type 1
Diabetes Mellitus: A Pilot Study
Published online: 17 June 2017
Ó Springer International Publishing Switzerland 2017
Background and objectives Ultra-long-acting insulin
degludec (DEG) has a longer duration of action and less
daily variability relative to other basal insulin (BI), and
thus may beneﬁt patients with type 1 diabetes mellitus
(T1DM). We examined the impact of switching BI to DEG
on glycemic control and insulin dose in T1DM.
Methods T1DM patients (n = 22; six male; mean age:
64.5 ± 12.6 years) receiving basal-bolus insulin therapy
were included. Initially, the BI dose was replaced with
DEG in a 1:1 ratio; 80–100% of the total dose was replaced
with DEG for multiple basal insulin injections. DEG was
titrated according to study protocol. Changes in HbA1c,
daily insulin dose, glycemic self-monitored blood glucose
variations, and hypoglycemia frequency were evaluated for
Results Once-daily DEG signiﬁcantly decreased HbA1c
levels when switched from once-daily BI (7.9 ± 0.8 vs.
7.5 ± 0.9%, p = 0.020) and maintained HbA1c when
switched from twice-daily BI (8.5 ± 1.6 vs. 8.4 ± 1.2%,
p = 0.457). The BI dose decreased by -7.8 ± 13.9%
(p = 0.017) and -16.6 ± 16.9% (p = 0.050) when swit-
ched from once-daily BI and twice-daily BI, respectively.
The total bolus insulin dose signiﬁcantly decreased when
switched from once-daily BI (21.7 ± 8.3 to 19.3 ± 8.8
U/day, p = 0.016) especially in the injection before
breakfast and evening meal. Body weight and hypo-
glycemia frequency was not signiﬁcantly different.
Conclusion DEG improved glycemic control when swit-
ched from once-daily BI and maintained glycemic control
when switched from twice-daily BI without increasing
Switching basal insulin to degludec improved
glycemia and reduced basal and bolus insulin doses
in patients with T1DM.
The beneﬁt of changing basal insulin to degludec
was more prominent when switched from once-daily
basal insulin injection.
Adjustment of bolus insulin dosing was different
between switching from once daily and twice daily.
Insulin degludec, a newly developed and ultra-long-acting
form of insulin, was reported to have a much longer
duration of action and less day-to-day variability than other
types of basal insulin. Speciﬁcally, pharmacokinetic anal-
ysis of insulin degludec identiﬁed a ﬂat, stable proﬁle with
a terminal half-life and a duration of action exceeding 25
and 40 h, respectively [1, 2]. In addition, pharmacody-
namic data revealed a fourfold decrease in day-to-day
variability with insulin degludec vs. insulin glargine .
& Yoshiyuki Hamamoto
Center for Diabetes and Endocrinology, The Tazuke Kofukai
Foundation, Medical Research Institute, Kitano Hospital,
Ikeda Hospital, Ikeda, Hyogo, Japan
Present Address: Center for Diabetes, Endocrinology and
Metabolism, Kansai Electric Power Hospital, Osaka
Clin Drug Investig (2017) 37:845–852