Prevailing wisdom has been that individuals with type 1 diabetes who take basal insulin twice a day experience better glycemic outcomes than those who only take it once a day.

Yet a recent observational study presented at the 7th International Conference on Advanced Technologies and Treatments for Diabetes (ATTD) in Austria last month suggests patients taking the twice-daily dose may not necessarily achieve improved blood sugar levels or fewer severe hypoglycemic events. However, many factors may have influenced these findings and further study is needed for any conclusive evidence.

“This was a retrospective observational analysis which to me speaks of the need to do a true randomized clinical trial with a similar insulin treatment regimen between the two groups,” said Dr. Irl Hirsch, lead author and professor of medicine at the University of Washington Medical Center. “The populations receiving once vs. twice daily may be different for many reasons so I don’t think we can make any strong conclusions, however these preliminary findings indicate the need for further study.”

The researchers of the study analyzed data from nearly 4,000 adults enrolled in the T1D Exchange Clinic Registry who self-reported taking glargine or detemir insulin one or two times a day. The median age of the participants was 32 years, 46 percent were female, and 83 percent were white non-Hispanic.

After adjusting for age, T1D duration, race/ethnicity, education, income, and daily self-monitoring blood glucose measurements, the data revealed the proportion of those who experienced severe hypoglycemic events defined as a seizure or loss of consciousness in the past twelve months was not significant—11 percent for once daily versus 13 percent for twice daily.

The T1D Exchange clinic registry, from which the patient data for the study was drawn, aims to help researchers characterize individuals living with type 1 diabetes, conduct exploratory or hypothesis-generating analyses, and identify participants for future clinical studies.

The authors of the study are Irl Hirsch, MD, professor of medicine at the University of Washington Medical Center, Stephanie DuBose, epidemiologist/biostatistician at the Jaeb Center for Health Research, Kellee Miller, epidemiologist/biostatistician at the Jaeb Center for Health Research, David Maahs, MD, assistant professor of pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado, and Roy Beck, executive director and founder of the Jaeb Center for Health Research.