And simplification of the rules for bolus insulin administration can be utilized. The simplest guide would be to give a small amount of insulin if eating a small amount of carb, a moderate amount of insulin if eating a moderate amount of carb, and a large amount of insulin if eating a large dose of carb. And no insulin if no carb. Deciding on what's "small," "moderate," or "large" would be individually decided by the patient together with the physician. This simplification is a good place to start when introducing the system to new patients.
Now, back to the study. Although basal-bolus therapy is pretty standard in T1DM, there's not been much written about using basal-bolus insulin programs in type 2 diabetes. The authors decided to try evaluating a standard carb-counting vs. a simplified version of basal-bolus treatment in people with T2DM who were already taking insulin, with or without metformin. Over 24 weeks, they found that both programs work to lower A1C. The A1C had been in the range of 7–10% at screening, and the average A1C levels at week 24 were down to 6.70% (simple algorithm) and 6.54% (carb counting).
On the downside, severe hypoglycemia did happen, although rates were considered to be low and equal in the two groups (53 episodes of severe hypoglycemia in 19 patients on the simple algorithm, and the carb count group had 37 episodes in 19 patients). And weight increased in both groups: simple algorithm 3.6 kg (3.4%) and carb count 2.4 kg (2.3%).
I think this study is fascinating, as it demonstrates that basal-bolus insulin therapy can be an alternative for people with T2DM who need to start insulin therapy, and unsurprisingly, it shares the same concerns as any other program of insulin therapy: the risks of hypoglycemia and weight gain. The reported improvement in A1C over the short term (24 weeks) in people who were failing on other insulin programs was dramatic. How much of the improvement was due to basal-bolus therapy, vs. other parameters (such as increased adherance to meal plans and blood-glucose monitoring schedules when in a study) is unclear, but it's dramatic none-the-less.
My advice, if you are taking insulin for either T1DM or T2DM: if you are not on a basal-bolus program, and want better glucose control, and you're willing to do the extra work (giving extra shots, doing frequent blood-glucose testing, paying attention to the carbs in the food you eat, and learning to adjust insulin doses based on the carb content of the meal), it's worth thinking about switching to a basal-bolus program.
