What are the treatment options for Diabetes Mellitus (DM) type 1 in adults?

From the Guidelines

Adults with type 1 diabetes should be treated with continuous subcutaneous insulin infusion or multiple daily doses of prandial and basal insulin, with a preference for insulin analogs over human insulins to minimize hypoglycemia risk. This approach is supported by the most recent guidelines from the Diabetes Care journal, published in 2025 1. The treatment plan should include:

• Continuous subcutaneous insulin infusion or multiple daily doses of prandial (injected or inhaled) and basal insulin
• Use of insulin analogs (or inhaled insulin) instead of injectable human insulins to reduce the risk of hypoglycemia
• Early implementation of continuous glucose monitoring to improve glycemic outcomes, quality of life, and minimize hypoglycemia
• Offer automated insulin delivery systems to all adults with type 1 diabetes
• Education on matching mealtime insulin doses to carbohydrate, fat, and protein intake, as well as modifying insulin doses based on concurrent glycemia, glycemic trends, and anticipated physical activity

The treatment plan should be regularly reevaluated (every 3-6 months) and adjusted to incorporate individual factors that impact treatment choice and ensure achievement of personalized glycemic goals, as recommended by the 2025 guidelines 1. This comprehensive approach aims to maintain optimal glycemic control, minimize hypoglycemia risk, and support the patient's quality of life.

From the FDA Drug Label

The safety and effectiveness of Insulin Glargine given once-daily at bedtime was compared to that of once-daily and twice-daily NPH insulin in open-label, randomized, active-controlled, parallel studies of 2,327 adult patients and 349 pediatric patients with type 1 diabetes mellitus In two clinical studies (Studies A and B), adult patients with type 1 diabetes (Study A, n=585, Study B n=534) were randomized to 28 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin. In another clinical study (Study C), patients with type 1 diabetes (n=619) were randomized to 16 weeks of basal-bolus treatment with Insulin Glargine or NPH insulin.

The treatment options for Diabetes Mellitus (DM) type 1 in adults include:

• Basal-bolus insulin regimen with Insulin Glargine or NPH insulin
• Insulin Glargine administered once-daily at bedtime
• NPH insulin administered once-daily or twice-daily
• Insulin detemir (LEVEMIR) administered once- or twice-daily as part of a basal-bolus regimen 2, 3 Key points:
• Insulin Glargine and NPH insulin had similar effects on HbA1c
• Insulin detemir (LEVEMIR) had similar efficacy to NPH human insulin and insulin glargine in reducing HbA1c
• The choice of treatment should be individualized based on patient characteristics and needs.

From the Research

Treatment Options for Diabetes Mellitus (DM) Type 1 in Adults

• The primary treatment options for type 1 diabetes mellitus (T1DM) in adults include multiple daily injections of basal/bolus insulin and continuous subcutaneous insulin infusion (CSII) 4, 5.
• Most patients with T1DM should follow a regimen of multiple daily injections of basal/bolus insulin, but those not meeting individual glycemic targets or those with frequent or severe hypoglycemia or pronounced dawn phenomenon should consider CSII 4.
• CSII could also be an alternative based on patient preferences and availability of reimbursement 4.

Insulin Management Options

• Basal insulin analogues with a reduced peak profile and an extended duration of action with lower intraindividual variability relative to neutral protamine Hagedorn insulin are preferred 4.
• The clinical advantages of basal analogues compared with older basal insulins include reduced injection burden, better efficacy, lower risk of hypoglycemic episodes (especially nocturnal), and reduced weight gain 4.
• For prandial glycemic control, any rapid-acting prandial analogue (aspart, glulisine, lispro) is preferred over regular human insulin 4, 5.
• Faster-acting insulin aspart is a relatively new option with the advantage of better postprandial glucose coverage 4.

Continuous Subcutaneous Insulin Infusion (CSII)

• CSII can provide long-term clinically relevant and sustained reductions in hypoglycemia, particularly in those with greater initial risk of hypoglycemia and higher body weight, and improved glycemic control compared with multiple daily injections (MDI) 6.
• The relative benefit of CSII over MDI was found to increase with higher baseline A1c 7.
• CSII emerges as an important modality for implementing intensive therapy and may be uniquely advantageous in patients with poor glycemic control 7.

Patient Education and Monitoring

• Frequent blood glucose measurements along with patient education on insulin dosing based on carbohydrate counting, premeal blood glucose, and anticipated physical activity is paramount 4.
• Education on the management of blood glucose under different circumstances is also important 4.
• Continuous glucose monitoring may improve glycemic control irrespective of treatment regimen 4.