Beneficial effects of flexible insulin therapy in children and adolescents with type 1 diabetes mellitus

Abstract

The purpose of this study was to determine the feasibility of a flexible multiple daily insulin (FMDI) regimen in routine pediatric diabetes care by comparing HbA(1c), body mass index (BMI), and episodes of severe hypoglycemia (SH) before and after initiation of FMDI therapy. Data from 44 patients (2-16 years old), on a conventional insulin (CI) regimen, were collected during quarterly diabetes clinic visits. These patients were transitioned from CI to FMDI regimen: pre-meal lispro (bolus) and once or twice daily Humulin Ultralente with or without bedtime Humulin NPH as the basal insulin. There was a significant improvement in HbA(1c) in prepubertal (9.3%+/-1.3% vs. 8.0%+/-1.1%, p<0.002) and pubertal subjects (9.2%+/-1.0% vs. 8.2%+/-0.9%, p<0.001). Pubertal subgroup demonstrated an increase in BMI (21.3+/-3.1 vs. 22.7+/-3.2 kg/m(2), p<0.0001) after one year. The rate of SH was decreased in both prepubertal ( p<0.01) and pubertal ( p<0.05) groups of patients on FMDI therapy. The use of FMDI in a general pediatric diabetic population is a feasible therapeutic option for maintenance and possible improvement of glycemic control. It may effectively decrease the HbA(1c), and reduce hypoglycemic episodes, without producing an abnormal increase in BMI.

Comparative Efficacy of Once Daily Insulin Glargine with Twice Daily NPH Insulin in Children with Type 1 Diabetes

“…The acceptance of this new insulin analogue was excellent; 34 patients in the insulin glargine group (86%) decided to continue using this treatment after completion of the study and perceived a better glycemic control as well as better quality of life. Though intensive insulin therapy with glargine has been linked with weight gain [23], our study showed age-appropriate changes in weight, height and BMI over the 6 months of study period which were not significant as shown by others [12,15]. Use of glargine in our patients was safe and well tolerated.…”

Effects of advanced carbohydrate counting in patients with Type 1 diabetes: a systematic review

“…Only minor changes in weight after introduction of advanced carbohydrate counting were documented and there were studies documenting reductions as well as studies reporting increases. It is noteworthy that one of the studies that found an increase in BMI was a study in children and adolescents and the authors commented that such increase was to be expected in growing young people . Based on the available evidence, there are no indications of an association between weight change and advanced carbohydrate counting.…”

Usefulness of the Long-acting Insulin Analogue Glargine in Basal-Bolus Therapy for Japanese Children and Adolescents with Type 1 Diabetes Mellitus

“…Hypoglycemia, including severe and nocturnal hypoglycemia, has been regarded as an almost inevitable consequence in intensified treatment of DM1, especially in younger patients 23 . More than half of the episodes of severe hypoglycemia occur during the night in pediatric patients 18 .…”