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

Abstract

Objective: To compare the efficacy of insulin glargine and insulin NPH in terms of glycemic control and risk of hypoglycemia in children with Type 1 diabetes (T1D) mellitus.Design: Prospective, randomized, open label, controlled trial.Setting: Pediatric Diabetes Clinic of a tertiary care hospital.Subjects: Eighty T1D children between 2 to12 years diagnosed for at least six months. Randomization:Computer generated random number table was used to randomize the patients into Glargine (n=40) and NPH (n=40) groups. Intervention:Patients received either once daily insulin glargine or twice daily NPH insulin as basal insulin. Monthly follow up was done for 6 consecutive months. Results:In the glargine group, significant reductions were noted from baseline to endpoint in mean fasting blood glucose (FBG) (152.80 ± 22.92 versus 113.08 ± 14.71, p value < 0.001), mean blood glucose (MBG) (171.0 ± 23.02 versus 126.20 ± 13.29, p value < 0.001), glycated hemoglobin (HbA1c) (8.89 ± 1.48 versus 7.44 ± 0.74, p value < 0.001), mean total insulin dose (0.92 ± 0.37 units/kg/day versus 0.70 ± 0.29, p value < 0.043), mean basal insulin dose (0.78 ± 0.34 versus 0.53 ± 0.23, p value < 0.001) and mean number of all types of hypoglycemic episodes whereas, mean unmodified insulin dose (0.14 ± 0.14 versus 0.16 ± 0.14, p value 1.000) remained unchanged. The changes in all these parameters in the NPH group were not significant. The percentage of patients suffering at least one episode of hypoglycemia was significantly less with glargine in contrast to NPH (2.02 ± 0.43 versus 2.36 ± 0.47, p value 0.001). Conclusion:Glargine was found to be more effective than NPH insulin for glycemic control and incidence of hypoglycemia in children with T1D.

Real-world experience of using basal insulin analogues in children with type 1 diabetes: is twice-daily dosing of insulin detemir justified?

“…These results indicate a similar efficacy of both basal analogues when used in once-daily dosing in routine clinical practice and are consistent with our previous studies in children with T1D [2,3]. The common belief amongst physicians that a twice-daily dosing is required in a substantial proportion of patients who are on iDet could not be ascertained in this small study [1].…”

“…In addition to the concerns regarding the last few hours of the iDet action, twice-daily dosing also results in increased costs and hence its limited use in resource-poor settings. Unfortunately, most of the studies on the efficacy and action duration have compared either of the insulin analogues with NPH, and head-to-head iGla-iDet comparisons are limited [2][3][4]. In particular, it is unknown whether there is really a waning of effect of iDet during the last few hours of its action duration in daily clinical practice, which would justify its twice-daily dosing.…”

A Review on Stem cell Research & Their Role in Various Diseases

“…Type 1 diabetes [67,68] is an autoimmune disorder characterized by T-cell-mediated destruction of insulin [69,70] producing cells and lifelong dependence on exogenous insulin [71] administration seen both in children and adults. The majority of efforts seeking to ameliorate the autoimmune process and reverse hyperglycemia have focused on the use of immunosuppressive or immunomodulatory drugs [72].…”

High Risk Factors of Cardiovascular Diseases in Type 2 Diabetes

“…Type 1 diabetes when a person has diabetes, either: their pancreas does not produce the insulin they need. A perfect Glycemic control in T1D is achieved in less than one-third of children only, the major challenge being a steady supply of basal insulin that mimics the physiological endogenous pancreatic insulin secretion [6]. Most cases of Type 1 diabetes mellitus (T1DM) are thought to result from selective autoimmune destruction of pancreatic beta cells.…”