Flexible Insulin Therapy With Glargine Insulin Improved Glycemic Control and Reduced Severe Hypoglycemia Among Preschool-Aged Children With Type 1 Diabetes Mellitus

Alemzadeh, Ramin; Berhe, Tseghai; Wyatt, David

doi:10.1542/peds.2004-1439

Cited by 65 publications

(65 citation statements)

References 34 publications

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“…As supported by previous studies in adolescents and children [10,12,18,19] we also observed a significant drop in the incidence of overall and symptomatic and severe symptomatic hypoglycemia in the insulin glargine group. As per the EURODIAB ACE study group [20], the most rapid rate of increase of T1D in children is in those under age 5 and symptomatic hypoglycemia occurred in 55% of 0-2 years, 45% 0f 2-5 years and 13% of >5 years of age [21], hence this group could benefit most from glargine therapy.…”

Section: Discussionsupporting

confidence: 90%

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

Saini¹,

Devidayal²,

Verma³

et al. 2011

J Diabetes Metab

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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.

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Section: Discussionsupporting

confidence: 90%

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

Saini¹,

Devidayal²,

Verma³

et al. 2011

J Diabetes Metab

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“…It helps to avoid both hyper and hypoglycemia [1,2,3,4,5,6,7] once it tries to match the amount of carbohydrates (CH) consumed on the meal with prandial insulin dose. The 2 main parameters that are used in the CC method are the insulin to carbohydrate ratio (ICR) and the sensitivity factor (SF).…”

Section: Introductionmentioning

confidence: 99%

“…Based on data obtained in non-pregnant individuals with T1DM, CC seems attractive also for pregnant populations because during pregnancy, the rise in counter-regulatory hormones favors postprandial hyperglycemia, which can be addressed using the CC strategy [3,5,14]; the flexibility that CC confers is interesting for the mother who has unpredictable food ingestion as a consequence of the periods of nausea [15]; the costs of its implementation are low and thus feasible in almost all social groups and clinical environments [7]; CC can help to minimize both hyper and hypoglycemia [1,2,3,4,5,6], situations that are especially detrimental during gestation and CC is associated with a better quality of life [6]. …”

Section: Introductionmentioning

confidence: 99%

Carbohydrate Counting during Pregnancy in Women with Type 1 Diabetes: Are There Predictable Changes That We Should Know?

et al. 2017

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Background/Aims: Carbohydrate counting (CC) is a helpful strategy for the treatment of type 1 diabetes mellitus (T1DM) and the main parameters used in this method are the insulin to carbohydrate ratio (ICR) and the sensitivity factor (SF). Throughout pregnancy, a state of insulin resistance develops. Therefore, we hypothesized that ICR and SF change and our aim was to describe the pattern of modification of these parameters in pregnant women with T1DM on CC. Methods: This study followed 21 women with T1DM throughout pregnancy. Starting ICR was 1:15 and SF was calculated using the formula: 1,500/total daily insulin dose (TDID; for regular insulin) or 1,800/TDID (for ultra-rapid analogs). ICR was adjusted every 1-2 weeks according to self-monitoring of blood glucose. SF was recalculated every 1-2 weeks. Results: Throughout gestation there was a mean decrease in the ICR in breakfast, lunch and dinner of 8.2 (p < 0.0001), 7.7 (p = 0.003) and 7 (p = 0.005) grams per international units (g/IU), respectively. Mean SF reduction from first to third trimester was 10 mg/dL per IU (mg/dL/IU; p < 0.0001). Conclusions: Women with T1DM in CC during pregnancy evolve with a progressive reduction in the ICR at every meal (mean of 8.2 g/IU for breakfast, 7.7 g/IU for lunch and 7 g/IU for dinner) and also in the SF (10 mg/dL/IU).

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“…(34) avaliaram durante dois anos consecutivos dois esquemas de insulinoterapia em um mesmo grupo de crianças na faixa etária entre 2,6 e 6,3 anos, com média de 4,8 ± 1,0. No primeiro ano, utilizou-se o regime denominado múl-tiplas doses diárias (MDD) que constituiu de uma dose diária de glargina ao deitar-se associada à insulina lispro em horários de refeições preestabelecidos.…”

Section: Insulinoterapia Em Dm1unclassified

A evolução da insulinoterapia no diabetes melito tipo 1

Pires

Chacra

2008

Arq Bras Endocrinol Metab

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RESuMOA descoberta da insulina foi o grande marco da história do diabetes melito e a grande conquista para o seu tratamento. A primeira insulina disponibilizada foi a regular. na seqüência, Hagedorn acrescentou a protamina à insulina, criando, assim, a insulina nPH. na década de 1950 foi sintetizada uma insulina desprovida de protamina, denominada insulina lenta. com o advento da biologia molecular, sintetizou-se, via dnA recombinante, a insulina humana sintética. Mais recentemente, foram disponibilizados vários tipos de análo-gos de insulina que permitiram o melhor controle metabólico dos pacientes. o tratamento do diabetes melito tipo 1, além do processo educacional, incluindo a prática regular de atividades físicas e orientações dietéticas, resumese na substituição plena de insulina de longa e curta durações de ação, de maneira individualizada, de acordo com a experiência do médico-assistente. no diabetes melito tipo 1, a preferência é pelas insulinas de menor variabilidade, por meio do esquema basal/bólus ou pelas bombas de infusão contí-nua de insulina subcutânea com o objetivo de mimetizar a liberação fisiológica de insulina pelas células-β. ABStRAct insulin therapy for type 1 Diabetes Mellitus: past and present. the discovery of insulin can be considered the milestone of diabetes mellitus history and a great achievement for its treatment. the first insulin available was the regular. Afterwards, Hagedorn added the protamine to the insulin, thus, creating the nPH insulin. in the 1950s an insulin free of protamine was synthesized: the lente insulin. With the advent of molecular biology, synthetic human insulin was synthesized using recombinant dnA technology. Most recently several types of insulin analogues were available, providing the patients with better metabolic control. type 1 diabetes mellitus treatment includes plain substitution and individualization for short-acting plus long-acting insulin according to the physician's assistance, besides regular practice of physical activities and diet orientations. in type 1 diabetes mellitus the insulin of low variability is the best choice since basal/bolus insulin therapy or continuous subcutaneous insulin infusion pump can mimetize the physiological release of insulin by β cells.

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Flexible Insulin Therapy With Glargine Insulin Improved Glycemic Control and Reduced Severe Hypoglycemia Among Preschool-Aged Children With Type 1 Diabetes Mellitus

Cited by 65 publications

References 34 publications

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

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

Carbohydrate Counting during Pregnancy in Women with Type 1 Diabetes: Are There Predictable Changes That We Should Know?

A evolução da insulinoterapia no diabetes melito tipo 1

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