Initiation of insulin glargine in children and adolescents with type 1 diabetes

Abstract

This retrospective study suggests that glargine is at least as effective as other long-acting insulins but that care must be taken during the conversion process to avoid hypoglycemia.

Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand: A survey of current practice

“…The strong bias seen for insulin aspart is not due to access, with identical open access to all options in both countries, or supported by the available literature, which suggests comparable pharmacokinetic/pharmacodynamic properties across the three available rapid‐acting analogues . In contrast, the dominance of glargine is unsurprising, being the only readily available truly once‐daily basal insulin option due to its smooth long‐acting plasma concentration profile for many years now, in addition to the purported potential benefits in hypoglycaemia, irrespective of timing of injection . It is also possible that choice of insulin reflects some form of pharmaceutical bias or simply the historical order that new analogues became available locally, with clinicians persisting with established insulin choices.…”

ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes

“…Pump studies have shown that younger children often need more basal insulin before midnight than after (reversed dawn phenomenon). With a basal/bolus analog regimen this can be achieved by giving regular instead of rapid acting insulin for the last bolus of the day (night time blood glucose levels need to be checked) …”

Use of new insulins in children

“…Others have found an overall reduction in the number of episodes of hypoglycaemia in this age group. [62][63][64] There are limited published data on clinical effects of insulin Detemir in the paediatric age range, due to the recent market availability, but studies in adult populations have suggested a reduction in nocturnal hypoglycaemia, 47 65 66 and it is likely that this may be replicated in children.…”