Basal insulin supplementation in Type 1 diabetic children: A long-term comparative observational study between continuous subcutaneous insulin infusion and glargine insulin
No long-term data are available on the efficacy of glargine insulin in comparison with continuous sc insulin infusion (CSII) in children and adolescents affected by Type 1 diabetes (T1D). Our aim was to compare the 2-yr efficacy of the 2 insulin approaches, in order to know how to best supply basal insulin in these patients. Thirty-six 9 to 18-yr-old consecutive children with at least 3 yr previous T1D diagnosis were enrolled. As part of routine clinical care, the patients consecutively changed their previous insulin scheme (isophane insulin at bedtime and human regular insulin at meals) and were randomly selected in order to receive either multiple daily injections (MDI) treatment with once-daily glargine and human regular insulin at meals, or CSII with aspart or lispro insulin. Both groups showed a significant decrease in glycosylated hemoglobin (HbA1c) values during the 1st year of therapy, though only in the CSII treated children was the decrease also observed during the 2nd year. The overall insulin requirement significantly decreased only in the CSII group and exclusively during the 1st year, while no significant differences were observed concerning body mass index SD score, severe hypoglycémic episodes and basal insulin supplementation. The work illustrates the first long-term study comparing the efficacy of CSII to MDI using glargine as basal insulin in children. Only with CSII were better HbA1c values obtained for prolonged periods of time, so that CSII might be considered the gold standard of intensive insulin therapy also for long-term follow-ups.
Key-wordsType 1 diabetes glargine insulin continuous subcutaneous insulin infusion HbA1c
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- 7.Lepore M, Pampanelli S, Fanelli C, et al. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes 2000, 49: 2142–8.PubMedCrossRefGoogle Scholar
- 14.Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA. Insulin Glargine (HOE 901) Type 1 Diabetes Investigator Group. Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care 2000, 23: 639–43.Google Scholar
- 18.Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimes using insulin lispro in type 1 diabetic patients on intensified treatment. The Study Group for the Development of Pump Therapy in Diabetes. Diabetes Care 2000, 23: 1232–5.Google Scholar
- 21.Kanc K, Jannssen MMJ, Keulen ETP, et al. Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM. Diabetologia 1998, 41: 322–9.PubMedCrossRefGoogle Scholar
- 25.Lepore G, Dodesini AR, Nosari I, Trevisan R. Both continuous subcutaneous insulin infusion and a multiple daily insulin injection regimen with glargine as basal insulin are equally better than traditional multiple daily insulin injection treatment. Diabetes Care 2003, 26: 1321–2.PubMedCrossRefGoogle Scholar
- 27.The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997, 20: 1183–97.Google Scholar
- 34.Armstrong DU, King AB. Basal insulin: continuous glucose monitoring reveals less overnight hypoglycemia with continuous subcutaneous insulin infusion than with glargine (Abstract). Diabetes 2002, 51 (Suppl 2): A92.Google Scholar