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Multiple daily injections in young patients using the ezy‐BICC bolus insulin calculation card, compared to mixed insulin and CSII
Author(s) -
Anderson Donald G
Publication year - 2009
Publication title -
pediatric diabetes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.678
H-Index - 75
eISSN - 1399-5448
pISSN - 1399-543X
DOI - 10.1111/j.1399-5448.2008.00484.x
Subject(s) - medicine , insulin , bolus (digestion) , observational study , anesthesia , pediatrics
Objective: To describe the easy bolus insulin calculation card (ezy‐BICC) approach to multiple daily injections and to compare in an observational study, the haemoglobin A1c (HbA1c) achieved while using ezy‐BICC, mixed insulin injections and continuous subcutaneous insulin infusion (CSII). Methods: HbA1c results from 7121 clinic visits by 573 patients aged 1–20 yr using the three methods between June 2000 and July 2008 were reviewed. Results: For mixed insulin median, mean and SD HbA1c were 8.3%, 8.3%, 1.33, for ezy‐BICC, 7.6%, 7.7%, 1.40, and for CSII, 7.6%, 7.8%, 1.31. HbA1c increases with age significantly more in those using CSII (p < 0.001). By regression, compared with mixed insulin HbA1c is 0.7% lower using ezy‐BICC (p < 0.018) and 1.5% lower using CSII (p < 0.001). For patients using CSII compared with <6 yr, those 6–12 yr have HbA1c 0.7% higher (p < 0.001), 12–15 yr 1.0% higher (p < 0.001) and 15–20 yr 1.2% higher (p < 0.001). For subjects >12 yr, HbA1c is lower while using ezy‐BICC than CSII. HbA1c increases 0.2% per yr following diagnosis for 2.8 yr. In those who change from mixed insulin to ezy‐BICC after this time, the mean HbA1c is 0.5% lower by 9 months, 0.7% lower at 21 months and 0.6% lower at 24 months (p < 0.05). Conclusions: The ezy‐BICC system is inexpensive and convenient and allows patients to vary meal size. Subjects achieve lower HbA1c while using CSII and ezy‐BICC MDI than with mixed insulin. Very young subjects achieve excellent HbA1c using CSII, but for 12 to 20 yr‐old patients, ezy‐BICC results in lower HbA1c than CSII for a lower cost.