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Changes in insulin therapy regimens over 10 yr in children and adolescents with type 1 diabetes attending diabetes camps
Author(s) -
Redon Isabelle,
Beltrand Jacques,
Martin Delphine,
Taupin Pierre,
Choleau Carine,
Morandini Mélina,
Cahané Michel,
Robert JeanJacques
Publication year - 2014
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/pedi.12062
Subject(s) - medicine , bedtime , diabetes mellitus , insulin , regimen , basal (medicine) , type 2 diabetes , type 1 diabetes , bolus (digestion) , insulin pump , endocrinology
Objective To describe the changes in insulin therapy regimens of children and adolescents with type 1 diabetes over 10 yr and their correlation with hemoglobin A1c ( HbA1c ). Research design and methods: The study included 7206 children and adolescents (age 12.8 ± 2.7 yr, more than 1 yr of diabetes duration) admitted in summer camps between 1998 and 2007 (707–896/yr). Based on injection times (breakfast, lunch, afternoon, dinner, bedtime) and insulin types (short, long and premixed; human or analog), 786 different therapeutic combinations were classified in six main types of regimens. The distribution of the different regimens and their correlation with HbA1c were evaluated as a function of year and age. Results Over 10 yr, basal bolus increased from 13 to 52% and the pump from <1 to 13%, regimens with two to three injections per day decreased from 50 to 25%, those with only premixed insulins from 33 to 7%, and diverse regimens from 9 to 1%. HbA1c was significantly higher with premixed insulin only, but there were no differences between the other regimens throughout the follow‐up. Mean yearly HbA1c (8.21–8.45%) did not show any significant decrease, but the percentage of patients with HbA1c > 9 and 10% decreased significantly, in those treated with two to three injections and the pump, not with basal bolus or premixed only regimens. Conclusion A major trend in intensifying insulin treatment in children and adolescents with type 1 diabetes was accompanied by modest improvements in HbA1c . No insulin regimen has shown any better results, except over premixed insulins.