Background. Basal insulin detemir and glargine each have characteristics that may make them a superior choice in children and adolescents with type 1 diabetes, but there is a paucity of data on glycemic results in this population. Objective. Examination of variables associated with achievement of HbA1c goal in children and adolescents with newly diagnosed type 1 diabetes. Methods. The primary outcome, factors associated with achievement of HbA1c goal, was examined in a retrospective chart review. Variables, including type of basal insulin, were collected during the first year of diagnosis of patients in a pediatric diabetes clinic. Secondary outcomes included change in HbA1c, severe hypoglycemic events, and episodes of DKA. Results. 94 patients were included in the study. HbA1c at diagnosis was found to be a significant predictor of achievement of goal at 3 months ( ) and of change in HbA1c at 3 and 12 months ( for each). Severe hypoglycemia and episodes of DKA were uncommon. Conclusions. Choice of basal insulin was not found to be a predictor of achieving HbA1c goal or of change in HbA1c over the course of the first year of diagnosis with type 1 diabetes. 1. Introduction In patients newly diagnosed with type 1 diabetes, clinicians have three choices of basal insulin: NPH or one of two insulin analogs, glargine and detemir. While NPH is the traditional choice, the insulin analogs better mimic natural insulin secretion. In a meta-analysis, Monami and colleagues found that the use of glargine and detemir resulted in decreased hemoglobin A1c (HbA1c) and a reduced risk of nocturnal and severe hypoglycemia when compared to insulin NPH [1]. The American Diabetes Association recommends the use of insulin analogs in many patients with type 1 diabetes, particularly those in whom hypoglycemia has been a complicating factor [2]. The choice of long-acting analog in newly diagnosed patients with type 1 diabetes is less clear. Several studies have measured pharmacokinetic and dynamic endpoints. A study in patients with type 1 diabetes demonstrated that while the activity of glargine and detemir was initially similar, after 12 hours detemir’s effects decreased significantly, and the average end of action was 17.5 hours compared to glargine’s 24 hours [3]. Detemir has been found to have a dose-dependent duration, with lower doses having a shorter duration of action. It is also possible that the duration of action will be attenuated in children and adolescents with type 1 diabetes [4]. However, Heise and colleagues found that, when compared to insulin NPH and glargine,
References
[1]
M. Monami, N. Marchionni, and E. Mannucci, “Long-acting insulin analogues vs. NPH human insulin in type 1 diabetes. A meta-analysis,” Diabetes, Obesity and Metabolism, vol. 11, no. 4, pp. 372–378, 2009.
[2]
“American Diabetes Association: position statement. Standards of medical care in diabetes—2013,” Diabetes Care, vol. 36, no. 1, pp. S11–S66, 2013.
[3]
F. Porcellati, P. Rossetti, N. R. Busciantella, et al., “Comparison of pharmacokinetics and dynamics of the long-acting insulin analogs glargine and detemir at steady state in type 1 diabetes,” Diabetes Care, vol. 30, pp. 2447–2452, 2007.
[4]
H. L. Miles and C. L. Acerini, “Insulin analog preparations and their use in children and adolescents with type 1 diabetes mellitus,” Pediatric Drugs, vol. 10, no. 3, pp. 163–176, 2008.
[5]
T. Heise, L. Nosek, B. B. Ro？nn et al., “Lower within-subject variability of insulin detemir in comparison to NPH insulin and insulin glargine in people with type 1 diabetes,” Diabetes, vol. 53, no. 6, pp. 1614–1620, 2004.
[6]
T. Dann, N. Datz, L. Endahl et al., “Insulin detemir is characterized by a more reproducible pharmacokinetic profile than insulin glargine in children and adolescents with type 1 diabetes: results from a randomized, double-blind, controlled trial,” Pediatric Diabetes, vol. 9, no. 6, pp. 554–560, 2008.
[7]
T. R. Pieber, H.-C. Treichel, B. Hompesch et al., “Comparison of insulin detemir and insulin glargine in subjects with type 1 diabetes using intensive insulin therapy,” Diabetic Medicine, vol. 24, no. 6, pp. 635–642, 2007.
[8]
M. Yenigun and M. Honka, “Switching patients from insulin glargine-based basal-bolus regimens to a once daily insulin detemir-based basal-bolus regimen: results from a subgroup of the PREDICTIVE study,” International Journal of Clinical Practice, vol. 63, no. 3, pp. 425–432, 2009.
[9]
U. M. Kabadi, “Deleterious outcomes after abrupt transition from insulin glargine to insulin detemir in patients with type 1 diabetes mellitus,” Clinical Drug Investigation, vol. 28, no. 11, pp. 697–701, 2008.
[10]
M. Rewers, C. Pihoker, K. Donaghue, R. Hanas, P. Swift, and G. J. Klingensmith, “Assessment and monitoring of glycemic control in children and adolescents with diabetes,” Pediatric Diabetes, vol. 10, no. 12, pp. 71–81, 2009.
[11]
H. H. Aly and P. Gottlieb, “The honeymoon phase: intersection of metabolism and immunology,” Current Opinion in Endocrinology, Diabetes and Obesity, vol. 16, no. 4, pp. 286–292, 2009.
[12]
J. S. Borus and L. Laffel, “Adherence challenges in the management of type 1 diabetes in adolescents: prevention and intervention,” Current Opinion in Pediatrics, vol. 22, no. 4, pp. 405–411, 2010.
[13]
K. Hassan and R. A. Heptulla, “Glycemic control in pediatric type 1 diabetes: role of caregiver literacy,” Pediatrics, vol. 125, no. 5, pp. e1104–e1108, 2010.
[14]
B.-S. Levine, B. J. Anderson, D. A. Butler, J. E. Antisdel, J. Brackett, and L. M. B. Laffel, “Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes,” Journal of Pediatrics, vol. 139, no. 2, pp. 197–203, 2001.
[15]
R. Nimri, Y. Lebenthal, S. Shalitin, H. Benzaquen, S. Demol, and M. Phillip, “Metabolic control of insulin detemir in basal-bolus therapy: treat-to-target study in children and adolescents with type 1 diabetes,” Pediatric Diabetes, vol. 14, no. 3, pp. 196–202, 2013.
[16]
S. Kurtoglu, M. E. Atabek, C. Dizdarer et al., “Insulin detemir improves glycemic control and reduces hypoglycemia in children with type 1 diabetes: findings from the Turkish cohort of the PREDICTIVE observational study,” Pediatric Diabetes, vol. 10, no. 6, pp. 401–407, 2009.
