Evaluation of characteristics of glycemic control in patients with diabetes mellitus type 1, treated with conventional and basal & bolus insulin in Mofid children’s hospital (2012-2018)

Document Type : Original Article

Authors

Shahid Beheshti University of Medical sciences, department of Pediatric endocrinology and Metabolism , Tehran , Iran

Abstract

Abstract:
Aim: Treatment of diabetes mellitus type 1 in children is achieved with different insulin regimens. Evaluation of each of these regimens and comparing them together, helps us to decide which of them is better for our patients. The aim of this study is to evaluate glycemic control and anthropometric indices in DM1 patients under treatment with two different insulin regimen (conventional and basal & bolus).
Method: In this cross sectional study 73 children with DM1 divided into two groups (conventional therapy= 35patients and basal & bolus treatment in 38 patients). Demographic data include: age, sex, height, weight, BMI, duration of diabetes, mean FBS in last month, mean post prandial glucose in last month, mean 9 month HbA1C, number of hypoglycemia in last month and number of DKA in last year.
Result: There was higher height and weight Z score of patients in basal & bolus group compare to conventional group. (P: 0.024).But there was not significant difference in BMI Z score between two groups, and also there was not significant difference in glycemic control and acute complications (hypoglycemia and DKA) between two groups.
Conclusion: Therapeutic regimen must be achieved by considering personal, familial and psychological property in Iranian patients.

Keywords


1-Danne T, Lange K, Kordonouri O. New developments in the treatment of type 1 diabetes in children. Archives of disease in childhood. 2007;92(11):1015-9.
2-Biester T, Kordonouri O, Danne T. Pharmacotherapy of type1 diabetes in children and adolescents: more than insulin? Therapeutic advances in endocrinology and metabolism. 2018;9(5):157-66.
3-Wolfsdorf JI, Allgrove J, Craig ME, Edge J, Glaser N, Jain V, et al. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatric diabetes. 2014;15 Suppl 20:154-79.
4-Zahed G, Shakiba M, Seifi K. The Prevalence of Psychological Disorders among Children with Diabetes Aged 5-12 Years Old Referred to the Endocrinology Clinic of Mofid Hospital, Tehran, Iran in 2014-2015. Iranian journal of child neurology. 2018;12(3):101-12.
5-Cleary PA, Dahms W, Goldstein D, Malone J, Tamborlane WV. Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT). J Pediatr. 2001;139:804-12.
6-Control D, Group CTR. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. J pediatr. 1994;125:177-88.
7-Danne T, Weber B, Hartmann R, Enders I, Burger W, Hovener G. Long-term glycemic control has a nonlinear association to the frequency of background retinopathy in adolescents with diabetes: follow-up of the Berlin Retinopathy Study. Diabetes care. 1994;17(12):1390-6.
8-Dorchy H. Dietary management for children and adolescents with diabetes mellitus: personal experience and recommendations. Journal of Pediatric Endocrinology and Metabolism. 2003;16(2):131-48.
9-Chase HP, Lockspeiser T, Peery B, Shepherd M, MacKenzie T, Anderson J, et al. The impact of the diabetes control and complications trial and humalog insulin on glycohemoglobin levels and severe hypoglycemia in type 1 diabetes. Diabetes Care. 2001;24(3):430-4.
10-Danne T, Mortensen HB, Hougaard P, Lynggaard H, Aanstoot H-J, Chiarelli F, et al. Persistent differences among centers over 3 years in glycemic control and hypoglycemia in a study of 3,805 children and adolescents with type 1 diabetes from the Hvidøre Study Group. Diabetes Care. 2001;24(8):1342-7.
11-Bangstad HJ, Danne T, Deeb L, Jarosz‐Chobot P, Urakami T, Hanas R. Insulin treatment in children and adolescents with diabetes. Pediatric diabetes. 2009;10:82-99.
12-Swift P. Services provided by the diabetes team: do they affect glycemic outcome? Pediatric diabetes. 2006;7(5):19-20.
13-Al-Fifi SH. Intensive insulin treatment versus conventional regimen for adolescents with type 1 diabetes, benefits and risks. Saudi medical journal. 2003;24(5):485-7.
14-Chase HP, Dixon B, Pearson J, Fiallo-Scharer R, Walravens P, Klingensmith G, et al. Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine Hagedorn insulin. The Journal of pediatrics. 2003;143(6):737-40.
15-Schober Ε, Schoenle Ε, Van Dyk J, Wernicke-Panten Κ, Glargine PSGoI. Comparative Trial Between Insulin Glargine and NPH Insulin in Children and Adolescents with Type I Diabetes Mellitus. Journal of Pediatric Endocrinology and Metabolism. 2002;15(4):369-76.
16-Robertson K, SchÖnle E, Gucev Z, Mordhorst L, Tamer SC, Gall M-a, et al. Benefits of insulin detemir over NPH insulin in children and adolescents with type 1 diabetes: lower and more predictable fasting plasma glucose and lower risk of nocturnal hypoglycemia. Diabetes. 2004;53:A144.
17-Kristensen PL, Tarnow L, Bay C, Norgaard K, Jensen T, Parving HH, et al. Comparing effects of insulin analogues and human insulin on nocturnal glycaemia in hypoglycaemia-prone people with Type 1 diabetes. Diabetic medicine : a journal of the British Diabetic Association. 2017;34(5):625-31.
18-Sanches ACC, Correr CJ, Venson R, Gonçalves PR, Garcia MM, Piantavini MS, et al. Insulin analogues versus human insulin in type 1 diabetes: direct and indirect meta-analyses of efficacy and safety. Brazilian Journal of Pharmaceutical Sciences. 2013;49(3):501-9.
19-Middelkoop BJ, Geelhoed-Duijvestijn PH, van der Wal G. Effectiveness of culture-specific diabetes care for Surinam South Asian patients in the Hague: a randomized controlled trial/controlled before-and-after study. Diabetes Care. 2001;24(11):1997-8.