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A randomized cross-over trial to identify the optimal use of insulin glargine in prepubertal children using a three-times daily insulin regimen.
- Source :
-
Diabetic Medicine . Dec2007, Vol. 24 Issue 12, p1406-1411. 6p. 3 Charts, 1 Graph. - Publication Year :
- 2007
-
Abstract
- Aims The long-acting insulin analogue glargine reduces nocturnal hypoglycaemia and stabilizes morning blood glucose levels in patients with Type 1 diabetes (T1DM) on multiple injection therapy. However, young children may not tolerate such intensive insulin regimens. We investigated the effects of glargine in various three-injections-daily insulin combinations on 24-h glucose control in prepubertal children. Methods Seventeen T1DM prepubertal children (10 boys), median age 10.2 years (range 6.0–12.4), glycated haemoglobin (HbA1c) 8.8% (6.8–11.5) were recruited to a randomized, open-label, cross-over study. After a 2-week run-in period (with NPH pre-bed), every child underwent three different 3-week treatment blocks in random order. All treatment blocks included glargine pre-bed, but used different morning insulins: block 1, soluble only; block 2, soluble + NPH; block 3, aspart + NPH. Continuous glucose monitoring was performed for 3 days at the end of the run-in and each treatment block. Results Compared with the run-in period on NPH, the three glargine treatment blocks were associated with lower ( P < 0.0001) and less variable ( P < 0.05) pre-breakfast glucose levels, and with an 8–15% reduction in total daily insulin dose ( P < 0.0001). Risk of nocturnal hypoglycaemia detected by continuous glucose monitoring varied significantly between the three glargine treatment blocks, and was lowest when children were given aspart + NPH in the morning (block 3). Conclusion Insulin glargine pre-bed can be used in three-injections-daily regimens in prepubertal children to lower and stabilize pre-breakfast glucose levels. However, to avoid the risk of nocturnal hypoglycaemia, the pre-bed glargine dose should be lowered by giving a further long-acting insulin, such as NPH, in the morning. [ABSTRACT FROM AUTHOR]
- Subjects :
- *DIABETES
*INSULIN
*HYPOGLYCEMIC agents
*BLOOD sugar
*INJECTIONS
*CHILDREN
Subjects
Details
- Language :
- English
- ISSN :
- 07423071
- Volume :
- 24
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- Diabetic Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 27608599
- Full Text :
- https://doi.org/10.1111/j.1464-5491.2007.02277.x