The Rate of Improvement in Metabolic Control in Children with Diabetes Mellitus Type 1 on Insulin Glargine Depends on Age

Abstract

Background: To evaluate the changes in the glycemic profile and metabolic control after introducing glargine in children with DMT1 in a one-year follow up.

Methods: 70 children (36 boys) at the average age of 12.03±2.50 with the mean diabetes duration of 3.35±2.19 years were observed. Glargine was substituted for NPH in children treated with multiple daily injections.

Results: The analysis showed the differences in the dynamics of changes in mean glycemia based on home blood glucose monitoring and HbA1c between prepubertal children (Group 1) and teenagers (Group 2). A significant reduction in mean glycemia from baseline to 12 months was observed at all chosen points in Group 2: fasting glycemia (125±27 mg/dl vs 117±17 mg/dl,p<0.05), bedtime glycemia (128±24 mg/dl vs. 117±20 mg/dl,p=0.001) and 3 a.m. glycemia (143±47 mg/dl vs. 90±25 mg/dl,p<0.001). A significant decrease in mean glycemia in Group 1 was observed from the beginning of treatment only at bedtime (0-12 months:129±27 mg/dl vs. 112±25 mg/dl,p=0.001) and at 3 am with the delay (6-12 months:122±36 mg/dl vs. 90±22 mg/dl,p<0.05). A significant improvement in HbA1c between baseline and 12 months was observed in both groups but with different dynamics of changes: 6.91±0.77% vs. 6.59±0.65% (p<0.05) and 7.44±1.26% vs. 7.18±1.58% (p=0.001) respectively in the groups. A trend towards decreasing the number of hypoglycemic episodes and no changes in BMI and insulin requirement were noted.

Conclusions: Introduction of glargine provides diabetic children with a better stabilization of the daily glycemic profile even in the cases of baseline good metabolic control. The rate of reaching the target in a long-term observation depends on age. A slower reduction of glycemia observed in smaller subjects suggests a great individuality in the regimen of diabetic children.

Key words

diabetes mellitus type 1 - children - glargine - glycemic profile

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