Institution of basal-bolus therapy at diagnosis for children with type 1 diabetes mellitus

Soumya Adhikari, Beverley Adams-Huet, Yu Chi A Wang, James F. Marks, Perrin C. White

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE. We studied whether the institution of basal-bolus therapy immediately after diagnosis improved glycemic control in the first year after diagnosis for children with newly diagnosed type 1 diabetes mellitus. METHODS. We reviewed the charts of 459 children ≥6 years of age who were diagnosed as having type 1 diabetes between July 1, 2002, and June 30, 2006 (212 treated with basal-bolus therapy and 247 treated with a more-conventional neutral protamine Hagedorn regimen). We abstracted data obtained at diagnosis and at quarterly clinic visits and compared groups by using repeated-measures, mixed-linear model analysis. We also reviewed the records of 198 children with preexisting type 1 diabetes mellitus of >1-year duration who changed from the neutral protamine Hagedorn regimen to a basal-bolus regimen during the review period. RESULTS. Glargine-treated subjects with newly diagnosed diabetes had lower hemoglobin A1c levels at 3, 6, 9, and 12 months after diagnosis than did neutral protamine Hagedorn-treated subjects (average hemoglobin A1c levels of 7.05% with glargine and 7.63% with neutral protamine Hagedorn, estimated across months 3, 6, 9, and 12, according to repeated-measures models adjusted for age at diagnosis and baseline hemoglobin A1c levels; treatment difference: 0.58%). Children with long-standing diabetes had no clinically important changes in their hemoglobin A1c levels in the first year after changing regimens. CONCLUSION. The institution of basal-bolus therapy with insulin glargine at the time of diagnosis of type 1 diabetes was associated with improved glycemic control, in comparison with more-conventional neutral protamine Hagedorn regimens, during the first year after diagnosis.

Original languageEnglish (US)
JournalPediatrics
Volume123
Issue number4
DOIs
StatePublished - Apr 2009

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Type 1 Diabetes Mellitus
Protamines
Hemoglobins
Therapeutics
Ambulatory Care
Linear Models
Insulin Glargine

Keywords

  • Glargine
  • Glycemic control
  • Hemoglobin A1c
  • Honeymoon
  • Pediatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Institution of basal-bolus therapy at diagnosis for children with type 1 diabetes mellitus. / Adhikari, Soumya; Adams-Huet, Beverley; Wang, Yu Chi A; Marks, James F.; White, Perrin C.

In: Pediatrics, Vol. 123, No. 4, 04.2009.

Research output: Contribution to journalArticle

Adhikari, Soumya ; Adams-Huet, Beverley ; Wang, Yu Chi A ; Marks, James F. ; White, Perrin C. / Institution of basal-bolus therapy at diagnosis for children with type 1 diabetes mellitus. In: Pediatrics. 2009 ; Vol. 123, No. 4.
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