Effect of insulin glargine on glycemic control in adolescents with type 1-diabetes

BackgroundAdolescence is a transitional phase characterized by multiple physiological and psychosocial factors that make glycemic control more difficult, and often results in hyperglycemia and/or hypoglycemia-related emergencies, and increases the risk of chronic complications. Insulin analogs were introduced with the aim of overcoming such difficulties.ObjectiveTo study the role of long acting insulin analog (insulin glargine) in glycemic control of adolescents with poorly controlled type 1 diabetes who suffer from frequent hypoglycemic attacks and marked glucose variability, and to compare its effectiveness and cost versus intermediate acting insulin (NPH) in a country with limited resources like Egypt.Subject and methodA non-randomized open label treat to target trial that included twenty-nine adolescents (10–18 years), with T1DM. They were on MDI regimen. All had unsatisfactory glycemic control with frequent hypoglycemia and/or recurrent glucose excursions. All were shifted from twice daily NPH to single bedtime injection of insulin glargine (Lantus), and followed up for a minimum period of 6 months.ResultsSwitching to insulin glargine was associated with a statistically significant reduction in attacks of hypoglycemia and DKA (p < 0.001), but with insignificant reduction in HbA1c (p = 0.9). BMI showed a significant increase (p = 0.004), as well as the cost of basal insulin as glargine compared to NPH.ConclusionThe present study encourages the use of insulin glargine in the presence of significant hypoglycemia and glucose variability, with close monitoring of diet and weight. Cost effectiveness and effect on HbA1c and quality of life need further longitudinal studies with larger numbers.