Utilização da insulina glargina em crianças menores de oito anos de idade

Abstract

RESUMOObjetivos: Avaliar prospectivamente a eficácia e a segurança da insulina glargina no controle metabólico de crianças com diabetes melito tipo 1 (DMT1) com menos de oito anos de idade. Métodos: Foram avaliados 19 meninos e 11 meninas. Antes de iniciar a insulina glargina, todas as crianças foram colocadas em tratamento intensivo com insulina NPH e insulina asparte durante três meses. Posteriormente, os pacientes foram acompanhados por 12 meses para o tratamento com glargina. Todos os pacientes realizavam medidas da glicemia capilar 3-7 vezes ao dia. Desfechos principais: controle metabólico por meio da hemoglobina glicada (A1c); ocorrência de hipoglicemia leve (glicemia capilar < 60 mg/dL) e ocorrência de hipoglicemia grave (perda ou alteração na consciência, convulsão ou necessidade de intervenção médica). Resultados: A1c média no início do estudo foi 8,68%, semelhante ao valor obtido ao final dos 12 meses de tratamento com glargina (8,64%; p = 0,82). A frequência de hipoglicemia leve às 3 horas da madrugada foi 1,43/3 meses por paciente com insulina NPH e de 0,28/3 meses por paciente com insulina glargina (p < 0,007). Em relação à hipoglicemia severa, houve uma diferença favorável à glargina: 0,008 versus 0,56 eventos/3 meses por paciente (p < 0,002). Conclusões: O uso da insulina glargina no tratamento de crianças com DMT1 foi considerado tão eficaz quanto o uso da NPH, apresentando, no entanto, melhor perfil de segurança caracterizado pelo menor risco de hipoglicemia noturna e severa. Arq Bras Endocrinol Metab. 2009;53(6):721-5 Descritores Diabetes melito tipo 1; insulina glargina; criança; hipoglicemia ABSTRACT Objectives: To evaluate prospectively the efficacy and safety of insulin glargine use for the metabolic control of type 1 diabetes mellitus (T1DM) children younger than eight years old. Methods: Nineteen boys and 11 girls with T1DM were included. Before initiating insulin glargine, all children received intensive NPH and aspart insulins for three months. Afterwards, they were assisted for 12 more months for glargine treatment. All patients performed self blood glucose monitoring before and two hours after meals and in early morning (3:00 AM). Primary endpoints: metabolic control using A1C levels; frequency of mild hypoglycemia (capillary glycemia < 60 mg/dL); and frequency of severe hypoglycemia (loss or alteration of consciousness, seizures or need for medical intervention). Results: Mean A1C at the study entry was 8.68% and after 12 months of glargine, was 8.64% (p = 0.82). Frequency of mild hypoglycemia at 3.00 AM was 1.43/3 months during the NPH period and 0.28/3 months during the glargine period (p < 0.007). Frequency of severe hypoglycemia was 0.56/3 months during the NPH period and 0.008/3 months during the glargine period (p < 0.002). Conclusions: The treatment of T1DM children with insulin glargine was considered as efficacious as with NPH. However, a better safety profile, disclosed by the lower incidence of nocturnal and severe hypoglycemia episodes, was observed for insulin glargine....

The efficacy of insulin degludec and insulin glargine over NPH insulin among toddlers and preschoolers with type 1 diabetes using glycemic variability and time in range

“…However, they found a significant decrease in nocturnal hypoglycemia from the baseline with insulin degludec but not with insulin glargine [ 32 ]. In agreement with these data, Rollin and colleagues found a significant decrease in the frequency of hypoglycemia and clinically significant hypoglycemia among children with T1D receiving insulin glargine than those receiving NPH insulin [ 33 ].…”

Metabolic and infectious pathologies in Brazilian medical literature: a review

“…Santos et al 1 evaluated the frequency of metabolic syndrome among adults with type 1 diabetes mellitus according to the criteria of the International Diabetes Federation, the National Cholesterol Education Program, and the World Health Organization and concluded that the latter set of criteria may be preferable in identifying patients in this group, because of better sensitivity. Rollim et al 2 prospectively evaluated the efficacy and safety of using insulin glargine to metabolically control type 1 diabetes mellitus in children younger than eight years old and concluded that it was as efficacious as Neutral Protamine Hagedorn commonly refered to as NPH but presented a better safety profile, as disclosed by the lower incidence of nocturnal and severe hypoglycemic episodes. Xavier et al 3 described the periodontal status of children and adolescents with type 1 diabetes mellitus and concluded that the duration of diabetes and poor glycemic control were significantly associated with periodontal disturbances, suggesting a higher susceptibility of this population in developing probing depth.…”

Pharmacological Treatments for Type 2 Diabetes

“…These changes result in a standard single release from the injection site. That is, this analog precipitates in the subcutaneous tissue, allowing a gradual absorption into the bloodstream [91].…”