Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy

Abstract

BackgroundThis study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy.MethodsA total of 825 individuals aged ≤ 20 years with T1DM, using either basal-bolus or premixed insulin regimens, were retrospectively recruited from 2001 to 2015. Rates of DKA after diagnosis, severe hypoglycemia, and the level of glycated hemoglobin A1c (HbA1c) improvement during the follow-up period were analyzed.ResultsOf the 825 patients, 226 receiving a premixed regimen were matched to the same number of patients receiving a basal-bolus regimen. In the matched cohort, DKA (10.62% vs. 5.31%; p = 0.037) and severe hypoglycemic episodes (25.22% vs. 10.62%; p < 0.001) were significantly higher in patients receiving a premixed regimen than those receiving a basal-bolus regimen. The median reduction of HbA1c, compared to the treatment-naive level, was better with the basal-bolus regimen than with the premixed regimen in both matched (2.2 vs. 2.1; p = 0.034) and the entire (3.1 vs. 1.9; p < 0.001) cohorts. Regardless of insulin regimen, a higher HbA1c level was significantly linked to higher risk of DKA development (hazard ratio [HR] 1.35 per 1% increase; p < 0.001) once the HbA1c level was ≥7.5%.ConclusionsA premixed insulin regimen may increase the DKA occurrence rate and severe hypoglycemic risk in children, adolescents, and young adults with TIDM, compared to a basal-bolus regimen. Tight glycemic control with HbA1c < 7.5% may prevent the increased risk of DKA.

Glycemic Control in a Cohort of children with type1 Diabetes Mellitus in Sulaimanyah City

“…Basal bolus insulin regimen as a form of intensive insulin therapy has been found to be superior to conventional mixed insulin regimen. [16][17][18] In this study neither regimens had a significant effect on diabetic control, most likely because the study sample had a poor diabetic control generally in both groups, an important factor in this regard is that, basal bolus insulin regimen needs high level of education and training, because the flexibility in daily insulin dosage, according to dietary intake and blood sugar parameters, is the main advantage of this regimen over the twice daily regimens, this necessitates multiple daily decision making, needing appropriate training and mathematical skills, demanding a sufficient number of diabetic educators and dietitians in every diabetic center, a factor not sufficiently available in this study setting. The importance of education resonates well with the finding that maternal education had a significant effect on diabetic control in this cohort (P-value; 0.03).…”

Pediatric diabetes in China: Challenges and actions

“…32 It's a controversial issue whether premixed insulin therapy has a poor control of HbA1c and increases DKA occurrence rate compared to MDI in T1DM. 33 Other T1DM patients may integrate traditional Chinese medicine to reduce the risk of diabetic ketoacidosis in patients with type 1 diabetes mellitus. 34 Also, it was reported that 5% patients may withdraw insulin therapy inappropriately during honeymoon period.…”

“…Premixed insulin therapy with injections twice daily is also administered among part of T1DM children 32 . It's a controversial issue whether premixed insulin therapy has a poor control of HbA1c and increases DKA occurrence rate compared to MDI in T1DM 33 . Other T1DM patients may integrate traditional Chinese medicine to reduce the risk of diabetic ketoacidosis in patients with type 1 diabetes mellitus 34 .…”

Basal-bolus or premixed? Shedding light on optimal insulin regime for type 1 diabetes

“…In this issue of the Biomedical Journal , Chou et al. [1] examine a long history of cases of TD1 to determine whether different injection/dosing regimes influence the risk of developing serious complications of the disease.…”

“…To shed light on the issue, Chou et al. [1] carry out a large retrospective review of patients with TD1 recorded in a Taiwanese registry.…”