Insulin management and metabolic control of Type 1 diabetes mellitus in childhood and adolescence in 18 countries

Abstract

Insulin regimens and metabolic control in children and adolescents with Type 1 diabetes mellitus were evaluated in a cross-sectional, non-population-based investigation, involving 22 paediatric departments, from 18 countries in Europe, Japan, and North America. Blood samples and information were collected from 2873 children from March to August 1995. HbA1c was determined once and analysed centrally (normal range 4.4-6.3%, mean 5.4%). Year of birth, sex, duration of diabetes, height, body weight, number of daily insulin injections, types and doses of insulin were recorded. Average HbA1c in children under 11 years was 8.3 +/- 1.3% (mean +/- SD) compared with 8.9 +/- 1.8% in those aged 12-18 years. The average insulin dose per kg body weight was almost constant (0.65 U kg(-1) 24 h(-1)) in children aged 2-9 years for both sexes, but there was a sharp increase during the pubertal years, particularly in girls. The increase in BMI of children with diabetes was much faster during adolescence compared to healthy children, especially in females. Sixty per cent of the children (n = 1707) used two daily insulin injections while 37% (n = 1071) used three or more. Of those on two or three injections daily, 37% used pre-mixed insulins, either alone or in combination with short- and intermediate-acting insulin. Pre-adolescent children on pre-mixed insulin showed similar HbA1c levels to those on a combination of short- and long-acting insulins, whereas in adolescents significantly better HbA1c values were achieved with individual combinations. Very young children were treated with a higher proportion of long-acting insulin. Among adolescent boys, lower HbA1c was related to use of more short-acting insulin. This association was not found in girls. We conclude that numerous insulin injection regimens are currently used in paediatric diabetes centres around the world, with an increasing tendency towards intensive diabetes management, particularly in older adolescents. Nevertheless, the goal of near normoglycaemia is achieved in only a few.

Metformin as additional therapy in adolescents with poorly controlled type 1 diabetes: randomised placebo-controlled trial with aspects on insulin sensitivity

“…Weight gain is prevalent in adolescent females with type 1 diabetes after attainment of final height (4), which might further impair insulin sensitivity (5). Insulin dosages are often increased to overcome the resistance to insulin, but the metabolic control, however, often deteriorates during the later stages of pubertal development (6).…”

Establishing glycaemic control with continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes: experience of the PedPump Study in 17 countries

“…This probably reflects an age-related effect; as would be expected, the duration of use tended to increase with age and hence the longest durations were seen in the adolescent group, who also had the highest HbA 1c levels. Several studies have shown that HbA 1c levels in adolescents are typically >8%, and that reduction is often difficult to achieve in this group [5,24]. Indeed there was a negative association between age and number of boluses, and it is likely that missed mealtime boluses in the adolescent age group contributed to this [22].…”

Relation of circulating concentrations of chemokine receptor CCR5 ligands to C-peptide, proinsulin and HbA1c and disease progression in type 1 diabetes

“…We investigated the association of circulating CCL3, CCL4, and CCL5 with different definitions of remission and β-cell function in the well characterized prospective Hvidøre cohort of newly diagnosed juvenile type 1 diabetes patients during the first year [11,22].…”