Therapy with insulin glargine (Lantus®) in toddlers, children and adolescents with type 1 diabetes

Colino, Esmeralda; López-Capapé, M.; Golmayo, Luz; Alvarez, María Angeles Escobar; Alonso, Milagros; Barrio, Raquel

doi:10.1016/j.diabres.2005.02.004

Cited by 37 publications

(54 citation statements)

References 21 publications

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“…While the mean total and the basal insulin doses decreased significantly, the mean unmodified insulin dose increased non-significantly in the glargine group as compared to NPH group. Comparable results have been shown earlier [15,22] though higher insulin requirement with glargine has also been reported in literature [12,19].…”

Section: Discussionsupporting

confidence: 76%

“…The acceptance of this new insulin analogue was excellent; 34 patients in the insulin glargine group (86%) decided to continue using this treatment after completion of the study and perceived a better glycemic control as well as better quality of life. Though intensive insulin therapy with glargine has been linked with weight gain [23], our study showed age-appropriate changes in weight, height and BMI over the 6 months of study period which were not significant as shown by others [12,15]. Use of glargine in our patients was safe and well tolerated.…”

Section: Discussionmentioning

confidence: 60%

“…This is important as previous trials either failed to confirm lower HbA1c levels with glargine [10,12] or showed insignificant reductions [13]. It has been suggested that insulin glargine is particularly efficacious in patients with poorly controlled diabetes and higher baseline HbA1c levels [14,15]. A change in the treatment plan may contribute to this better outcome as previously noted in patients with poor glycemic control [16].…”

Section: Discussionmentioning

confidence: 84%

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Comparative Efficacy of Once Daily Insulin Glargine with Twice Daily NPH Insulin in Children with Type 1 Diabetes

Saini¹,

Devidayal²,

Verma³

et al. 2011

J Diabetes Metab

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Objective: To compare the efficacy of insulin glargine and insulin NPH in terms of glycemic control and risk of hypoglycemia in children with Type 1 diabetes (T1D) mellitus.Design: Prospective, randomized, open label, controlled trial.Setting: Pediatric Diabetes Clinic of a tertiary care hospital.Subjects: Eighty T1D children between 2 to12 years diagnosed for at least six months. Randomization:Computer generated random number table was used to randomize the patients into Glargine (n=40) and NPH (n=40) groups. Intervention:Patients received either once daily insulin glargine or twice daily NPH insulin as basal insulin. Monthly follow up was done for 6 consecutive months. Results:In the glargine group, significant reductions were noted from baseline to endpoint in mean fasting blood glucose (FBG) (152.80 ± 22.92 versus 113.08 ± 14.71, p value < 0.001), mean blood glucose (MBG) (171.0 ± 23.02 versus 126.20 ± 13.29, p value < 0.001), glycated hemoglobin (HbA1c) (8.89 ± 1.48 versus 7.44 ± 0.74, p value < 0.001), mean total insulin dose (0.92 ± 0.37 units/kg/day versus 0.70 ± 0.29, p value < 0.043), mean basal insulin dose (0.78 ± 0.34 versus 0.53 ± 0.23, p value < 0.001) and mean number of all types of hypoglycemic episodes whereas, mean unmodified insulin dose (0.14 ± 0.14 versus 0.16 ± 0.14, p value 1.000) remained unchanged. The changes in all these parameters in the NPH group were not significant. The percentage of patients suffering at least one episode of hypoglycemia was significantly less with glargine in contrast to NPH (2.02 ± 0.43 versus 2.36 ± 0.47, p value 0.001). Conclusion:Glargine was found to be more effective than NPH insulin for glycemic control and incidence of hypoglycemia in children with T1D.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 84%

See 1 more Smart Citation

Comparative Efficacy of Once Daily Insulin Glargine with Twice Daily NPH Insulin in Children with Type 1 Diabetes

Saini¹,

Devidayal²,

Verma³

et al. 2011

J Diabetes Metab

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“…Neste estudo, após a mudança de terapêutica de NPH para glargina, por 12 semanas, verificou-se redução dos níveis de A1c, de acordo com os alguns autores (13)(14)(15)(16)(17)(18). Além da redução da A1c, vem sendo descrita a redução dos níveis de glicemia de jejum, como demonstrado por Fulcher e cols., que obtiveram, ainda, redução de 9,2 para 8,3% da A1c (vs. NPH: 9,7 para 9,1%) (13).…”

Section: Discussionunclassified

Substituição da insulina NPH por insulina glargina em uma coorte de pacientes diabéticos: estudo observacional

Maia

Melo

Araujo

et al. 2007

Arq Bras Endocrinol Metab

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RESUMOEste estudo avaliou o impacto da introdução da insulina glargina na terapia basal/bólus em pacientes com diabetes mellitus do tipo 1 (DM1) e do tipo 2 (DM2), com controle inadequado (A1c > 6,9%) em uso prévio de insulina basal NPH. Foi realizado um estudo retrospectivo, não-controlado, com 49 pacientes (28F/21M), idade média 24,7 ± 16,5 anos, tempo de diabetes de 13,2 ± 10,1, sendo 93,1% dos pacientes com DM1, que receberam insulina glargina combinada com insulina ultra-rápida (aspart/lispro) pré-refeições, durante 90 dias de seguimento. Foram analisados dose total de insulina, incidência de hipoglicemias, crises convulsivas, complicações hiperglicêmicas (cetoacidose) e níveis de A1c antes e após três meses do uso da insulina glargina. Os valores de A1c foram determinados pelo método HPLC, com valores de referência de 4,3% a 6,9%. Após 3 meses da modificação do esquema basal para insulina glargina, observou-se redução significativa dos níveis de A1c (10,2 ± 2,0 vs. 9,1 ± 1,8%; p= 0,019). Além disso, verificou-se redução de 0,11 U/kg/dia na dose total de insulina utilizada (NPH: 0,75 U/kg para 0,64 U/kg de insulina glargina; p< 0,05). O uso da insulina glargina associou-se com redução das crises hipoglicêmicas (p= 0,02), crises convulsivas por hipoglicemia grave (p= 0,023) e nenhum caso de cetoacidose (p= 0,001). Este estudo corrobora a eficácia da introdução da insulina glargina em pacientes diabéticos mal controlados, em uso prévio de insulina NPH, com redução importante dos níveis de A1c. Estima-se uma melhora da qualidade de vida desses pacientes, marcada pela redução de eventos hipoglicêmicos (inclusive os graves), episódios de cetoacidose e utilização de menor dose diária de insulina, com provável impacto em políticas de saúde pública. ABSTRACTSwitching of NPH Insulin to Glargine Therapy in a Cohort of Poorly Controlled Diabetic Patients: Observational Study. This study examined the impact of insulin glargine introduction in basal-bolus therapy in type 1 and type 2 diabetic patients with inadequate metabolic control (A1c > 6.9%) using previous NPH insulin regime. In this uncontrolled, retrospective study, 49 patients (28F/21M), average age 24.7 ± 16.5, mean duration of DM 13.2 ± 10.1 yrs., 93.1% DM1 patients, received insulin glargine plus mealtime rapid-acting insulin (lispro or aspart) followed by 90-day treatment. We analyzed mean total insulin dose, incidence of hypoglycemic events, convulsive crisis, hyperglycemic complications and A1c levels before and after three months of introduction of glargine therapy. A1c values were determined using the HPLC instrument, with a normal range of 4.3% to 6.9%. After switching to insulin glargine therapy, mean A1c dropped from 10.2 ± 2.0 to 9.1 ± 1.8%, with significant impact (p= 0.019). We observed a significant reduction of 0.11U/kg/day in total insulin dose, dropped from 0.75U/kg of NPH to 0.64U/kg of glargine, with significant correlation (p< 0.05). The introduction of glargine therapy was coincident with a decrease of hypoglycemic crisis (p= 0.02), convu...

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“…The frequency of symptomatic hypoglycemic events was similar between groups. In a 6-month study of 80 children and adolescents with Type 1 diabetes, aged 2-9 years, insulin glargine was substituted for NPH in the patients' multiple daily injection therapy [27]. The initial dose of insulin glargine was the same as the prior NPH dose for patients who had been receiving NPH once daily, but was reduced by 20% of the NPH dose for those who had been taking NPH more than once daily.…”

Section: Pediatric Patientsmentioning

confidence: 99%

Insulin glargine: a basal insulin for the management of diabetes

Lansang

Kennedy

2007

Expert Review of Endocrinology & Metabolism

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The prevalence of diabetes mellitus has been increasing steadily in the last 30 years and it is predicted that there will be 300 million people affected by 2025. Insulin deficiency is a feature of both Type 1 and 2 diabetes; insulin treatment, obligatory in Type 1, will also be required in many Type 2 patients. Insulin glargine is the first available synthetic insulin that can truly be described as basal -administered as a once-daily subcutaneous injection it raises the background, or basal, insulin level without a significant peak action and less hypoglycemia than previously used basal insulins. Insulin glargine is the first basal insulin that can be administered as a single injection daily as part of an intensive basal-bolus insulin regimen in Type 1 diabetes. In Type 2 diabetes, insulin glargine, administered once daily with one or two oral hypoglycemic drugs, can enable more than 50% of patients to achieve an A 1c of less than 7%. The titration of the insulin glargine dose to an appropriate level over a period of weeks is essential to its successful use in Type 2 diabetes.

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Therapy with insulin glargine (Lantus®) in toddlers, children and adolescents with type 1 diabetes

Cited by 37 publications

References 21 publications

Comparative Efficacy of Once Daily Insulin Glargine with Twice Daily NPH Insulin in Children with Type 1 Diabetes

Comparative Efficacy of Once Daily Insulin Glargine with Twice Daily NPH Insulin in Children with Type 1 Diabetes

Substituição da insulina NPH por insulina glargina em uma coorte de pacientes diabéticos: estudo observacional

Insulin glargine: a basal insulin for the management of diabetes

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