Endocrine Abstracts (2008) 17 P52

Comparison of twice daily insulin and multiple daily insulin regimens in children and adolescents newly diagnosed with type 1 diabetes

G Lyder, J Kirk, T Barrett, N Shaw & W Hogler

Birmingham Children’s Hospital, Birmingham, UK.

Aims: To compare glycaemic control and change in body mass index (BMI) in children and adolescents newly diagnosed with type 1 diabetes (T1D) and started on either twice daily insulin (BD) or multiple daily insulin (MDI).

Methods: This study looked retrospectively at all children newly diagnosed with T1D at our hospital from January 2006 to June 2007. There were 44 children and the outcome measures used were change in haemoglobin A1c (HbA1c) and BMI standard deviation score (BMI SDS) 12 months after diagnosis and total daily insulin dose per kilogram body weight at 12 months.

Results: There were 44 children identified over this period. Ten were excluded as there was incomplete data, a change in insulin regimen in the 12 months studied or the patient moved away. There were 19 children (7 male) in the BD group, median age 8 years (range 4.5–14.3 years), and 16 children (14 male) in the MDI group, median age 12.9 years (range 6.5–15.9 years). The median HbA1c at diagnosis was 10.6% (7.7–13.9%) for the BD group and 10.8% (6.8–13.5%) for the MDI group. The median (range) BMI SDS at diagnosis was 0.8 (−2.11 to 2.22) in the BD group, and 0.11 (−3.4 to 1.43) in the MDI group.

The median (range) HbA1c change at 12 months in the BD group was −2.20% (−8.4 to 1.9%) and in the MDI group was −2.95% (−7.2 to 1.3%) (P=0.3). The BMI-SDS change at 12 months was −0.44 (−1.77 to 1.04) in the BD group and −0.55(−2.61 to 0.43) in the MDI group (P=0.2).At 12 months the total insulin dose (median (range)) was 0.93 U/kg per day (0.44–1.36) in the BD group and 0.79 U/kg per day (0.4–1.52) (N=14) in the MDI group.

Conclusions: Using a general linear model, adjusting for age, there was no significant difference in glycaemic control, insulin doses or change in body mass index between the two groups. The assumption was that the MDI regimen helps achieve better glycaemic control but this has not been demonstrated. The small size of the groups may have been a contributing factor. Another larger study using age and sex matched controls on a BD regimen would be useful.

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