BSPED2010 Oral Presentations (RCN CYP diabetes session) (1) (5 abstracts)
Differences in metabolic effects of twice daily versus multiple daily insulin injections in children with type 1 diabetes
N Abid 1 , G Buckley 1 , L Porter 1 , E Day 1 , P Davies 2 , N Shaw 1 , J Kirk 1 , N Krone 2 , W Hogler 1 & T Barrett 2
1Birmingham Children’s Hospital, Birmingham, UK; 2Centre for Endocrinology, Diabetes and Metabolism, School for Clinical, Birmingham, UK.
Introduction: Two insulin regimes are commonly used in type 1 diabetes (T1D): twice daily (BD) premixed insulin (short and intermediate acting), and multiple daily injections (MDI) of short acting insulin with once daily bolus of long acting insulin. MDI is associated with better glucose control in adults, but the evidence base is weaker for children.
Objectives: We aimed to compare children started on MDI to BD from diagnosis, on HbA1c as a measure of glucose control, and weight gain.
Methods: In our unit newly diagnosed children were started on BD insulin till 2005 when we changed over to MDI. Those on BD were offered a changeover to MDI. We collected data on all children with T1D between 2003 and 2009: HbA1c and body mass index standard deviation score (BMI SDS) at diagnosis of T1D or changing over to MDI and after 12 months.
Results: There were 88 (45f) children started on BD insulin (group 1), 29 (10f) on MDI (group 2), and 36 (20 f) children started on BD then changed to MDI (group 3). Mean HbA1c at baseline and 12 months: Group 1 (11.4%, 9.1% (P<0.001)); Group 2 (11.5%, 7.9%, (P<0.001)); Group 3 (8.9%, 9.2% (P=ns)). The improvement in HbA1c in group 2 versus group 1 at 12 months was 1.1% (P<0.001). The results for mean BMI SDS at baseline and 12 months were: Group 1 (0.41, 0.90 (P<0.001)); Group 2 (0.28, 0.56 (P=0.04)); Group 3 (0.8, 0.8 (P=ns)). The difference in BMI SDS at 12 months between groups 1 vs 2 (0.34) was not significant (P=0.1).
Conclusion: MDI from diagnosis results in better glycaemic control and a trend to less weight gain at 12 months than BD. Children who start on BD then switch to MDI after 12 months do not show the same benefit.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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