Published online March 2, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e673-e678 (doi:10.1542/peds.2008-3027)
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ARTICLE

Institution of Basal-Bolus Therapy at Diagnosis for Children With Type 1 Diabetes Mellitus

Soumya Adhikari, MDa, Beverley Adams-Huet, MSb, Yu-Chi A. Wang, MDa, James F. Marks, MD, MPHa and Perrin C. White, MDa

a Division of Pediatric Endocrinology, Department of Pediatrics
b Division of Biostatistics, Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas

OBJECTIVE. We studied whether the institution of basal-bolus therapy immediately after diagnosis improved glycemic control in the first year after diagnosis for children with newly diagnosed type 1 diabetes mellitus.

METHODS. We reviewed the charts of 459 children ≥6 years of age who were diagnosed as having type 1 diabetes between July 1, 2002, and June 30, 2006 (212 treated with basal-bolus therapy and 247 treated with a more-conventional neutral protamine Hagedorn regimen). We abstracted data obtained at diagnosis and at quarterly clinic visits and compared groups by using repeated-measures, mixed-linear model analysis. We also reviewed the records of 198 children with preexisting type 1 diabetes mellitus of >1-year duration who changed from the neutral protamine Hagedorn regimen to a basal-bolus regimen during the review period.

RESULTS. Glargine-treated subjects with newly diagnosed diabetes had lower hemoglobin A1c levels at 3, 6, 9, and 12 months after diagnosis than did neutral protamine Hagedorn-treated subjects (average hemoglobin A1c levels of 7.05% with glargine and 7.63% with neutral protamine Hagedorn, estimated across months 3, 6, 9, and 12, according to repeated-measures models adjusted for age at diagnosis and baseline hemoglobin A1c levels; treatment difference: 0.58%). Children with long-standing diabetes had no clinically important changes in their hemoglobin A1c levels in the first year after changing regimens.

CONCLUSION. The institution of basal-bolus therapy with insulin glargine at the time of diagnosis of type 1 diabetes was associated with improved glycemic control, in comparison with more-conventional neutral protamine Hagedorn regimens, during the first year after diagnosis.

Key Words: glargine • hemoglobin A1c • honeymoon • glycemic control • pediatric

Abbreviations: T1DM—type 1 diabetes mellitus • RAIA—rapid-acting insulin analog • CI—confidence interval • NPH—neutral protamine Hagedorn

Accepted Dec 17, 2008.


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