Insulin Glargine versus Neutral Protamine Hagedorn Insulin in Young and Preschool Children with Type 1 Diabetes Mellitus

Abstract

Background: Diabetic patients need to maintain tight glycemic control to avoid long term complications. Children need to achieve tight control without the risk of hypoglycemic excursions.

Objective: To assess the safety and efficacy of insulin glargine as a basal insulin in type 1 diabetic children aged 3 to 8 years old in comparison to neutral protamine Hagedorn (NPH) insulin as regards the key parameters of diabetes management and low-grade inflammation.

Patients and Methods: Fifty children aged 3-8 years old with type 1 diabetes mellitus following in pediatric diabetes clinic, Ain Shams University Hospital were enrolled in this study. They were randomized into two groups, group A: shifted from NPH insulin to basal-bolus regimen using insulin glargine once a day and group B: kept on using NPH insulin two to three times a day. Both used regular insulin or rapid acting analogues at mealtime.

Results: At six months, weight gain was significantly higher among group B patients 0.6 kg (±0.14 SD) vs 0.38 kg, mean fasting blood sugar was lower in group A, 109.1(+17) mg/dl versus 125.3(+20) mg/dl in group B. HbA1C showed significant improvement in both groups with tight control, however group A was better with a mean of 6.7(+0.5)% versus 7.4(+0.7) and still with significantly less hypoglycemic excursions. Hs-CRP as a marker of inflammation showed significant drop with better overall control independent of the basal insulin used.

Conclusion: Insulin glargine as once daily basal insulin is safe in achieving good glycemic control in young and preschool children with less hypoglycemic excursions.