Beneficial effects of flexible insulin therapy in children and adolescents with type 1 diabetes mellitus

Abstract.

The purpose of this study was to determine the feasibility of a flexible multiple daily insulin (FMDI) regimen in routine pediatric diabetes care by comparing HbA_1c, body mass index (BMI), and episodes of severe hypoglycemia (SH) before and after initiation of FMDI therapy. Data from 44 patients (2–16 years old), on a conventional insulin (CI) regimen, were collected during quarterly diabetes clinic visits. These patients were transitioned from CI to FMDI regimen: pre-meal lispro (bolus) and once or twice daily Humulin Ultralente with or without bedtime Humulin NPH as the basal insulin. There was a significant improvement in HbA_1c in prepubertal (9.3%±1.3% vs. 8.0%±1.1%, p<0.002) and pubertal subjects (9.2%±1.0% vs. 8.2%±0.9%, p<0.001). Pubertal subgroup demonstrated an increase in BMI (21.3±3.1 vs. 22.7±3.2 kg/m², p<0.0001) after one year. The rate of SH was decreased in both prepubertal (p<0.01) and pubertal (p<0.05) groups of patients on FMDI therapy. The use of FMDI in a general pediatric diabetic population is a feasible therapeutic option for maintenance and possible improvement of glycemic control. It may effectively decrease the HbA_1c, and reduce hypoglycemic episodes, without producing an abnormal increase in BMI.