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European Journal of Pediatrics

, Volume 162, Issue 1, pp 22–29 | Cite as

Insulin injection regimens and metabolic control in an international survey of adolescents with type 1 diabetes over 3 years: results from the Hvidore study group

  • Reinhard W. Holl
  • Peter G. Swift
  • Henrik B. Mortensen
  • Helle Lynggaard
  • Phillip Hougaard
  • Henk-Jan Aanstoot
  • Francesco Chiarelli
  • Denis Daneman
  • Thomas Danne
  • Harry Dorchy
  • Patrick Garandeau
  • Steven Greene
  • Hilary M. Hoey
  • Eero A. Kaprio
  • Mirjana Kocova
  • Pedro Martul
  • Nobuo Matsuura
  • Kenneth J. Robertson
  • Eugen J. Schoenle
  • Oddmund Sovik
  • Rosa-Maria Tsou
  • Maurizio Vanelli
  • Jan Åman
Original Paper

Abstract.

The optimal insulin regimen for paediatric patients with type 1 diabetes remains controversial. Therefore this multicentre study was performed in adolescents over a 3-year period to assess metabolic control, severe hypoglycaemia, and weight gain in relation to insulin injection regimens. Out of 2873 children and adolescents in an international survey in 1995, 872 adolescents (433 boys, 439 girls, mean age in 1995 11.3±2.2 years) were restudied in 1998, relating insulin regimens to HbA1c measured in a central laboratory. In addition, the daily dose of insulin, changes in body mass index (BMI), and events of severe hypoglycaemia were evaluated. Over 3 years, the use of multiple injection regimens increased from 42% to 71%: 251 patients remained on twice daily insulin, 365 remained on multiple injections and 256 shifted from twice daily insulin to multiple injections. In all three subgroups an increase in insulin dose, a deterioration of metabolic control, and an increase in BMI were observed. Metabolic control deteriorated less than expected over 3 years during adolescence (HbA1c 1995: 8.7±1.6%; 1998 observed: 8.9±1.6%, HbA1c expected for 1998: 9.0%). BMI increased more than expected, the increase was greatest in patients switching from twice daily to multiple injections, and higher in females compared to males. Conclusion: in this international study, metabolic control was unsatisfactory in many adolescents with type 1 diabetes irrespective of the insulin regimen. No improvement in metabolic control was observed in this cross-sectional survey, over 3 years in any of the subgroups. Even the group switching from twice to multiple injections did not improve blood glucose control and the increase in body mass index was most pronounced in this group. Conclusive evidence, however, should be based on prospectively planned, randomised therapeutic trials in paediatric patients.

Body mass index Hypoglycaemia Insulin regimen Metabolic control Type 1 diabetes mellitus 

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Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • Reinhard W. Holl
    • 1
  • Peter G. Swift
    • 2
  • Henrik B. Mortensen
    • 3
  • Helle Lynggaard
    • 4
  • Phillip Hougaard
    • 4
  • Henk-Jan Aanstoot
    • 5
  • Francesco Chiarelli
    • 6
  • Denis Daneman
    • 7
  • Thomas Danne
    • 8
  • Harry Dorchy
    • 9
  • Patrick Garandeau
    • 10
  • Steven Greene
    • 11
  • Hilary M. Hoey
    • 12
  • Eero A. Kaprio
    • 13
  • Mirjana Kocova
    • 14
  • Pedro Martul
    • 15
  • Nobuo Matsuura
    • 16
  • Kenneth J. Robertson
    • 17
  • Eugen J. Schoenle
    • 18
  • Oddmund Sovik
    • 19
  • Rosa-Maria Tsou
    • 20
  • Maurizio Vanelli
    • 21
  • Jan Åman
    • 22
  1. 1.University of Ulm, ZIBMT, Albert-Einstein-Allee 47, 89081 Ulm, Germany
  2. 2.Leicester Royal Infirmary Children's Hospital, Leicester, UK
  3. 3.Glostrup University Hospital, Glostrup, Denmark
  4. 4.Novo Nordisk, Bagsvaerd, Denmark
  5. 5.Erasmus University Medical Centre, Rotterdam, The Netherlands
  6. 6.Clinica Pediatrica Universita, Chieti, Italy
  7. 7.The Hospital for Sick Children, University of Toronto, Toronto, Canada
  8. 8.Virchow-Klinikum, Berlin, Germany
  9. 9.Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
  10. 10.Institut Saint Pierre, Montpellier, France
  11. 11.Ninewells Hospital, Dundee, Scotland
  12. 12.Department of Paediatrics, Trinity College Dublin, National Children's Hospital, Tallaght, Ireland
  13. 13.Peijas Hospital, Vantaa, Finland
  14. 14.Paediatric Clinic, University of Skopje, Skopje, Macedonia
  15. 15.Hospital de Cruces, Baracaldo, Spain
  16. 16.Kitasato University School of Medicine, Kanagawa, Japan
  17. 17.Royal Hospital for Sick Children, Glasgow, Scotland
  18. 18.University Children's Hospital, Zurich, Switzerland
  19. 19.Haukeland Hospital, Bergen, Norway
  20. 20.Hospital S. Joao, Porto, Portugal
  21. 21.Clinica Pediatrica, Università di Parma, Parma, Italy
  22. 22.Regionsjukhuset i Örebro, Örebro, Sweden

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