Skip to main content
SpringerLink
Log in

Basal insulin supplementation in Type 1 diabetic children: A long-term comparative observational study between continuous subcutaneous insulin infusion and glargine insulin

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

No long-term data are available on the efficacy of glargine insulin in comparison with continuous sc insulin infusion (CSII) in children and adolescents affected by Type 1 diabetes (T1D). Our aim was to compare the 2-yr efficacy of the 2 insulin approaches, in order to know how to best supply basal insulin in these patients. Thirty-six 9 to 18-yr-old consecutive children with at least 3 yr previous T1D diagnosis were enrolled. As part of routine clinical care, the patients consecutively changed their previous insulin scheme (isophane insulin at bedtime and human regular insulin at meals) and were randomly selected in order to receive either multiple daily injections (MDI) treatment with once-daily glargine and human regular insulin at meals, or CSII with aspart or lispro insulin. Both groups showed a significant decrease in glycosylated hemoglobin (HbA1c) values during the 1st year of therapy, though only in the CSII treated children was the decrease also observed during the 2nd year. The overall insulin requirement significantly decreased only in the CSII group and exclusively during the 1st year, while no significant differences were observed concerning body mass index SD score, severe hypoglycémic episodes and basal insulin supplementation. The work illustrates the first long-term study comparing the efficacy of CSII to MDI using glargine as basal insulin in children. Only with CSII were better HbA1c values obtained for prolonged periods of time, so that CSII might be considered the gold standard of intensive insulin therapy also for long-term follow-ups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pickup JC, Keen H. Continuous subcutaneous insulin infusion at 25 years: evidence base for the expanding use of insulin pump therapy in type 1 diabetes. Diabetes Care 2002, 25: 593–8.

    Article  PubMed  Google Scholar 

  2. Mack-Fogg JE, Orlowski CC, Jospe N. Continuous subcutaneous insulin infusion in toddlers and children with type 1 diabetes mellitus is safe and effective. Pediatr Diabetes 2005, 6: 17–21.

    Article  PubMed  Google Scholar 

  3. Low KG, Massa L, Lehman D, Olshan JS. Insulin pump use in young adolescents with type 1 diabetes: a descriptive study. Pediatr Diabetes 2005, 6: 22–31.

    Article  PubMed  Google Scholar 

  4. Pickup JC, Mattock M, Kerry S. Glycaemic control with continuous subcutaneous insulin infusion compared with intensive insulin injections in patients with type 1 diabetes: meta-analysis of randomised controlled trials. BMJ 2002, 324: 705.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  5. Ahern JAH, Boland EA, Doane R, et al. Insulin pump therapy in pediatrics: a therapeutic alternative to safely lower HbA1c levels across all age groups. Pediatr Diabetes 2002, 3: 10–5.

    Article  PubMed  Google Scholar 

  6. Fox LA, Buckloh LM, Smith SD, Wysocki T, Mauras N. A randomized controlled trial of insulin pump therapy in young children with type 1 diabetes. Diabetes Care 2005, 28: 1277–81.

    Article  PubMed  CAS  Google Scholar 

  7. Lepore M, Pampanelli S, Fanelli C, et al. Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes 2000, 49: 2142–8.

    Article  PubMed  CAS  Google Scholar 

  8. Kuerzel GU, Shukla U, Scholtz HE, et al. Biotransformation of insulin glargine after subcutaneous injection in healthy subjects. Curr Med Res Opin 2003, 19: 34–40.

    Article  PubMed  CAS  Google Scholar 

  9. Reinhart L, Panning CA. Insulin glargine: a new long-acting insulin product. Am J Health Syst Pharm 2002, 59: 643–9.

    PubMed  CAS  Google Scholar 

  10. Bolli GB. Physiological insulin replacement in type 1 diabetes mellitus. Exp Clin Endocrinol Diabetes 2001, 109 (Suppl 2): S317–32.

    Article  PubMed  CAS  Google Scholar 

  11. Binder C, Lauritzen T, Faber O, Pramming S. Insulin pharmacokinetics. Diabetes Care 1984, 7: 188–99.

    Article  PubMed  Google Scholar 

  12. Brange J, Langkjaer L. Insulin formulation and delivery. Pharm Biotechnol 1997, 10: 343–409.

    Article  PubMed  CAS  Google Scholar 

  13. Rosenstock J, Park G, Zimmerman J; U.S. Insulin Glargine (HOE 901) Type 1 Diabetes Investiagtor Group. Basal insulin glargine (HOE 901) versus NPH insulin in patients with type 1 diabetes on multiple daily insulin regimens. Diabetes Care 2000, 23: 1137–42.

    Article  PubMed  CAS  Google Scholar 

  14. Ratner RE, Hirsch IB, Neifing JL, Garg SK, Mecca TE, Wilson CA. Insulin Glargine (HOE 901) Type 1 Diabetes Investigator Group. Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. Diabetes Care 2000, 23: 639–43.

    CAS  Google Scholar 

  15. Hamann A, Matthaei S, Rosak C, Silvestre L; HOE901/4007 Study Group. A randomized clinical trial comparing breakfast, dinner or bedtime administration of insulin glargine in patients with type 1 diabetes. Diabetes Care 2003, 26: 1738–44.

    Article  PubMed  CAS  Google Scholar 

  16. Schober E, Schoenle E, Van Dyk J, Wernicke-Panten K; Pédiatric Study Group of Insulin Glargine. Comparative trial between insulin glargine and NPH insulin in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2002, 15: 369–76.

    Article  PubMed  CAS  Google Scholar 

  17. Murphy NP, Keane SM, Ong KK, et al. Randomized cross-over trial of insulin glargine plus lispro or NPH insulin plus regular human insulin in adolescents with type 1 diabetes on intensive insulin regimens. Diabetes Care 2003, 26: 799–804.

    Article  PubMed  CAS  Google Scholar 

  18. Hanaire-Broutin H, Melki V, Bessieres-Lacombe S, Tauber JP. Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimes using insulin lispro in type 1 diabetic patients on intensified treatment. The Study Group for the Development of Pump Therapy in Diabetes. Diabetes Care 2000, 23: 1232–5.

    CAS  Google Scholar 

  19. Raskin P, Bode BW, Marks JB, et al. Continuous subcutaneous insulin infusion and multiple daily injection therapy are equally effective in type 2 diabetes: a randomized, parallel-group, 24-week study. Diabetes Care 2003, 26: 2598–603.

    Article  PubMed  CAS  Google Scholar 

  20. Schiffrin AD, Desrosiers M, Aleyassine H, Belmonte MM. Intensified insulin therapy in the type 1 diabetic adolescent: a controlled trial. Diabetes Care 1984; 7: 107–13.

    Article  PubMed  CAS  Google Scholar 

  21. Kanc K, Jannssen MMJ, Keulen ETP, et al. Substitution of night-time continuous subcutaneous insulin infusion therapy for bedtime NPH insulin in a multiple injection regimen improves counterregulatory hormonal responses and warning symptoms of hypoglycaemia in IDDM. Diabetologia 1998, 41: 322–9.

    Article  PubMed  CAS  Google Scholar 

  22. Fahlen M, Eliasson B, Oden A. Optimization of basal insulin delivery in Type 1 diabetes: a retrospective study on the use of continuous subcutaneous insulin infusion and insulin glargine. Diabet Med 2005, 22: 382–6.

    Article  PubMed  CAS  Google Scholar 

  23. Schiaffini R, Ciampalini P, Spera S, Cappa M, Crinò A. An observational study comparing continuous subcutaneous insulin infusion (CSII) and insulin glargine in children with type 1 diabetes. Diabet Metab Res Rev 2005, 21: 347–52.

    Article  CAS  Google Scholar 

  24. King AB, Armstrong D. A comparison of basal insulin delivery: continuous subcutaneous insulin infusion versus glargine. Diabetes Care 2003, 26: 1322.

    Article  PubMed  Google Scholar 

  25. Lepore G, Dodesini AR, Nosari I, Trevisan R. Both continuous subcutaneous insulin infusion and a multiple daily insulin injection regimen with glargine as basal insulin are equally better than traditional multiple daily insulin injection treatment. Diabetes Care 2003, 26: 1321–2.

    Article  PubMed  Google Scholar 

  26. Dunn CJ, Plosker GL, Keating GM, McKeage K, Scott LJ. Insulin glargine: an updated review of its use in the management of diabetes mellitus. Drugs 2003, 63: 1743–78.

    Article  PubMed  CAS  Google Scholar 

  27. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997, 20: 1183–97.

    Google Scholar 

  28. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003, 26: 3160–7.

    Article  Google Scholar 

  29. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993, 329: 977–86.

    Article  Google Scholar 

  30. Nordfeldt S, Ludvigsson J. Adverse events in intensively treated children and adolescents with type 1 diabetes. Acta Paediatr 1999, 88: 1184–93.

    Article  PubMed  CAS  Google Scholar 

  31. Ludvigsson J, Bolli GB. Intensive insulin treatment in diabetic children. Diabetes Nutr Metab 2001, 14: 292–304.

    PubMed  CAS  Google Scholar 

  32. Schade DS, Valentine V. To pump or not to pump. Diabetes Care 2002, 25: 2100–2.

    Article  PubMed  Google Scholar 

  33. Hathout EH, Fujishige L, Geach J, Ischandar M, Maruo S, Mace JW. Effect of therapy with insulin glargine (lantus) on glycemie control in toddlers, children, and adolescents with diabetes. Diabetes Technol Ther 2003, 5: 801–6.

    Article  PubMed  CAS  Google Scholar 

  34. Armstrong DU, King AB. Basal insulin: continuous glucose monitoring reveals less overnight hypoglycemia with continuous subcutaneous insulin infusion than with glargine (Abstract). Diabetes 2002, 51 (Suppl 2): A92.

    Google Scholar 

  35. Doyle EA, Weinzimer SA, Steffen AT, Ahern JAH, Vincent M, Tamborlane WV. A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care 2004, 27: 1554–8.

    Article  PubMed  CAS  Google Scholar 

  36. Cherubini V, lannilli A, lafusco D, et al. Premeal insulin treatment during basal-bolus regimen in young children with type 1 diabetes. Diabetes Care 2006, 29: 2311–2.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pédiatric Medicine Unit of Endocrinology and Diabetology, Bambino Gesù Children’s Hospital, IRRCS, Piazza S. Onofrio, 4, 00165, Roma, Italy

    R. Schiaffini, P. I. Patera, C. Bizzarri, P. Ciampalini & M. Cappa MD, PhD

Authors
  1. R. Schiaffini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. I. Patera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Bizzarri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Ciampalini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Cappa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Cappa MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schiaffini, R., Patera, P.I., Bizzarri, C. et al. Basal insulin supplementation in Type 1 diabetic children: A long-term comparative observational study between continuous subcutaneous insulin infusion and glargine insulin. J Endocrinol Invest 30, 572–577 (2007). https://doi.org/10.1007/BF03346351

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03346351

Key-words

Search

Navigation