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 (original) (raw)

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.

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Authors and Affiliations

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

Authors

  1. Reinhard W. Holl
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  2. Peter G. Swift
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  3. Henrik B. Mortensen
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  4. Helle Lynggaard
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  5. Phillip Hougaard
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  6. Henk-Jan Aanstoot
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  7. Francesco Chiarelli
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  8. Denis Daneman
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  9. Thomas Danne
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  10. Harry Dorchy
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  11. Patrick Garandeau
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  12. Steven Greene
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  13. Hilary M. Hoey
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  14. Eero A. Kaprio
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  15. Mirjana Kocova
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  16. Pedro Martul
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  17. Nobuo Matsuura
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  18. Kenneth J. Robertson
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  19. Eugen J. Schoenle
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  20. Oddmund Sovik
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  21. Rosa-Maria Tsou
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  22. Maurizio Vanelli
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  23. Jan Åman
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Holl, R.W., Swift, P.G., Mortensen, H.B. et al. 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.Eur J Pediatr 162, 22–29 (2003). https://doi.org/10.1007/s00431-002-1037-2

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