Paediatric Endocrinology and Diabetes Unit, Department of Women's and Children's Health, Karolinska Institute and University Hospital, Stockholm, Sweden.
Pediatr Diabetes. 2011 Aug;12(5):501-5. doi: 10.1111/j.1399-5448.2010.00723.x. Epub 2011 Mar 28.
Insulin glargine offers sustained insulin delivery for 24 h. Change to glargine treatment consistently results in lower fasting glucose and fewer hypoglycemic episodes in children with type 1 diabetes compared to continuation of NPH, although glargine has not been shown to improve HbA1c in randomized trials. Studies comparing glargine and NPH in multiple injection therapy in children treated from diagnosis of type 1 diabetes are lacking.
HbA1c and insulin requirement were compared in a retrospective study of children (7-17 yr of age) with type 1 diabetes treated from diagnosis with basal insulin glargine (n = 49) or NPH (n = 49) in a multiple injection therapy (MIT) regimen with a rapid-acting insulin analogue. Patients were followed every third month for 1 yr. HbA1c, insulin dose, and weight data were retrieved.
HbA1c (mean ± SD) was lower at 3-5 months (5.5 ± 0.89 vs. 6.2 ± 0.89%, p < 0.05) and 6-9 months (5.6 ± 1.14 vs. 6.6 ± 0.99%; p < 0.001) in glargine treated. After 12 months, HbA1c was significantly lower in glargine treated (6.3 ± 1.56 vs. 7.1 ± 1.28; p < 0.01). Reported total insulin doses were similar at nadir (0.5 U/kg BW × 24 h), but significantly lower at 12 months in glargine treated (0.64 ± 0.23 vs. 0.86 ± 0.3 U/kg BW × 24 h; p < 0.001).
HbA1c 1 yr from diagnosis was lower in children treated with glargine from start as compared with those on NPH. This observation should be viewed in the light of a significantly lower dose of total daily insulin in the glargine group.
甘精胰岛素可提供 24 小时持续胰岛素输送。与继续使用 NPH 相比，改用甘精胰岛素治疗可使 1 型糖尿病儿童的空腹血糖降低，低血糖发作次数减少，尽管在随机试验中，甘精胰岛素并未显示能改善 HbA1c。缺乏比较在诊断为 1 型糖尿病后开始接受甘精胰岛素和 NPH 多次注射治疗的儿童的研究。
在一项回顾性研究中，比较了从诊断开始接受基础胰岛素甘精胰岛素（n = 49）或 NPH（n = 49）治疗的 1 型糖尿病儿童（7-17 岁）的 HbA1c 和胰岛素需求，他们采用速效胰岛素类似物进行多次注射治疗（MIT）方案。患者每 3 个月随访 1 年，检索 HbA1c、胰岛素剂量和体重数据。
甘精胰岛素治疗的 3-5 个月（5.5 ± 0.89 与 6.2 ± 0.89%，p < 0.05）和 6-9 个月（5.6 ± 1.14 与 6.6 ± 0.99%，p < 0.001）的 HbA1c 较低。治疗 12 个月后，甘精胰岛素治疗的 HbA1c 明显降低（6.3 ± 1.56 与 7.1 ± 1.28%，p < 0.01）。最低时的总胰岛素剂量报告相似（0.5 U/kg BW × 24 h），但甘精胰岛素治疗的 12 个月时明显降低（0.64 ± 0.23 与 0.86 ± 0.3 U/kg BW × 24 h；p < 0.001）。
与 NPH 相比，从诊断开始接受甘精胰岛素治疗的儿童在诊断后 1 年的 HbA1c 降低。这一观察结果应结合甘精胰岛素组总日胰岛素剂量显著降低来看待。
