Long term feasibility of multiple daily injections with insulin pens in children and adolescents with diabetes.

During a period of 17 months, 15 C-peptide negative insulin-dependent diabetic children (14 +/- 4 years old) have used an injector pen (Novopen, Novo, France) to deliver soluble insulin before meals, in association with an insulin syringe for long-acting insulin administration at bedtime. Despite frequent daily insulin injections (4-5) and blood glucose determinations (3-4), long-term patient acceptability as well as cutaneous tolerance were excellent. Novopen was experienced as a progress (100%) which made a multiple injection regimen acceptable and provided an improvement in the quality of life (77%), as recorded by questionnaires answered at the end of the study. Twelve out of 15 patients chose to continue this treatment. No significant change in glycaemic control was observed in the group as a whole. An improvement in glycosylated haemoglobin (HbA 1c) was noticed only in the previously "poorly-controlled" children (n = 8) with initial HbA1c greater than 7%. In this group HbA1c decreased from 8.4 +/- 1.8% (mean +/- SD), to 7.3 +/- 1.2% (P less than 0.05) within the first 6 months of Novopen therapy. No increment of hypoglycaemia frequency and mean daily insulin requirements was observed. No ketoacidotic episode was noticed during the study. In conclusion, in this group of diabetic children, no long term metabolic improvement was obtained, despite excellent acceptability of the multiple injection regimen with Novopen.