Current treatment in type 1 diabetes focuses on the development of physiological insulin replacement. Although this has led to the increased progress in the development of semi closed loop systems and different algorithms allowing this, the majority of youth still has to cope with insulin injections. Improving metabolic outcome with injection therapy has become more demanding, imposing an increased number of injections and improved knowledge of food composition. For those able to calculate the appropriate meal dose and without injection phobia these intensified multiple dose strategies have led to improved outcome, and more flexibility in life style. To cover for the overnight period, an insulin without peak and of at least 12 h effect should be used. The development of these products have led to a reduction in nocturnal hypoglycemia and improved outcome.
Over time it has clearly been shown that this option does not fit all. Numeracy may be one problem as well as non acceptance of diabetes or need phobia.
In the adolescent group this problem can be observed regularly and potentially one injection may be given. Current development includes longer acting insulins which may cover at least 1824 h. Although meal adjustment is still requested the basal need could be covered by such products. Not only adolescents with type 1 diabetes, but as well the increasing number of youths with type 2 diabetes form a potentially relevant group as the early use of metformin and insulin becomes more frequent.
Further studies are needed to identify the best use for these products in the different age groups, improving metabolic control without increased weight gain or acute complications. This will allow the clinician to tailor the treatment to the individual patient ensuring optimal long term outcome.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology