Background: Functional insulin therapy allows precise insulin adjustments to achieve normoglycaemia.
Objective and hypotheses: To assess metabolic control (A1c) and lipid profile in children and adolescents with DM1 in a 3-year period under multiple daily injections (MDI) since the diagnosis.
Method: Retrospective analysis of children and adolescents under functional insulin therapy since the diagnosis of DM1. The variables studied were: age at diagnosis, gender, pubertary stage; insulin daily dose (IDD), average blood glucose, A1c, hypo and hyperglycemias and lipid profile in the first 3 years of disease.
Results: Forty-six children and adolescents were included, 26 (56.5%) females, age at diagnosis was 8.9±3.4 years, 69.6% pre-pubescent. IDD increase significantly over the years: year 1 (0.64±0.19 U/kg per day) and year 3 (0.88±0.24; P<0.001), and average blood glucose (140.85±26.8 mg/dl vs 157.13±29.4; P<0.001). In the pre-pubertal group, there was no significant increase in the first 2 years (142.53±23.9 vs 150.9±27.2; P=0.057). A1c did not vary significantly: year 1 (7.18±0.99%) and year 3 (7.4±0.84%; P=0.139). In the pubescent group A1c increased significantly (6.86±0.93 vs 7.6±1.09; P=0.037). Hyperglycemia increased significantly: year 1 (31.9±18.1%) and year 3 (44.3±15.3%; P<0.001), without variation in hypoglycemia rate: year 1 (9.1±4.4%) and year 3 (9.1±5.8%; P=0.979). There was no significant variation of LDL cholesterol and triglycerides (2.1±0.57 vs 2.2±0.57 mmol/l; P=0.410.71±0.29 vs 0.80±0.37 mmol/l; P=0.113).
Conclusion: Functional insulin therapy contributes to good metabolic control with low frequency of hypoglycemia, even in pre-pubertal children. Therapeutic education is needed on how to adjust insulin to avoid hyperglycemia increasing. This therapy is safe since the diagnosis of DM1.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology