Background: Insulin degludec (IDeg; Tresiba®) is a novel basal insulin with an ultra-long, flat and stable action profile. In adults, it provides a more consistent glucose-lowering effect and lower rates of hypoglycaemia than glargine (IGlar). Data on children and adolescents are scarce.
Objective and hypotheses: To assess efficacy of IDeg among children and adolescents affected by type 1 diabetes (T1DM) previously on IGlar.
Method: The study included 20 (9 males) children and adolescents (15.1±4.0 years old, 7 prepubertal) with T1DM (mean duration 7.2±3.7 years), started on IDeg once daily as basal insulin after at least 1 year on IGlar. Anthropometric (BMI-SDS), metabolic (HbA1c (%), FPG (mg/dl) and severe hypoglycaemia rates (n)) and therapeutic parameters (IGlar or IDeg and short-acting or regular mealtime insulin dose (UI/kg per day)) were collected at baseline (T0) and after 3 and 6 months (T1 and T2) on IDeg. Data were analysed according to pubertal status.
Results: BMI-SDS did not change on IDeg both in prepubertal and in pubertal patients. Even if HbA1c diminished on IDeg without achieving any statistical significance (ΔHbA1c T0-T1 −0.3%, P 0.1; T0-T2 −0.1%, P 0.6), FPG significantly decreased from T0 to T1 (−18.6±34.1 mg/dl, P 0.05). No severe hypoglycaemia was registered on IDeg. The doses of both basal insulin (IGlar vs IDeg: 21.8±8.9 vs 19.4±7.8 UI/day, P 0.003) and short-acting or regular mealtime insulin (T2 vs T0 0.50±0.15 vs 0.56±0.13 UI/kg per day, P 0.02) were significantly reduced.
Conclusion: In our cohort, IDeg seemed to improve the glycemic control reducing FPG at a lower basal insulin dose if compared with IGlar. Moreover, it allowed the reduction of the dose of mealtime insulin.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology