Introduction: To optimal glycemic control without hypoglycemia must be the aim of insulin treatment for all patients with type 1 diabetes (T1DM). Despite the advantages of the basal-bolus insulin regimens with MDI, hypoglycemia presents a major barrier in achieving desirable blood glucose levels. Degludec is a new basal insulin analog with longer half-life and lower variability.
Objetive: To investigate the differences between long-acting insulins glargine and degludec, in real-life study in pediatric and adolescent patients with T1DM.
Materials and methods: This observational, retrospective study enrolled 19 patients with T1DM. They were on basal bolus therapy with Glargine administered once daily and pre-prandial insulin boluses. Blinded CGM (Medtronic iPro 2®) was chosen to monitoring glucose values. Glucose data obtained by CGM during treatment with Glargine and 3 months after switching to Degludec were compared. Each patient serves as a self-control. Data were analyzed by several indexes: HbA1c, total insulin dose, basal/bolus ratio, average glucose and SD, fasting mean glucose, time in range (70180 mg/dl), time in hypoglycemia (<70 mg/dl, <54 mg/dl), time in hyperglycemia (>180 mg/dl, >250 mg/dl), hypoglycemia episodes and glucose variability (coefficient of variation (CV), MAGE, MODD and CONGA). Stastistical processing was performed using IMB SPSS Statistic 19. T Student test for paired samples.
Results: Nineteen patients with T1DM (10 boys, 9 girls, age 819, with an average duration of T1DM of 7 years, were on basal-bolus therapy with Glargine once a day and preprandial fast acting insulin boluses. Reason of switching: hypoglycemia or variability. Overall glucose control was the same between the two treatments, and HbA1c did not change after switching from Glargine to Degludec (7.05±0.7% vs 7.01±0.7%). Total daily insulin requirement was reduced in 10 patients, dependent on basal insulin. Looking at hypoglycemia (n=16), a statistically significant increase in fasting mean glycemia was observed (120.4 vs 151.2, P=0.08). Time spent by patients in hypoglycemia (<54 and <70 mg/dl) was not statistically different between Glargine and Degludec. Current tratment with Degludec, episodes of hypoglycaemia are reduced (11 vs 8, P=0.09). Switching from Glargine to Degludec did no change in terms of daily glycemic variability, despite CONGA index with a significant increase.
Discussion: The potencial limitation of this study is the small sample size, but it shows that Degludec is effective as Glargine in glycemic control, without differences in glucose variability, and might be advantageous in patients with risk of hypoglycemia.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology