Achieving optimal metabolic control can be extremely challenging in some children and adolescents with T1DM. The adherence to multiple injections/day is among the leading causes of suboptimal control. Recently insulin degludec/aspart co-formulation (70%IDeg+30%IAsp: IDegAsp) has become available. Because of the longer-duration of IDeg, and retained individual pharmacokinetics of IDeg and IAsp, we wanted to test insulin IDegAsp's efficacy in our patients with poor glycemic control.
Objective: We investigated the number of hypoglycemic episodes, diabetic ketoacidosis (DKA) frequency, and HbA1c levels before and after changing to IDegAsp.
Methods: Patients >4 years of age who had diabetes duration of >1 year and on poor control on basal-bolus insulin regimens (≤4 injections/day) were included in the study. IDegAsp treatment were offered to the patients with HbA1c of >8.5%, or having DKA while on insulin treatment or labile diabetes and/or omitting insulin injections. Their insulin regimen were changed to one IDeg/Asp injection and two IAsp injections (three injections/day) with dose titration.
Results: Forty-six patients (20 girls) were included in the study. The mean age and the age of onset of diabetes were 12.9±3.4 (4-18) and 5.2±3.1 years (1.0-13.7), respectively. The reasons for the transition to IDeg/Asp were requirement of two doses of basal insulin (5 injections/day) (18), frequent episodes of hypoglycemia (9), daily glucose variability (9), frequent DKA (6). Ten patients discontinued IDeg/Asp due to continuing hyperglycemias (n:5), dosing difficulties (n:3), transition to pump (n:1) or DKA (n:1).
36 patients were evaluated at the 1styear of IDeg/Asp treatment. Their metabolic control parameters were compared to that of the previous year. No change in HbA1c levels has been detected after switching to IDegAsp (p:0.96). However, the number of self-reported mild-moderate hypoglycemia decreased significantly (P<0.05). There was only one episode of severe hypoglycemia before and after the regimen change. In previous year before regimen change, 8 DKA attacks in 7 patients were detected, which decreased to 3 DKA attacks in 3 patients during the year on IDegAsp (p:0.15). No significant change in BMI-SDS (p:0.13, but the decrease in insulin doses (unit/kg) (P<0.05) were detected.
Conclusion: IDegAsp regimen could be useful in patients with frequent hypoglycemia and DKA attacks, who have poor compliance with multiple injections. Better adherence to treatment because of less injection number and longer duration of IDeg could preventive for DKA in some cases.
19 Sep 2019 - 21 Sep 2019