ESPE Abstracts

Introduction:Despite the widely proven value of insulin analogs in the treatment of children with type 1 diabetes (T1D), pediatric studies of Increased weight gain in T1D are complicated by the age-dependency and gender-dependency of BMI, and also by a trend towards obesity in the general population.

Objective: to assess the impact of switching from Humain Insulin (HI) to insulin analogues on the BMI of children with T1D.

Patients and Methods: It was a retrospective descriptive study evaluating, in 80 children with type 1 diabetes, the impact of switching from human insulin (NPH + rapid insulin) in a twice-daily protocol to insulin analogs in the Basal-Bolus protocol on their nutritional status. Epidemiological, clinical and therapeutic parameters as well as glycemic homeostasis of each child were analyzed before and after the change of insulin therapy.

Results: At the time of switching from human insulin to insulin analogs, the mean age of the patients was 10.9 years and the mean history of diabetes was 3.7 years. The rate of compliance with the diet varied non-significantly before and after introduction of the analogs (19% vs. 21%, P=0.8). Before or after the introduction of analogs, the majority of patients did not practice sports regularly: 53% versus 51% (P=0.752). Glycated hemoglobin A1C decreased mainly in children who adhered to their diet (from 9.93% to 9.38% (P=0.06)) and/or practiced regular sports activity (from 10.40% to 8.61% (P=0.043)). The mean BMI was 18.04% for a mean duration of human insulin use of 3.7 years. It had significantly increased to 19.20% after a mean duration of 1.83 years of analogs use (P=0.026). When analyzing the change in BMI we found: a decrease in the rate of obesity (9% vs. 8%; P=0.51), a decrease in malnutrition (31% vs. 15%; P=0.012) and an increase in overweight (11% vs. 24%; P=0.038). The age distribution of BMI did not change after introduction of the analogs. The rate of malnutrition was more pronounced in children aged > 10 years (P=0.001). Overweight and obesity were more prevalent in children aged 5 and 10 years (P=0.001). After switching to analogues, there was no significant change in BMI according to gender.

Conclusions: The switch from human insulin to insulin analogues has significantly increased the BMI of children with diabetes. The therapeutic education of type 1 diabetic children should encourage physical activity and compliance with the diet in order to reduce excess weight and obesity.