ESPE Abstracts

Basal-bolus insulin therapy is currently, the most common treatment modality in children and adolescents with type 1 diabetes mellitus (T1DM) worldwide. Insulin glargine and detemir are two different molecules, produced with small modifications, of human insulin. In this prospective longitudinal study, we aimed to compare HbA1c, time in range in CGM, basal insulin doses and hypoglyccemia frequencies in children and adolescents with T1DM who underwent switching from insulin detemir to insulin glargine by usual practice.

Material method: Eighteen patients aged 5-18 years who were using levemir and planned to switch to lantus were included in the study. Primary outcome measures were collected 3 months before conversion and compared with outcomes collected 3 months after conversion. Basal insulin dose, mean hemoglobin a1c values, time in range and frequency of hypoglycemia were investigated. Statistical analysis was performed using the SPSS software, version 22. Paired t tests were used for continuous variables, including insulin dose, A1C, and weight.

Results: A total of 18 patients (10M/8F) were included in the study. The mean age was 10,6 ± 1,85 years, and mean duration time of diabetes 33,6± 17,1 months. Insulin detemir were switched to insulin glargine due to the use of high doses, the inability to adapt to the two doses, and the fear of injection. The majority (15 patients [83.3%]) had a decrease in insulin dose on conversion and three were converted on a unit-for-unit basis. Three months after switching, significant change in mean insulin glargine dose was noted compared with baseline insulin detemir dose in patients (37.7 vs 31.1 units/day, P<0.05). When the hba1c levels of the patients were compared, it was not statistically significant, but a lower mean was obtained with lantus(8,5±1,5 vs 8,1± 1,02; P=0,074). However, time in range values were found to be significantly higher with lantus (65,7%± 11 vs 72.5%± 17; P=0.010) and the frequency of hypoglycemia was significantly reduced (2,1 vs 1,6; P=0.035).

Conclusion: In our study, children with T1DM using detemir or glargine as basal insulin had similar results in terms of Hba1c, but they remained time in range for a longer time with insulin glargine and the frequency of hypoglycemia and mean basal insulin dose decreased. Administration of lower and single dose basal insulin with glargin increased compliance and provided better glycemic control in our cases.