ESPE Abstracts

Introduction: The selection of insulin therapy for children with type 1 diabetes (T1DM) poses a challenge, particularly in low- and middle-income countries. This study aimed to assess the utilization of insulin analogues in diabetic children and identify factors associated with achieving glycemic goals.

Methods: In a retrospective study involving 80 children with T1DM, the impact of transitioning from human insulin to insulin analogues was evaluated. Epidemiological, clinical, and therapeutic parameters, as well as glycemic control, were analyzed before and after the change in insulin therapy.

Results: The average age of patients at the time of switching was 10.9 years, with an average diabetes duration of 3.7 years. Following the transition, there was a significant decrease in fasting blood glucose levels (11.11mol/l vs. 9.62 mmol / l;(P=0.024)) and postprandial glucose levels (20.17 mmol /l to 19.07 mmol /l). The mean HbA1c levels improved with insulin analogues, especially in patients regularly engaging in physical activities (10.40% to 8.61% (P=0.043)). The number of hospital admissions per year significantly reduced after the switch (0.35/year to 0.23 hospital admissions/year (P=0.001)). High costs and the lack of social security coverage led to the majority of patients (82%) reusing needles multiple times per day. Temporary discontinuation of intensive insulin therapy with analogues, resulting in acid-keto decompensation, was primarily due to financial constraints (22%), voluntary decisions (10%), or forgetfulness (68%). Twelve patients switched back to human insulin after an average duration of 1.5 years. Definitive discontinuation of insulin analogues occurred due to the cessation of social security coverage (2 cases) or difficulties in acquiring self-financed micro-fine needles (8 cases).

Conclusion: Insulin analogues exhibit beneficial effects on glycemic control and hospitalization rates, despite the ongoing challenge of attaining optimal glycemic objectives. Personalized therapeutic education plays a pivotal role in preventing therapy discontinuation and should incorporate socioeconomic considerations. By prioritizing affordable physical activities, tailored dietary approaches, and individualized action plans, outcomes can be improved.