Author(s): Jackson A, Ternand C, Brunzell C, Kleinschmidt T, Dew D,
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Abstract The pediatric diabetes team at the University of Minnesota made a clinical decision to switch patients with type 1 diabetes with a hemoglobin A1c level greater than 8.0\% to insulin glargine in an effort to improve glycemic control. Retrospective chart analysis was performed on 37 patients 6 months after the switch to insulin glargine therapy. RESULTS: After 6 months, the average hemoglobin A1c level in the entire cohort dropped from 10.1 +/- 2.0 to 8.9 +/- 1.6\% (p = 0.001). Thirty patients responded with an average hemoglobin A1c drop of 1.7 +/- 1.5\%, from 10.3 +/- 2.2 to 8.6 +/- 1.5\% (p < 0.001). Seven patients did not respond to insulin glargine therapy, with an average hemoglobin A1c rise of 1.0 +/- 0.8\% from a baseline of 9.5 +/- 1.0\% to 10.4 +/- 1.4\% (p = 0.01). The greatest response was seen in children with an A1c > 12.0\%, who dropped their hemoglobin A1c by 3.5 +/- 1.9\%. Compared with responders, non-responders had significantly less contact with the diabetes team in the form of clinic visits and telephone conversations both before and after initiation of glargine therapy. Sixty-two per cent of patients received insulin glargine at lunchtime, when injections could be supervised at school. Three episodes of severe hypoglycemia occurred after initiation of insulin glargine therapy. CONCLUSIONS: Insulin glargine substantially improved glycemic control in children and adolescents with poorly controlled type 1 diabetes. This response was most remarkable in those with a baseline hemoglobin A1c level > 12.0\%, and may have been related to increased supervision of injections.
This article was published in Pediatr Diabetes
and referenced in Journal of Diabetes & Metabolism