Insulin Regimens and Clinical Outcomes in a Type 1 Diabetes Cohort
Published Date:Sep 06 2012
Source:Diabetes Care. 2013; 36(1):27-33.
Corporate Authors:for the SEARCH for Diabetes in Youth Study Group*
Pubmed Central ID:PMC3526205
Funding:1U18DP002709/DP/NCCDPHP CDC HHS/United States
1UL1RR026314-01/RR/NCRR NIH HHS/United States
M01RR00037/RR/NCRR NIH HHS/United States
M01RR00069/RR/NCRR NIH HHS/United States
P30 DK57516/DK/NIDDK NIH HHS/United States
U01 DP000244/DP/NCCDPHP CDC HHS/United States
U01 DP000245/DP/NCCDPHP CDC HHS/United States
U01 DP000246/DP/NCCDPHP CDC HHS/United States
U01 DP000247/DP/NCCDPHP CDC HHS/United States
U01 DP000248/DP/NCCDPHP CDC HHS/United States
U01 DP000250/DP/NCCDPHP CDC HHS/United States
U01 DP000254/DP/NCCDPHP CDC HHS/United States
U18DP000247-06A1/DP/NCCDPHP CDC HHS/United States
U18DP002708-01/DP/NCCDPHP CDC HHS/United States
U18DP002710-01/DP/NCCDPHP CDC HHS/United States
U18DP002714/DP/NCCDPHP CDC HHS/United States
U48/CCU419249/PHS HHS/United States
U48/CCU519239/PHS HHS/United States
U48/CCU819241-3/PHS HHS/United States
U48/CCU919219/PHS HHS/United States
U58/CCU019235-4/PHS HHS/United States
U58CCU919256/PHS HHS/United States
UL1 TR000077/TR/NCATS NIH HHS/United States
UL1RR029882/RR/NCRR NIH HHS/United States
To examine the patterns and associations of insulin regimens and change in regimens with clinical outcomes in a diverse population of children with recently diagnosed type 1 diabetes.
RESEARCH DESIGN AND METHODS
The study sample consisted of youth with type 1 diabetes who completed a baseline SEARCH for Diabetes in Youth study visit after being newly diagnosed and at least one follow-up visit. Demographic, diabetes self-management, physical, and laboratory measures were collected at study visits. Insulin regimens and change in regimen compared with the initial visit were categorized as more intensive (MI), no change (NC), or less intensive (LI). We examined relationships between insulin regimens, change in regimen, and outcomes including A1C and fasting C-peptide.
Of the 1,606 participants with a mean follow-up of 36 months, 51.7% changed to an MI regimen, 44.7% had NC, and 3.6% changed to an LI regimen. Participants who were younger, non-Hispanic white, and from families of higher income and parental education and who had private health insurance were more likely to be in MI or NC groups. Those in MI and NC groups had lower baseline A1C (P = 0.028) and smaller increase in A1C over time than LI (P < 0.01). Younger age, continuous subcutaneous insulin pump therapy, and change to MI were associated with higher probability of achieving target A1C levels.
Insulin regimens were intensified over time in over half of participants but varied by sociodemographic domains. As more intensive regimens were associated with better outcomes, early intensification of management may improve outcomes in all children with diabetes. Although intensification of insulin regimen is preferred, choice of insulin regimen must be individualized based on the child and family’s ability to comply with the prescribed plan.
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