A randomized, controlled trial comparing twiee-a-day insulin glargine mixed with rapid-acting insulin analogs versus standard neutral protamine hagedorn (NPH) therapy in newly diagnosed type 1 diabetes

Krishnavathana Hassan, Luisa M. Rodriguez, Susan E. Johnson, Susanne Tadlock, Rubina A. Heptulla

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

OBJECTIVE.Insulin glargine is difficult to use for children due to the number of injections required because it is claimed to be immiscible with rapid-acting insulin analogs. For this study, we hypothesized that treating new-onset type 1 diabetes with twice-daily insulin glargine plus a rapid-acting insulin analog mixed in the same syringe would result in better glycosylated hemoglobin than twice-daily neutral protamine Hagedorn with a rapid-acting insulin analog (standard treatment). METHODS. Forty-two patients with new-onset type 1 diabetes were started on standard treatment. Three months after diagnosis, if patients were found compliant and had a glycosylated hemoglobin level of <9%, then they were randomly assigned either to receive insulin glargine twice daily mixed with a rapid-acting Insulin analog or to continue on standard treatment for 3 more months. Additional lunchtime rapid- acting insulin analog injections were given for the insulin glargine group as necessary. RESULTS. Nineteen patients in the insulin glargine group and 17 in the neutral protamine Hagedorn group completed the study. The glycosylated hemoglobin level at baseline was 6.8% ± 1% vs 6.9% ± 1% and at poststudy was 6.7% ± 1.3% vs 7.6% ± 1% in the insulin glargine versus neutral protamine Hagedorn group, respectively. Two patients in the Insulin glargine group required lunch rapid-acting Insulin analog in the last month of the study. Although both groups were encouraged to contact the principal investigator with all queries, more in the insulin glargine arm opted to do so. CONCLUSIONS. Glycemic control with insulin glargine mixed with a rapid-acting insulin analog given twice daily seems significantly more effective than the standard therapy in newly diagnosed type 1 diabetes. Furthermore, it decreases pain and burden of injections for children with diabetes by allowing patients to mix glargine with rapid-acting insulin analog.

Original languageEnglish (US)
JournalPediatrics
Volume121
Issue number3
DOIs
StatePublished - Mar 2008
Externally publishedYes

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Short-Acting Insulin
Protamines
Type 1 Diabetes Mellitus
Randomized Controlled Trials
Glycosylated Hemoglobin A
Therapeutics
Lunch
Injections
Insulin Glargine
Syringes
Research Personnel

Keywords

  • Children
  • Diabetes
  • Insulin

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

A randomized, controlled trial comparing twiee-a-day insulin glargine mixed with rapid-acting insulin analogs versus standard neutral protamine hagedorn (NPH) therapy in newly diagnosed type 1 diabetes. / Hassan, Krishnavathana; Rodriguez, Luisa M.; Johnson, Susan E.; Tadlock, Susanne; Heptulla, Rubina A.

In: Pediatrics, Vol. 121, No. 3, 03.2008.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE.Insulin glargine is difficult to use for children due to the number of injections required because it is claimed to be immiscible with rapid-acting insulin analogs. For this study, we hypothesized that treating new-onset type 1 diabetes with twice-daily insulin glargine plus a rapid-acting insulin analog mixed in the same syringe would result in better glycosylated hemoglobin than twice-daily neutral protamine Hagedorn with a rapid-acting insulin analog (standard treatment). METHODS. Forty-two patients with new-onset type 1 diabetes were started on standard treatment. Three months after diagnosis, if patients were found compliant and had a glycosylated hemoglobin level of <9{\%}, then they were randomly assigned either to receive insulin glargine twice daily mixed with a rapid-acting Insulin analog or to continue on standard treatment for 3 more months. Additional lunchtime rapid- acting insulin analog injections were given for the insulin glargine group as necessary. RESULTS. Nineteen patients in the insulin glargine group and 17 in the neutral protamine Hagedorn group completed the study. The glycosylated hemoglobin level at baseline was 6.8{\%} ± 1{\%} vs 6.9{\%} ± 1{\%} and at poststudy was 6.7{\%} ± 1.3{\%} vs 7.6{\%} ± 1{\%} in the insulin glargine versus neutral protamine Hagedorn group, respectively. Two patients in the Insulin glargine group required lunch rapid-acting Insulin analog in the last month of the study. Although both groups were encouraged to contact the principal investigator with all queries, more in the insulin glargine arm opted to do so. CONCLUSIONS. Glycemic control with insulin glargine mixed with a rapid-acting insulin analog given twice daily seems significantly more effective than the standard therapy in newly diagnosed type 1 diabetes. Furthermore, it decreases pain and burden of injections for children with diabetes by allowing patients to mix glargine with rapid-acting insulin analog.",
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AU - Tadlock, Susanne

AU - Heptulla, Rubina A.

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N2 - OBJECTIVE.Insulin glargine is difficult to use for children due to the number of injections required because it is claimed to be immiscible with rapid-acting insulin analogs. For this study, we hypothesized that treating new-onset type 1 diabetes with twice-daily insulin glargine plus a rapid-acting insulin analog mixed in the same syringe would result in better glycosylated hemoglobin than twice-daily neutral protamine Hagedorn with a rapid-acting insulin analog (standard treatment). METHODS. Forty-two patients with new-onset type 1 diabetes were started on standard treatment. Three months after diagnosis, if patients were found compliant and had a glycosylated hemoglobin level of <9%, then they were randomly assigned either to receive insulin glargine twice daily mixed with a rapid-acting Insulin analog or to continue on standard treatment for 3 more months. Additional lunchtime rapid- acting insulin analog injections were given for the insulin glargine group as necessary. RESULTS. Nineteen patients in the insulin glargine group and 17 in the neutral protamine Hagedorn group completed the study. The glycosylated hemoglobin level at baseline was 6.8% ± 1% vs 6.9% ± 1% and at poststudy was 6.7% ± 1.3% vs 7.6% ± 1% in the insulin glargine versus neutral protamine Hagedorn group, respectively. Two patients in the Insulin glargine group required lunch rapid-acting Insulin analog in the last month of the study. Although both groups were encouraged to contact the principal investigator with all queries, more in the insulin glargine arm opted to do so. CONCLUSIONS. Glycemic control with insulin glargine mixed with a rapid-acting insulin analog given twice daily seems significantly more effective than the standard therapy in newly diagnosed type 1 diabetes. Furthermore, it decreases pain and burden of injections for children with diabetes by allowing patients to mix glargine with rapid-acting insulin analog.

AB - OBJECTIVE.Insulin glargine is difficult to use for children due to the number of injections required because it is claimed to be immiscible with rapid-acting insulin analogs. For this study, we hypothesized that treating new-onset type 1 diabetes with twice-daily insulin glargine plus a rapid-acting insulin analog mixed in the same syringe would result in better glycosylated hemoglobin than twice-daily neutral protamine Hagedorn with a rapid-acting insulin analog (standard treatment). METHODS. Forty-two patients with new-onset type 1 diabetes were started on standard treatment. Three months after diagnosis, if patients were found compliant and had a glycosylated hemoglobin level of <9%, then they were randomly assigned either to receive insulin glargine twice daily mixed with a rapid-acting Insulin analog or to continue on standard treatment for 3 more months. Additional lunchtime rapid- acting insulin analog injections were given for the insulin glargine group as necessary. RESULTS. Nineteen patients in the insulin glargine group and 17 in the neutral protamine Hagedorn group completed the study. The glycosylated hemoglobin level at baseline was 6.8% ± 1% vs 6.9% ± 1% and at poststudy was 6.7% ± 1.3% vs 7.6% ± 1% in the insulin glargine versus neutral protamine Hagedorn group, respectively. Two patients in the Insulin glargine group required lunch rapid-acting Insulin analog in the last month of the study. Although both groups were encouraged to contact the principal investigator with all queries, more in the insulin glargine arm opted to do so. CONCLUSIONS. Glycemic control with insulin glargine mixed with a rapid-acting insulin analog given twice daily seems significantly more effective than the standard therapy in newly diagnosed type 1 diabetes. Furthermore, it decreases pain and burden of injections for children with diabetes by allowing patients to mix glargine with rapid-acting insulin analog.

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