Complications and Chronic Conditions Increase Hospital Costs

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Comparison of glycemic variability associated with insulin glargine and intermediate-acting insulin when used as the basal component of multiple daily injections for adolescents with type 1 diabetes, by Neil H White and colleagues. Diabetes Care 32:387–393, 2009

What is the problem and what is known about it so far?

Keeping blood glucose tightly controlled can help prevent diabetes complications. This is especially important in children and teens with type 1 diabetes, since they will have diabetes for many years. However, tight control can make hypoglycemia (low blood glucose) more common. Studies have shown that blood glucose levels can vary inconsistently throughout the day and night even in people who have near-normal A1C levels. These glucose variations may make hypoglycemia more likely with tight glucose control. Also, although not yet proven, these wide swings in blood glucose may play a role in the development of diabetes complications. Diabetes doctors are starting to be concerned not only about lowering patients' A1C levels, but also about reducing their glucose swings to ensure their long-term health.  

Why did the researchers do this particular study?

The researchers wanted to compare glargine insulin to NPH insulin for young people who take insulin shots several times each day and to find out which one does a better job of controlling glucose swings.

Who was studied?

The study included 90 adolescent patients with type 1 diabetes who were taking part in a larger study of glargine and NPH insulin. The patients took lispro insulin shots for their mealtime insulin needs and either once-daily glargine or twice-daily NPH insulin for their "basal" (continual) insulin needs.

How was the study done?

The patients wore continuous glucose monitors for 3 days at the beginning, middle, and end of the 24-week study. These monitors measure and record glucose levels every 5 minutes throughout the day and night.

What did the researchers find?

Glucose swings were reduced in patients who used glargine insulin but not in those who used NPH insulin.

What were the limitations of the study?

The study included a subgroup of patients from a larger study who had agreed to wear continuous glucose monitoring devices. These patients may have been more motivated or conscientious about taking care of their diabetes. Also, the study group included children at different stages of adolescence, which may have some bearing on their glucose control and glucose swings.

What are the implications of the study?

Because glargine reduced glucose swings better than NPH insulin in young people using multiple daily insulin shots, glargine may be a better choice to lessen the risk of hypoglycemia and perhaps help prevent complications.

FOR MORE INFORMATION

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