Cargando…

Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy

BACKGROUND: This study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy. METHODS: A total of 825 individuals a...

Descripción completa

Detalles Bibliográficos
Autores principales: Chou, Wei-Yu, Li, Yan-Rong, Chan, Wai Kin, Chen, Szu-Tah
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Chang Gung University 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363560/
https://www.ncbi.nlm.nih.gov/pubmed/30709576
http://dx.doi.org/10.1016/j.bj.2018.10.005
_version_ 1783393125857755136
author Chou, Wei-Yu
Li, Yan-Rong
Chan, Wai Kin
Chen, Szu-Tah
author_facet Chou, Wei-Yu
Li, Yan-Rong
Chan, Wai Kin
Chen, Szu-Tah
author_sort Chou, Wei-Yu
collection PubMed
description BACKGROUND: This study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy. METHODS: A total of 825 individuals aged ≤ 20 years with T1DM, using either basal-bolus or premixed insulin regimens, were retrospectively recruited from 2001 to 2015. Rates of DKA after diagnosis, severe hypoglycemia, and the level of glycated hemoglobin A1c (HbA1c) improvement during the follow-up period were analyzed. RESULTS: Of the 825 patients, 226 receiving a premixed regimen were matched to the same number of patients receiving a basal-bolus regimen. In the matched cohort, DKA (10.62% vs. 5.31%; p = 0.037) and severe hypoglycemic episodes (25.22% vs. 10.62%; p < 0.001) were significantly higher in patients receiving a premixed regimen than those receiving a basal-bolus regimen. The median reduction of HbA1c, compared to the treatment-naive level, was better with the basal-bolus regimen than with the premixed regimen in both matched (2.2 vs. 2.1; p = 0.034) and the entire (3.1 vs. 1.9; p < 0.001) cohorts. Regardless of insulin regimen, a higher HbA1c level was significantly linked to higher risk of DKA development (hazard ratio [HR] 1.35 per 1% increase; p < 0.001) once the HbA1c level was ≥7.5%. CONCLUSIONS: A premixed insulin regimen may increase the DKA occurrence rate and severe hypoglycemic risk in children, adolescents, and young adults with TIDM, compared to a basal-bolus regimen. Tight glycemic control with HbA1c < 7.5% may prevent the increased risk of DKA.
format Online
Article
Text
id pubmed-6363560
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Chang Gung University
record_format MEDLINE/PubMed
spelling pubmed-63635602019-02-14 Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy Chou, Wei-Yu Li, Yan-Rong Chan, Wai Kin Chen, Szu-Tah Biomed J Original Article BACKGROUND: This study compared event rates of diabetic ketoacidosis (DKA) and severe hypoglycemia, as well as glycemic control, among children, adolescents, and young adults with type 1 diabetes mellitus (T1DM) receiving basal-bolus or premixed insulin therapy. METHODS: A total of 825 individuals aged ≤ 20 years with T1DM, using either basal-bolus or premixed insulin regimens, were retrospectively recruited from 2001 to 2015. Rates of DKA after diagnosis, severe hypoglycemia, and the level of glycated hemoglobin A1c (HbA1c) improvement during the follow-up period were analyzed. RESULTS: Of the 825 patients, 226 receiving a premixed regimen were matched to the same number of patients receiving a basal-bolus regimen. In the matched cohort, DKA (10.62% vs. 5.31%; p = 0.037) and severe hypoglycemic episodes (25.22% vs. 10.62%; p < 0.001) were significantly higher in patients receiving a premixed regimen than those receiving a basal-bolus regimen. The median reduction of HbA1c, compared to the treatment-naive level, was better with the basal-bolus regimen than with the premixed regimen in both matched (2.2 vs. 2.1; p = 0.034) and the entire (3.1 vs. 1.9; p < 0.001) cohorts. Regardless of insulin regimen, a higher HbA1c level was significantly linked to higher risk of DKA development (hazard ratio [HR] 1.35 per 1% increase; p < 0.001) once the HbA1c level was ≥7.5%. CONCLUSIONS: A premixed insulin regimen may increase the DKA occurrence rate and severe hypoglycemic risk in children, adolescents, and young adults with TIDM, compared to a basal-bolus regimen. Tight glycemic control with HbA1c < 7.5% may prevent the increased risk of DKA. Chang Gung University 2018-12 2019-01-11 /pmc/articles/PMC6363560/ /pubmed/30709576 http://dx.doi.org/10.1016/j.bj.2018.10.005 Text en © 2018 Chang Gung University. Publishing services by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Chou, Wei-Yu
Li, Yan-Rong
Chan, Wai Kin
Chen, Szu-Tah
Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy
title Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy
title_full Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy
title_fullStr Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy
title_full_unstemmed Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy
title_short Association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy
title_sort association of diabetic ketoacidosis, severe hypoglycemia and glycemic control among children and young adults with type 1 diabetes mellitus treated with premixed versus basal-bolus insulin therapy
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363560/
https://www.ncbi.nlm.nih.gov/pubmed/30709576
http://dx.doi.org/10.1016/j.bj.2018.10.005
work_keys_str_mv AT chouweiyu associationofdiabeticketoacidosisseverehypoglycemiaandglycemiccontrolamongchildrenandyoungadultswithtype1diabetesmellitustreatedwithpremixedversusbasalbolusinsulintherapy
AT liyanrong associationofdiabeticketoacidosisseverehypoglycemiaandglycemiccontrolamongchildrenandyoungadultswithtype1diabetesmellitustreatedwithpremixedversusbasalbolusinsulintherapy
AT chanwaikin associationofdiabeticketoacidosisseverehypoglycemiaandglycemiccontrolamongchildrenandyoungadultswithtype1diabetesmellitustreatedwithpremixedversusbasalbolusinsulintherapy
AT chenszutah associationofdiabeticketoacidosisseverehypoglycemiaandglycemiccontrolamongchildrenandyoungadultswithtype1diabetesmellitustreatedwithpremixedversusbasalbolusinsulintherapy