Insulin Usage and Practices in Children and Adolescents with Type 1 Diabetes

CONTEXT: Data on insulin usage and practices in children and adolescents with type 1 diabetes (T1D) is sparse in India. AIMS: To analyze the various insulin types and regimens used by children and adolescents with T1D, the techniques and the devices used for insulin administration, and the storage and disposal methods of delivery devices. SETTINGS AND DESIGN: Observational cross-sectional study. METHODS AND MATERIALS: Study subjects were children and adolescents with T1D ≥6 months and informed consent was obtained. A detailed demographic history was collected, and a predesigned, pretested questionnaire was used. RESULTS: The number of subjects were 90 (M: F; 32:58), age ranging from 3 to 18 years and duration of T1D was 6 months to 16 years. Mean age was 13 ± 4.6 yrs, HbA1c was 9.11 ± 2.2% and duration was 5 years. Conventional insulins were more commonly used than analogs. Basal-bolus (BB) regimen was used in 49% of the subjects. Mean HbA1c for analogs was 7.6% and conventional was 9.3% (p = 0.001). HbA1c <8% was significantly more in those aged 3-8 yrs, mean duration ≤4.1 yrs, those using pens and BB regimen. Fifty-six percent were using own refrigerators for storage and the most common barriers for insulin usage were fear of hypoglycemia (37%), inaccessibility (20%), and apprehension of shots (18%). Site rotation patterns were followed by 84% and 94% of the subjects reported disposing syringes and sharps as general waste. CONCLUSIONS: Conventional insulins and vial-syringes remain the most commonly used insulin delivery systems. Glycemic control was better in younger age, lesser duration, BB regimen, analog usage, and pen devices.