title: [Comparison of pre-dinner regular versus pre-lunch NPH of a third insulin application in adolescents with type 1 diabetes from a Public Health Service].
abstract: The majority of the type 1 Diabetes (DM1) patients are seen in Public Health Services. The management of these children, by several reasons, did not meet most of the standards for good diabetes control. In the present study we compare 2 different insulin treatment strategies in 53 uncontrolled DM1 adolescents despite a twice-a-day insulin regimen. A regimen: NPH + R before breakfast, R insulin before dinner and bedtime NPH. B regimen: NPH + R before breakfast and lunch and bedtime NPH. This was a 12-month open-label, randomized, clinical trial conducted in a Public Hospital. BMI (A: 23.4+/-3.5 Kg/m2 x B: 23.5+/-0.8 Kg/m2), average daily insulin dose (A: 1.04+/-0.28 U/Kg/d x B: 1.08+/-0.22 U/Kg/d) as well as the overall frequency of severe hypoglycemia (A: 9.4% x B: 7.5%) were similar in both groups during the study. However, HbA1c values at the end of the study were significantly lower in the B (9%) as compared to the A regimen (7,5%; p = 0.05). In conclusion, we have shown that breakfast and lunchtime NPH + R insulin plus bedtime NPH insulin is superior to pre-dinner R insulin plus breakfast and bedtime NPH insulin for overall glycemic control with similar weight status and comparable frequency of hypoglycemia. Thus, three times a day NPH insulin application is a feasible option for public service patients.
authors.affiliation: Centro de Diabetes, Departamento de Medicina, Universidade Federal de São Paulo, UNIFESP/EPM, São Paulo, SP. gabbay@ajato.com.br
authors.forename: Mônica A L
authors.initials: MA
authors.lastname: Gabbay
authors.forename: Denise
authors.initials: D
authors.lastname: Mori
authors.forename: Fernando
authors.initials: F
authors.lastname: Giuffrida
authors.forename: Sérgio A
authors.initials: SA
authors.lastname: Dib
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004435:Eating; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin