New options in insulin therapy.
OBJECTIVE
To review the new options in insulin therapy for controlling diabetes mellitus in children and adolescents.


METHODS
Articles indexed in PubMed were located using the search terms insulin analogs in children and adolescents and reviewed. Information was also obtained from American Diabetes Association and Sociedade Brasileira de Diabetes consensus documents.


RESULTS
Information is presented on new analogs of insulin and, for purposes of comparison, the other insulin modalities currently available are also reviewed, focusing on insulin therapies which attempt to approximate basal-bolus treatment strategies to physiology. With the objective of obtaining improved metabolic control, more and more children are being put on multiple daily injection regimes or using continuous subcutaneous insulin infusion. It is difficult to achieve optimum glycemic control in children due to the increased risk of hypoglycemia resulting from the great variability in dietary intake habits and in physical activity levels. With diabetes type 1, if rapid-acting analogs are given subcutaneously in bolus, they generally reduce hypoglycemia episodes and postprandial glycemia levels, compared with regular human insulin, while basal analogs tend to reduce particularly the number of episodes of nocturnal hypoglycemia.


CONCLUSIONS
Although the benefits to individual metabolic and clinical outcomes appear modest, the majority of studies demonstrate benefits when insulin analogs are used in the treatment of diabetes type 1 or 2.
Programa de Pós Graduação em Ciências Médicas, Fundação Faculdade Federal de Ciências Médicas de Porto Alegre (FFFCMPA), Porto Alegre, RS, Brazil. neurodiabetes@terra.com.br
Helena
H
Schmid
D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003422:Critical Care; D003920:Diabetes Mellitus / Q000188:drug therapy*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015918:Infusion Pumps, Implantable; D007279:Injections, Subcutaneous; D007328:Insulin / Q000031:analogs & derivatives / Q000627:therapeutic use*; D007332:Insulin Infusion Systems
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin