title: Multiple daily injections in young patients using the ezy-BICC bolus insulin calculation card, compared to mixed insulin and CSII.
abstract: OBJECTIVE
  To describe the easy bolus insulin calculation card (ezy-BICC) approach to multiple daily injections and to compare in an observational study, the haemoglobin A1c (HbA1c) achieved while using ezy-BICC, mixed insulin injections and continuous subcutaneous insulin infusion (CSII).
  
  
  METHODS
  HbA1c results from 7121 clinic visits by 573 patients aged 1-20 yr using the three methods between June 2000 and July 2008 were reviewed.
  
  
  RESULTS
  For mixed insulin median, mean and SD HbA1c were 8.3%, 8.3%, 1.33, for ezy-BICC, 7.6%, 7.7%, 1.40, and for CSII, 7.6%, 7.8%, 1.31. HbA1c increases with age significantly more in those using CSII (p < 0.001). By regression, compared with mixed insulin HbA1c is 0.7% lower using ezy-BICC (p < 0.018) and 1.5% lower using CSII (p < 0.001). For patients using CSII compared with <6 yr, those 6-12 yr have HbA1c 0.7% higher (p < 0.001), 12-15 yr 1.0% higher (p < 0.001) and 15-20 yr 1.2% higher (p < 0.001). For subjects >12 yr, HbA1c is lower while using ezy-BICC than CSII. HbA1c increases 0.2% per yr following diagnosis for 2.8 yr. In those who change from mixed insulin to ezy-BICC after this time, the mean HbA1c is 0.5% lower by 9 months, 0.7% lower at 21 months and 0.6% lower at 24 months (p < 0.05).
  
  
  CONCLUSIONS
  The ezy-BICC system is inexpensive and convenient and allows patients to vary meal size. Subjects achieve lower HbA1c while using CSII and ezy-BICC MDI than with mixed insulin. Very young subjects achieve excellent HbA1c using CSII, but for 12 to 20 yr-old patients, ezy-BICC results in lower HbA1c than CSII for a lower cost.
authors.affiliation: University of Newcastle, Department of Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, NSW, Australia. donald.anderson@hnehealth.nsw.gov.au
authors.forename: Donald G
authors.initials: DG
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis* / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D015918:Infusion Pumps, Implantable / Q000191:economics; D007279:Injections, Subcutaneous / Q000191:economics; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007332:Insulin Infusion Systems / Q000191:economics; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin