Predictors of insulin regimens and impact on outcomes in youth with type 1 diabetes: the SEARCH for Diabetes in Youth study.
OBJECTIVE
To describe the insulin regimens used to treat type 1 diabetes mellitus (T1DM) in youth in the United States, to explore factors related to insulin regimen, and to describe the associations between insulin regimen and clinical outcomes, particularly glycemic control.


METHODS
A total of 2743 subjects participated in the SEARCH for Diabetes in Youth study, an observational population-based study of youth diagnosed with T1DM, conducted at 6 centers. Data collected during a study visit included clinical and sociodemographic information, body mass index, laboratory measures, and insulin regimen.


RESULTS
Sociodemographic characteristics were associated with insulin regimen. Insulin pump therapy was more frequently used by older youth, females, non-Hispanic whites, and families with higher income and education (P = .02 for females, P < .001 for others). Insulin pump use was associated with the lowest hemoglobin A1C levels in all age groups. A1C levels were >7.5% in >70% of adolescents, regardless of regimen.


CONCLUSIONS
Youth using insulin pumps had the lowest A1C; A1C was unacceptably high in adolescents. There is a need to more fully assess and understand factors associated with insulin regimens recommended by providers and the influence of race/ethnicity, education, and socioeconomic status on these treatment recommendations and to develop more effective treatment strategies, particularly for adolescents.
Paris
Carolyn A
CA
University of Washington, Seattle, WA, USA. Carolyn.paris@seattlechildrens.org
Imperatore
Giuseppina
G
Klingensmith
Georgeanna
G
Petitti
Diana
D
Rodriguez
Beatriz
B
Anderson
Andrea M
AM
Schwartz
I David
ID
Standiford
Debra A
DA
Pihoker
Catherine
C
D000293:Adolescent; D000367:Age Factors; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007182:Income; D015918:Infusion Pumps, Implantable; D007267:Injections; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D044465:White People
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human