title: Long-acting insulin analogs and the risk of diabetic ketoacidosis in children and adolescents with type 1 diabetes: a prospective study of 10,682 patients from 271 institutions.
abstract: OBJECTIVE To investigate if long-acting insulin analogs decrease the risk of diabetic ketoacidosis (DKA) in young individuals with type 1 diabetes. RESEARCH DESIGN AND METHODS Of 48,110 type 1 diabetic patients prospectively studied between 2001 and 2008, the incidence of DKA requiring hospitalization was analyzed in 10,682 individuals aged </=20 years with a diabetes duration of >/=2 years. RESULTS The overall rate of DKA was 5.1 (SE +/- 0.2)/100 patient-years. Patients using insulin glargine or detemir (n = 5,317) had a higher DKA incidence than individuals using NPH insulin (n = 5,365, 6.6 +/- 0.4 vs. 3.6 +/- 0.3, P < 0.001). The risk for DKA remained significantly different after adjustment for age at diabetes onset, diabetes duration, A1C, insulin dose, sex, and migration background (P = 0.015, odds ratio 1.357 [1.062-1.734]). CONCLUSIONS Despite their long-acting pharmacokinetics, the use of insulin glargine or detemir is not associated with a lower incidence of DKA compared with NPH insulin.
authors.affiliation: Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany. bkarges@ukaachen.de
authors.forename: Beate
authors.initials: B
authors.lastname: Karges
authors.forename: Thomas
authors.initials: T
authors.lastname: Kapellen
authors.forename: Andreas
authors.initials: A
authors.lastname: Neu
authors.forename: Sabine E
authors.initials: SE
authors.lastname: Hofer
authors.forename: Tilman
authors.initials: T
authors.lastname: Rohrer
authors.forename: Joachim
authors.initials: J
authors.lastname: Rosenbauer
authors.forename: Johannes
authors.initials: J
authors.lastname: Wolf
authors.forename: Reinhard W
authors.initials: RW
authors.lastname: Holl
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000453:epidemiology*; D016883:Diabetic Ketoacidosis / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D015994:Incidence; D007328:Insulin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D000069057:Insulin Detemir; D000069036:Insulin Glargine; D007336:Insulin, Isophane / Q000008:administration & dosage / Q000493:pharmacokinetics; D049528:Insulin, Long-Acting / Q000008:administration & dosage / Q000493:pharmacokinetics; D008297:Male; D012307:Risk Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; D000069036:Insulin Glargine; D000069057:Insulin Detemir; D007336:Insulin, Isophane