title: A bridge to insulin pump therapy: twice-daily regimen with NPH and detemir insulins during initial treatment of youth with type 1 diabetes mellitus.
abstract: OBJECTIVE
  To describe clinical outcomes in youth with new-onset type 1 diabetes mellitus (T1DM) treated with a modified, twice-daily regimen of a mixture of NPH insulin and rapid-acting insulin analogue at breakfast and separate injections of rapid-acting insulin analogue and insulin detemir at dinner.
  
  
  METHODS
  Our clinic database was used to describe changes in insulin doses, hemoglobin A1c (A1C) levels, and frequency of severe hypoglycemia during the first year of therapy in young patients with T1DM diagnosed between September 2006 and April 2009. Data are presented as median values (25%, 75%).
  
  
  RESULTS
  Overall, 108 patients (62 girls; mean age, 10.0 ± 0.4 years) were eligible for inclusion. Total daily insulin doses at 3, 6, and 12 months were 0.6 (0.4, 0.8), 0.7 (0.4, 0.9), and 0.8 (0.6, 0.9) U/kg, respectively. A1C levels were 9.8% (8.5%, 10.8%) at 2 weeks (baseline). Of the 108 patients, 19 had switched to insulin pump therapy by 3 months and 49 had switched by 12 months after initial diagnosis of T1DM. The 49 pump-treated patients had an A1C of 6.9% (6.6%, 7.3%), whereas the 59 injection-treated patients had an A1C of 7.2% (6.7%, 7.7%) by 12 months. There were only 6 severe hypoglycemic events in 5 patients; none occurred during the first 3 months, none occurred during the night, and all occurred in patients receiving insulin injection treatment.
  
  
  CONCLUSIONS
  A twice-daily insulin regimen that uses insulin detemir for overnight basal replacement and morning NPH insulin to avoid lunch and afternoon snack doses is an effective initial treatment for young patients with new-onset T1DM that can provide a smooth transition to intensive basal/bolus insulin pump therapy.
authors.affiliation: Division of Pediatric Endocrinology and Diabetes, Yale School of Medicine, New Haven, Connecticut 06520, USA. Eda.Cengiz@yale.edu
authors.forename: Eda
authors.initials: E
authors.lastname: Cengiz
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Sherr
authors.forename: Ayca
authors.initials: A
authors.lastname: Erkin-Cakmak
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Weinzimer
authors.forename: Erin N
authors.initials: EN
authors.lastname: Burke
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Sikes
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Urban
authors.forename: William V
authors.initials: WV
authors.lastname: Tamborlane
mesh_terms: D000293:Adolescent; D002648:Child; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016883:Diabetic Ketoacidosis / Q000517:prevention & control; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006776:Hospitals, Pediatric; D006785:Hospitals, University; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D000069057:Insulin Detemir; D007332:Insulin Infusion Systems / Q000009:adverse effects; D007336:Insulin, Isophane / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D049528:Insulin, Long-Acting / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D061266:Insulin, Short-Acting / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D000069057:Insulin Detemir; D007336:Insulin, Isophane; D049528:Insulin, Long-Acting; D061266:Insulin, Short-Acting; C517652:hemoglobin A1c protein, human