title: Insulin regimens and clinical outcomes in a type 1 diabetes cohort: the SEARCH for Diabetes in Youth study.
abstract: OBJECTIVE
  To examine the patterns and associations of insulin regimens and change in regimens with clinical outcomes in a diverse population of children with recently diagnosed type 1 diabetes.
  
  
  METHODS
  The study sample consisted of youth with type 1 diabetes who completed a baseline SEARCH for Diabetes in Youth study visit after being newly diagnosed and at least one follow-up visit. Demographic, diabetes self-management, physical, and laboratory measures were collected at study visits. Insulin regimens and change in regimen compared with the initial visit were categorized as more intensive (MI), no change (NC), or less intensive (LI). We examined relationships between insulin regimens, change in regimen, and outcomes including A1C and fasting C-peptide.
  
  
  RESULTS
  Of the 1,606 participants with a mean follow-up of 36 months, 51.7% changed to an MI regimen, 44.7% had NC, and 3.6% changed to an LI regimen. Participants who were younger, non-Hispanic white, and from families of higher income and parental education and who had private health insurance were more likely to be in MI or NC groups. Those in MI and NC groups had lower baseline A1C (P = 0.028) and smaller increase in A1C over time than LI (P < 0.01). Younger age, continuous subcutaneous insulin pump therapy, and change to MI were associated with higher probability of achieving target A1C levels.
  
  
  CONCLUSIONS
  Insulin regimens were intensified over time in over half of participants but varied by sociodemographic domains. As more intensive regimens were associated with better outcomes, early intensification of management may improve outcomes in all children with diabetes. Although intensification of insulin regimen is preferred, choice of insulin regimen must be individualized based on the child and family's ability to comply with the prescribed plan.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA. catherine.pihoker@seattlechildrens.org
authors.forename: Catherine
authors.initials: C
authors.lastname: Pihoker
authors.forename: Angela
authors.initials: A
authors.lastname: Badaru
authors.forename: Andrea
authors.initials: A
authors.lastname: Anderson
authors.forename: Timothy
authors.initials: T
authors.lastname: Morgan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Dolan
authors.forename: Dana
authors.initials: D
authors.lastname: Dabelea
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Imperatore
authors.forename: Barbara
authors.initials: B
authors.lastname: Linder
authors.forename: Santica
authors.initials: S
authors.lastname: Marcovina
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Mayer-Davis
authors.forename: Kristi
authors.initials: K
authors.lastname: Reynolds
authors.forename: Georgeanna J
authors.initials: GJ
authors.lastname: Klingensmith
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D016896:Treatment Outcome
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin