title: Changes in insulin therapy regimens over 10 yr in children and adolescents with type 1 diabetes attending diabetes camps.
abstract: OBJECTIVE
  To describe the changes in insulin therapy regimens of children and adolescents with type 1 diabetes over 10 yr and their correlation with hemoglobin A1c (HbA1c).
  
  
  METHODS
  The study included 7206 children and adolescents (age 12.8 ± 2.7 yr, more than 1 yr of diabetes duration) admitted in summer camps between 1998 and 2007 (707-896/yr). Based on injection times (breakfast, lunch, afternoon, dinner, bedtime) and insulin types (short, long and premixed; human or analog), 786 different therapeutic combinations were classified in six main types of regimens. The distribution of the different regimens and their correlation with HbA1c were evaluated as a function of year and age.
  
  
  RESULTS
  Over 10 yr, basal bolus increased from 13 to 52% and the pump from <1 to 13%, regimens with two to three injections per day decreased from 50 to 25%, those with only premixed insulins from 33 to 7%, and diverse regimens from 9 to 1%. HbA1c was significantly higher with premixed insulin only, but there were no differences between the other regimens throughout the follow-up. Mean yearly HbA1c (8.21-8.45%) did not show any significant decrease, but the percentage of patients with HbA1c > 9 and 10% decreased significantly, in those treated with two to three injections and the pump, not with basal bolus or premixed only regimens.
  
  
  CONCLUSIONS
  A major trend in intensifying insulin treatment in children and adolescents with type 1 diabetes was accompanied by modest improvements in HbA1c. No insulin regimen has shown any better results, except over premixed insulins.
authors.affiliation: Pediatric and Adolescent Diabetes, Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Redon
authors.forename: Jacques
authors.initials: J
authors.lastname: Beltrand
authors.forename: Delphine
authors.initials: D
authors.lastname: Martin
authors.forename: Pierre
authors.initials: P
authors.lastname: Taupin
authors.forename: Carine
authors.initials: C
authors.lastname: Choleau
authors.forename: Mélina
authors.initials: M
authors.lastname: Morandini
authors.forename: Michel
authors.initials: M
authors.lastname: Cahané
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Robert
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D049528:Insulin, Long-Acting / Q000627:therapeutic use; D008297:Male; D055815:Young Adult
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human
keywords: adolescents; children; glycemic control (HbA1c); insulin therapeutic regimen; type 1 diabetes