title: Classifying insulin regimens--difficulties and proposal for comprehensive new definitions.
abstract: Modern insulin regimens for the treatment of type 1 diabetes are highly individualized. The concept of an individually tailored medicine accounts for a broad variety of different insulin regimens applied. Despite clear recommendations for insulin management in children and adolescents with type 1 diabetes there is little distinctiveness about concepts and the nomenclature is confusing. Even among experts similar terms are used for different strategies. The aim of our review--based on the experiences of the Hvidoere Study Group (HSG)--is to propose comprehensive definitions for current insulin regimens reflecting current diabetes management in childhood and adolescence. The HSG--founded in 1994--is an international group representing 24 highly experienced pediatric diabetes centers, from Europe, Japan, North America and Australia. Different benchmarking studies of the HSG revealed a broad variety of insulin regimens applied in each center, respectively. Furthermore, the understanding of insulin regimens has been persistently different between the centers since more than 20 yr. Not even the terms 'conventional' and 'intensified therapy' were used consistently among all members. Besides the concepts 'conventional' and 'intensified', several other terms for the characterization of insulin regimens are in use: Basal Bolus Concept (BBC), multiple daily injections (MDI), and flexible insulin therapy (FIT) are most frequently used, although none of these expressions is clearly or consistently defined. The proposed new classification for insulin management will be comprehensive, simple, and catchy. Currently available terms were included. This classification may offer the opportunity to compare therapeutic strategies without the currently existing confusion on the insulin regimen.
authors: Children's Hospital, University Hospital Tuebingen, Germany.
authors: A
authors: A
authors: Neu
authors: Department of Medical Psychology OE5430, Hannover Medical School, Germany.
authors: K
authors: K
authors: Lange
authors: Institute of Child Health, University of Birmingham, UK.
authors: T
authors: T
authors: Barrett
authors: Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Australia.
authors: F
authors: F
authors: Cameron
authors: Clinique de Diabetologie, Hopital Universitaire des Enfants, Brussels, Belgium.
authors: H
authors: H
authors: Dorchy
authors: Department of Paediatrics, University of Dublin, Trinity College, Ireland.
authors: H
authors: H
authors: Hoey
authors: Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland.
authors: P
authors: P
authors: Jarosz-Chobot
authors: Faculty of Health Science, University of Copenhagen, Denmark.
authors: H B
authors: HB
authors: Mortensen
authors: Department of Diabetes in Children and Adolescents, Hôpital Necker - Enfants Malades, Paris, France.
authors: J-J
authors: JJ
authors: Robert
authors: Department of Paediatrics, DCRTD, Kuwait.|Department of Diabetes, Royal Hospital for Sick Children, Glasgow, UK.
authors: K
authors: K
authors: Robertson
authors: DECCP, Clinique Pédiatrique/CHL, Luxembourg.
authors: C
authors: C
authors: de Beaufort
mesh_terms: D000293:Adolescent; D000295:Adolescent Medicine / Q000379:methods*; D019985:Benchmarking; D002648:Child; D032921:Consensus; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D004334:Drug Administration Schedule; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000592:standards; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D009626:Terminology as Topic
chemical_list: D004338:Drug Combinations; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: insulin regimens; treatment; type 1 diabetes