title: Improvement in glycemic control through changes in insulin regimens: findings from a Japanese cohort of children and adolescents with type 1 diabetes.
abstract: OBJECTIVE
  Although insulin analogs have dramatically changed diabetes treatment, scarce evidence is available on those effects. We aimed to explore whether glycemic control had improved, the use of insulin analogs had been increased, and hypoglycemic events had decreased over time in Japanese pediatric patients with type 1 diabetes (T1D).
  
  
  METHODS
  Glycated hemoglobin A1c (HbA1c) values, proportion of insulin regimens, incidence of severe hypoglycemic events, and pubertal increase in HbA1c were compared in three cohorts of childhood-onset Japanese T1D patients (567 subjects in the 1995 cohort, 754 subjects in the 2000 cohort, and 806 subjects in the 2008 cohort).
  
  
  RESULTS
  Mean HbA1c values tended to decrease [78.5 mmol/mol (9.33%) in the 1995 cohort, 68.2 mmol/mol (8.39%) in the 2000 cohort, and 61.2 mmol/mol (7.75%) in the 2008 cohort; P < .0001]. The proportion of patients who received basal-bolus treatment tended to increase with statistical significance, as did the proportion on insulin analogs. The incidence of severe hypoglycemic events (events/100 patients/y) had decreased (19.1 in the 2000 cohort and 8.7 in the 2008 cohort; P = .02). The pubertal increase in HbA1c tended to decrease [males, 12.0 mmol/mol (1.10%) in 1995, 9.4 mmol/mol (0.85%) in 2008, and 9.4 mmol/mol (0.86%) in 2008; P = .55; females, 14.0 mmol/mol (1.28%) in 1995, 10.3 mmol/mol (0.94%) in 2000, and 4.2 mmol/mol (0.38%) in 2008; P = .0003].
  
  
  CONCLUSIONS
  Glycemic control and incidence of severe hypoglycemic events were chronologically improved, especially in female adolescents.
authors.affiliation: Department of Pediatrics, University of Yamanashi, Yamanashi, Japan.
authors.forename: Mie
authors.identifier: http://orcid.org/0000-0002-5748-7388
authors.initials: M
authors.lastname: Mochizuki
authors.affiliation: Department of Pediatrics, Saitama Medial University, Saitama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kikuchi
authors.affiliation: Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Urakami
authors.affiliation: Department of Pediatrics, Yokohama City University Medical Center, Kanagawa, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kikuchi
authors.affiliation: Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Department of Health Sciences, Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yokomichi
authors.affiliation: Institute of Biopathological Medicine, Kanagawa, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Hoshino
authors.affiliation: Early Childhood Education, Seitoku University, Chiba, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Matsuura
authors.affiliation: Department of Pediatrics, Saitama Medial University, Saitama, Japan.
authors.forename: Nozomu
authors.initials: N
authors.lastname: Sasaki
authors.affiliation: Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Sugihara
authors.affiliation: Department of Pediatrics, Saitama Medial University, Saitama, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Amemiya
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000187:drug effects*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D007328:Insulin / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives; D007564:Japan / Q000453:epidemiology; D008297:Male; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: body mass index; child; diabetes mellitus; glycosylated; hemoglobin A1; hypoglycemia; type 1