Glucose Variability Less With Insulin Glargine vs NPH/Lente in Children

In pediatric patients with type 1 diabetes, insulin glargine is associated with greater reductions in glucose variability vs NPH/Lente insulin when used as the basal component of multiple daily injections (MDIs).

“Some investigators suggest that blood glucose variability, when combined with A1c [hemoglobin A1c] levels, is an important indicator of glycemic control and the risk for long-term complications,” write Neil H. White, MD, CDE, from Washington University School of Medicine, St. Louis Children’s Hospital in Missouri, and colleagues. “Insulin glargine (Lantus, sanofi-aventis U.S. LLC, Bridgewater, NJ) is a basal insulin with little or no pronounced action peak and limited site absorption variation. Its use as part of a[n]…MDI regimen demonstrated good glucose control with less hypoglycemia than NPH insulin in adults with type 1 and type 2 diabetes.”

 

The goal of this study was to compare the glucose variability associated with insulin glargine and NPH/Lente insulin used as the basal insulin component of an MDI regimen in adolescents with type 1 diabetes. The study sample consisted of a subset of 90 patients who agreed to use a continuous glucose monitoring system during an active-controlled, randomized, open-label trial evaluating the safety and efficacy of insulin glargine and NPH/Lente insulin used with insulin lispro as part of an MDI regimen.

From baseline to week 24, the group receiving insulin glargine had significant decreases in glucose variability as reflected in the SD of glucose values (adjusted mean change, −13.4 mg/dL [−0.74 mmol/L]; P ≤ .05), mean amplitude of glycemic excursion (adjusted mean change, −34.4 mg/dL [−1.91 mmol/L]; P ≤ .0001), and M value (adjusted mean change, −9.6 mg/dL [−0.53 mmol/L]; P ≤ .03). For the group receiving NPH/Lente, the corresponding decreases in glucose variability were not significant.

“Insulin glargine is associated with greater reductions in glucose variability than NPH/Lente insulin in pediatric patients with type 1 diabetes,” the study authors write. “Reductions in glycemic variability may have important clinical implications, including tighter glycemic control with less risk of hypoglycemia and a reduction in vascular complications.”

Limitations of this study include too few severe hypoglycemic events to identify differences between groups; the possibility that the continuous glucose monitoring system subgroup may have been different from the overall population, based on unmeasured variables that can affect disease management, such as motivation or conscientiousness; and inability to determine the impact of different stages of pubertal development on glycemic control and glucose variability.

“To the extent to which reduced glycemic variability may contribute to a decrease in diabetes-related complications, the use of insulin glargine may be beneficial,” the study authors conclude.
Diabetes Care. Published online December 23, 2008.