Insulin Regimens and Clinical Outcomes in a Type 1 Diabetes Cohort
The SEARCH for Diabetes in Youth study
- Catherine Pihoker, MD1⇓,
- Angela Badaru, MBBS, MRCP1,
- Andrea Anderson, MS2,
- Timothy Morgan, PHD2,
- Lawrence Dolan, MD3,
- Dana Dabelea, MD, PHD4,
- Giuseppina Imperatore, MD, PHD5,
- Barbara Linder, MD, PHD6,
- Santica Marcovina, PHD, SCD7,
- Elizabeth Mayer-Davis, PHD8,
- Kristi Reynolds, PHD, MPH9,
- Georgeanna J. Klingensmith, MD10,
- for the SEARCH for Diabetes in Youth Study Group*
- 1Department of Pediatrics, University of Washington, Seattle, Washington
- 2Department of Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- 3Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
- 4Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
- 5Division of Diabetes Translation, Centers for Diseases Control and Prevention, Atlanta, Georgia
- 6National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
- 7Department of Medicine, University of Washington, Seattle, Washington
- 8Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill, North Carolina
- 9Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
- 10Barbara Davis Center and Department of Pediatrics, University of Colorado Denver, School of Medicine, Aurora, Colorado
- Corresponding author: Catherine Pihoker, .
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.
RESEARCH DESIGN AND 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.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-0720/-/DC1.
↵* A complete list of the SEARCH for Diabetes in Youth Study Group can be found in the Supplementary Data online.
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the National Institute of Diabetes and Digestive and Kidney Diseases.
- Received April 16, 2012.
- Accepted July 3, 2012.
- © 2013 by the American Diabetes Association.
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