Long-acting insulin analogs and the risk of diabetic ketoacidosis in children and adolescents with type 1 diabetes
- Beate Karges, MD (bkarges{at}ukaachen.de)1,
- Thomas Kapellen, MD2,
- Andreas Neu, MD3,
- Sabine E. Hofer, MD4,
- Tilman Rohrer, MD5,
- Joachim Rosenbauer, MD6,
- Johannes Wolf, MD7,
- Reinhard W. Holl, MD8 and
- for the DPV initiative and the German BMBF Competence Network Diabetes mellitus
- 1Division of Endocrinology and Diabetes, RWTH Aachen University, Aachen, Germany
- 2Department of Pediatrics, University of Leipzig, Leipzig, Germany
- 3University Children's Hospital Tübingen, Tübingen, Germany
- 4Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
- 5Department of Pediatrics, University of Homburg-Saar, Homburg-Saar, Germany
- 6Institute of Biometrics and Epidemiology, German Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany
- 7Children's Hospital Paderborn, Paderborn, Germany
- 8Department of Epidemiology, University of Ulm, Ulm, Germany
Abstract
Objective: To investigate if long-acting insulin analogs decrease the risk of diabetic ketoacidosis (DKA) in young individuals with type 1 diabetes.
Research design and methods: Of 48,110 type 1 diabetes patients prospectively studied between 2001 and 2008, the incidence of DKA requiring hospitalization was analyzed in 10,682 individuals aged ≤20 years with a diabetes duration of ≥2 years.
Results: The overall rate of DKA was 5.1 (SE ± 0.2)/100 patient-years. Patients using insulin glargine or detemir (n = 5317) had a higher DKA incidence than individuals using NPH insulin (n = 5365, 6.6 ± 0.4 vs. 3.6 ± 0.3, p < 0.001). The risk for DKA remained significantly different after adjustment for age at diabetes onset, diabetes duration, A1C, insulin dose, sex and migration background (p = 0.015, odds ratio 1.357 [1.062-1.734]).
Conclusions: Despite their long-acting pharmacokinetics, the use of insulin glargine or detemir is not associated with a lower incidence of DKA compared to NPH insulin.
Footnotes
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- Received December 10, 2009.
- Accepted February 14, 2010.
- Copyright © American Diabetes Association
