In youth studied, sociodemographics impact odds of switch; better outcomes with more intensive regimens
TUESDAY, Jan. 29 (HealthDay News) — About half of youths with type 1 diabetes shift to a more intensive insulin regimen over time, which is associated with better glycemic control, according to research published in the January issue of Diabetes Care. Catherine Pihoker, M.D., of the University of Washington in Seattle, and colleagues examined the patterns and associations of insulin regimens and change in regimens with clinical outcome in a study involving 1,606 youth with recently diagnosed type 1 diabetes. The researchers found that, during 36 months of follow-up, 51.7 percent of participants changed to a more intensive regimen, 44.7 percent had no change, and 3.6 percent shifted to a less intensive regimen. Younger participants, non-Hispanic whites, and those from families with higher income and parental education and with private insurance were more likely to change to a more intensive regimen or experience no change. Compared with those who changed to a less intensive regimen, those with no change or who changed to a more intensive regimen had significantly lower baseline A1C and smaller increases in A1C over time. The probability of achieving target A1C levels was higher for participants with younger age, continuous subcutaneous insulin pump therapy, and those who changed to a more intensive regimen. ”For the majority of youth in this study, insulin regimen intensified over time, and more intensive regimens were associated with lower A1C,” the authors write. ”Taking together the better outcomes but sociodemographic disparities in intensification of insulin regimens, there is a dire need to develop strategies to improve care for all children with diabetes.”
Abstract Insulin Regimens and Clinical Outcomes in a Type 1 Diabetes CohortThe SEARCH for Diabetes in Youth study
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. Footnotes
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