Predictors of Insulin Regimens and Impact on Outcomes in Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Received 24 July 2008; received in revised form 2 December 2008; accepted 21 January 2009. published online 27 April 2009.

Refers to article:

In Pursuit Of Lower A1c
Michael J. Haller, Janet H. Silverstein
The Journal of Pediatrics
August 2009 (Vol. 155, Issue 2, Pages 161-162)
Full Text | Full-Text PDF (64 KB)

Objectives

To describe the insulin regimens used to treat type 1 diabetes mellitus (T1DM) in youth in the United States, to explore factors related to insulin regimen, and to describe the associations between insulin regimen and clinical outcomes, particularly glycemic control.

Study design

A total of 2743 subjects participated in the SEARCH for Diabetes in Youth study, an observational population-based study of youth diagnosed with T1DM, conducted at 6 centers. Data collected during a study visit included clinical and sociodemographic information, body mass index, laboratory measures, and insulin regimen.

Results

Sociodemographic characteristics were associated with insulin regimen. Insulin pump therapy was more frequently used by older youth, females, non-Hispanic whites, and families with higher income and education (P = .02 for females, P < .001 for others). Insulin pump use was associated with the lowest hemoglobin A1C levels in all age groups. A1C levels were >7.5% in >70% of adolescents, regardless of regimen.

Conclusions

Youth using insulin pumps had the lowest A1C; A1C was unacceptably high in adolescents. There is a need to more fully assess and understand factors associated with insulin regimens recommended by providers and the influence of race/ethnicity, education, and socioeconomic status on these treatment recommendations and to develop more effective treatment strategies, particularly for adolescents.

ADA, American Diabetes Association, DCCT, Diabetes Control and Complications Trial, DM, Diabetes mellitus, FCP, Fasting C-peptide, MDI, Multiple daily injection, T1DM, Type 1 diabetes mellitus

a University of Washington, Seattle, WA

b Division of Diabetes Translation, NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA

c Barbara Davis Center for Childhood Diabetes, University of Colorado at Denver and Health Sciences Center, Denver, CO

d Kaiser Permanente Southern California, Pasadena, CA

e Pacific Health Research Institute, Honolulu, HI

f Wake Forest University, Winston-Salem, NC

g University of South Carolina, Columbia, SC

h Children's Hospital Medical Center, Cincinnati, OH

Reprint requests: Carolyn A. Paris, MD, MPH, Children's Hospital & Regional Medical Center, 4800 Sand Point Way NE, B-5518, Seattle, Washington 98105-0371.

Funding and conflict of interest information available at www.jpeds.com (Appendix).

PII: S0022-3476(09)00051-1

doi:10.1016/j.jpeds.2009.01.063

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