Insulin regimens and glycemic control

Article Outline

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The SEARCH for Diabetes in Youth study was crafted as an observational population-based study in youth with type 1 diabetes mellitus (T1D). It was conducted at 6 centers with data collected concerning clinical and socio-demographic information, BMI, laboratory measures, and insulin regimen. Five different insulin regimens were monitored from basal-bolus with continuous subcutaneous insulin (pump) to one or two injections per day. In between were several multiple daily injection regimens with long- and short-acting insulins. Although the use of the pump was associated with the lowest levels of HbA1c, a large majority of the children and adolescents did not achieve target levels. There were strong socio-demographic factors with pump therapy over-represented in the older, non-Hispanic white females from families with higher income and education.

In the accompanying editorial, Haller and Silverstein note that we, as physicians, have a critical task to determine how to help more children achieve their HbA1c goal. Observational studies point the way, but do not present either a strategy or the tactics to accomplish this task. The editorialists conclude that continued efforts to better understand the complex socio-demographic factors that predict glycemic control, necessarily of a very different study design are needed “…to develop more effective strategies for treating children with T1D and preventing or reducing their risk for complications.” The long term health of our patients, and even our own professional lives, will be better when we develop and implement these strategies.

Article page 183▸

Editorial page 161▸