Insulin glargine improves hemoglobin Alc in children and adolescents with poorly controlled type 1 diabetes

The pediatric diabetes team at the University of Minnesota made a clinical decision to switch patients with type 1 diabetes with a hemoglobin A1c level greater than 8.0% to insulin glargine in an effort to improve glycemic control. Retrospective chart analysis was performed on 37 patients 6 months after the switch to insulin glargine therapy. Results: After 6 months, the average hemoglobin A1c level in the entire cohort dropped from 10.1±2.0 to 8.9±1.61% (p=0.001. Thirty patients responded with an average hemoglobin A1c drop of 1.7±1.5%, from 10.3±2.2 to 8.6±1.5% (p<0.001). Seven patients did not respond to insulin glargine therapy, with an average hemoglobin A1c rise of 1.0±0.8% from a baseline of 9.5±1.0% to 10.4±1.41% (p=0.01). The greatest response was seen in children with an A1c> 12.0%, who dropped their hemoglobin A1c by 3.5±1.9%. Compared with responders, non-responders had significantly less contact with the diabetes team in the form of clinic visits and telephone conversations both before and after initiation of glargine therapy. Sixty-two per cent of patients received insulin glargine at lunchtime, when injections could be supervised at school. Three episodes of severe hypoglycemia occurred after initiation of insulin glargine therapy. Conclusions: Insulin glargine substantially improved glycemic control in children and adolescents with poorly controlled type 1 diabetes. This response was most remarkable in those with a baseline hemoglobin A1c level > 12.0%, and may have been related to increased supervision of injections.