T1DM Insulin Intensification Patterns, Outcomes Studied

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."

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