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Beta cell function after intensive subcutaneous insulin therapy or intravenous insulin infusion at onset of type 1 diabetes in children without ketoacidosis
SkaS Hosp Grp, Sweden.
Hosp Halland, Sweden; Univ Gothenburg, Sweden.
SkaS Hosp Grp, Sweden.
Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
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2018 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 19, no 6, p. 1079-1085Article in journal (Refereed) Published
Abstract [en]

Background

Our aim was to see if IV insulin therapy at diagnosis preserves beta‐cell function better than multiple subcutaneous (SC) injections.

Methods

Fifty‐four children 9.9 ± 3.5 years (range 2.8‐14.9) without ketoacidosis were included in a 2 years, randomized multicenter study with insulin SC or 48 to 72 hours IV initially. Thirty‐three (61%) were boys, 22 (41%) were pubertal. Forty‐eight subjects completed 12 months follow‐up and 43 completed 24 months. At 1, 6, 12, and 24 months, hemoglobin A1c (HbA1c), C‐peptide and insulin/kg/24 h were measured. At 24 months, a mixed‐meal tolerance test (MMTT) was performed.

Results

HbA1c at diagnosis was 10.7%, (93 mmol/mol) for IV, 10.7%, (94 mmol/mol) for SC. During the first 2 full days of insulin therapy, mean plasma glucose was 8.2 mmol/L for IV, 9.5 for SC (P = .025). Mean insulin dose was 1.5 U/kg/d for IV vs 1.0 for SC (P = .001). Sixteen (7 in IV, 9 in SC group) started with insulin pumps during the follow‐up. At 24 months, we saw no significant differences: HbA1c (7.5%, 58 mmol/mol, for IV, 7.2%, 55 mmol/mol, for SC; ns), insulin doses (0.79 vs 0.88 U/kg/d; ns), fasting C‐peptide (0.08 vs 0.12 nmol/L; ns), maximal MMTT response (0.19 vs 0.25 nmol/L; ns) and AUC (18.26 vs 23.9 nmol/L*min; ns). Peak C‐peptide >0.2 nmol/L in the combined IV and SC groups correlated significantly with HbA1c and C‐peptide at onset in a multiple regression.

Conclusion

Residual beta cell function at 2 years seems to be independent from initial insulin regimens but related to HbA1c and C‐peptide at onset.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2018. Vol. 19, no 6, p. 1079-1085
Keywords [en]
children; C-peptide; HbA1c; type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:liu:diva-150204DOI: 10.1111/pedi.12657ISI: 000440556000006PubMedID: 29419919Scopus ID: 2-s2.0-85045289799OAI: oai:DiVA.org:liu-150204DiVA, id: diva2:1241082
Note

Funding Agencies|Healthcare sub-committee, Region Vastra Gotaland [VGFOUREG-1835, VGFOUREG-8786]

Available from: 2018-08-22 Created: 2018-08-22 Last updated: 2018-09-06Bibliographically approved

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Ludvigsson, Johnny
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Division of Children's and Women's healthFaculty of Medicine and Health SciencesH.K.H. Kronprinsessan Victorias barn- och ungdomssjukhus
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CiteExportLink to record
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