Comparison of the injection frequencies employed and basal-to-total insulin dose ratios obtained when glargine and detemir are used in children with type 1 diabetes mellitus treated by basal–bolus therapy

To compare the injection frequencies employed and the basal-to-total insulin dose ratios obtained when glargine (G) and detemir (D) are used in children with type 1 diabetes mellitus (T1DM) treated by basal–bolus therapy (BBT).

The study subjects consisted of 72 Japanese children and adolescents, including 40 males and 32 females, with T1DM. All patients were treated with BBT using rapid-acting insulin analogs such as aspart and lispro at each meal, and long-acting insulin analogs, including G and D, as the basal insulin preparation. We compared the daily injection frequencies and basal-to-total insulin dose ratios of G and D in children with T1DM.

All 72 patients initially received a basal insulin analog, either G or D, once daily. At the time of the study, once-daily injection was continued in 47 (65.3%) patients, whereas it was necessary to switch the treatment to twice-daily injections in the remaining 25 (34.7%) patients. Among the patients who continued with once-daily injection, G was used in 39 patients (83.0%), and D in 8 patients (17.0%). Thus, G was used significantly more frequently for once-daily injection than D (P < 0.01). On the other hand, among the patients who switched to twice-daily injections, G was used in 9 patients (36.0%), and D in 16 patients (64.0%). Thus, D was used significantly more frequently than G for twice-daily injections (P < 0.01). Furthermore, the basal-to-total insulin dose ratio increased significantly when D was switched from once-daily to twice-daily injections (P < 0.05), whereas a significant increase in the ratio was not noted when G was switched in this manner.

G is used as a once-daily basal insulin regimen for children and adolescents with T1DM, whereas twice-daily dosing appears to be needed in the majority of patients treated with D. It might be necessary to increase the dosage of D by ~50% when switching from once-daily to twice-daily dosing in order to achieve optimal blood glucose control.