Glycemic control for type 1 diabetic children in Tripoli children Hospital, Tripoli, Libya

Abstract

Background: Management of type 1 DM (T1DM) has changed dramatically over the past 30 years. Newer insulin regimens improved the ability to maintain nearnormal glycaemia safely. We aimed to audit our experience with two different strategies of insulin therapy namely premixed insulin (BD) and multiple daily injections (MDI) by assessment of well being, glycemic control and risk of acute complications. Patients and Methods: Patients T1DM for at least 1year who are attending at the endocrine clinic in Tripoli Children's Hospital between 2006 and 2007 were studied. Patients who were on BD insulin and got changed to MDI insulin were reviewed (20 patients) and those who on BD insulin and poor diabetic control (HbA1C > 9) were switched to MDI and were followed up for 1 year. The age of patients at the time of diagnosis of DM ranged from 2-16 years (mean 8.2±3.2 years). Results: 88% of patients were on twice daily therapy for about 1-6 years before they were switched to MDI; when we reviewed patient's age at starting MDI, our patients can be divided in 2 groups, 1st group includes patients aged from 2-7yrs (younger age group) and they were on twice daily therapy and second group patients aged from 8-16 years with mean age 13yrs±2.4years on MDI. After one year of follow up, 70% had normal weight, 24% were underweight and 6% were overweight. 2% of patients on BD insulin had HbA1c <7% improved to 26% after one year on MDI. 30% of those on BD insulin had acceptable HbA1c 7-9% which improved to 56%after one year on MDI. 68% of those on BD insulin with poor glycemic control (HbA1c>9%) improved to 18% on MDI for one year (P<0.001 for all groups). Hypoglycemia occurred in 26% of patients on BD insulin therapy reduced to only 2% after they were switched to MDI. Diabetic ketoacidosis (DKA), occurred in 14% of patients on BD insulin therapy reduced to none in children on MDI therapy. Conclusion: Most of our patients who has received MDI have better growth, glycemic control and experienced less hypoglycemia and DKA. We recommend generalization of intensive insulin therapy as the standard of care to all our patients.