Institution of Multiple Daily Insulin Regimen Compared with Twice Daily Pre-Mixed Insulin Regimen for Children with Type 1 Diabetes Mellitus

Abstract

Children and young adults with type 1 diabetes mellitus are usually commenced on either a multiple daily insulin (MDI) regimen or twice daily pre-mixed insulin regimen at diagnosis. The MDI regimen is thought to more closely mimic the normal secretory patterns of endogenous insulin production to improve glycaemic control compared to twice daily or thrice-daily insulin regimens. This study aims to look at the effect on glycaemic control and growth over an 18-month period in children with type 1 diabetes mellitus on a twice-daily pre-mixed bis die (BD) insulin therapy compared to MDI regimen. This is a retrospective study comparing glycaemic control (HbA1c) and growth parameters (height SDS, weight SDS and BMI SDS) at intervals over an 18-month period between children with type 1 diabetes mellitus started on a twice-daily pre-mixed insulin regimen compared to those children started on MDI regimen. No significant difference was found between the two groups. Multiple regression analysis examining independent variables (age at diagnosis, insulin regimen, gender) affecting HbA1c values at 3, 6, 12 and 18 months confirmed that there were no independent factors affecting glycaemic control at any time point A twice-daily insulin regimen and an MDI insulin regimen were equivocal in efficacy of HBA1c control and measures of growth parameters within an 18-month period in paediatric diabetic patients with type 1 diabetes mellitus. Future prospective studies are warranted to address the issues described.