Abstract
Aims This 52-week, randomized, multinational, open-label, parallel-group, non-inferiority trial investigated the efficacy and safety of basal–bolus treatment with insulin detemir vs. NPH (neutral protamine Hagedorn) insulin, in combination with insulin aspart, in subjects aged 2–16 years with Type 1 diabetes mellitus.Methods Of the 347 randomized and exposed subjects, 177 received insulin detemir and 170 NPH insulin, both administered once or twice daily in combination with mealtime insulin aspart. Glycaemic measurements and weight were followed over 52 weeks.Results After 52 weeks, insulin detemir was shown to be non-inferior to NPH insulin with regard to HbA1c [mean difference insulin detemir–NPH: 1.30 mmol/mol, 95% CI –1.32 to 3.92 (0.12%, 95% CI –0.12 to 0.36) in the full analysis set and 1.41 mmol/mol, 95% CI –1.26 to 4.08 (0.13%, 95% CI –0.12 to 0.37) in the per protocol analysis set]. Hypoglycaemic events per subject-year of exposure of 24-h and nocturnal hypoglycaemia were significantly lower with insulin detemir than with NPH insulin (rate ratio 0.76, 95% CI 0.60–0.97, P = 0.028 and 0.62, 95% CI 0.47–0.84, P = 0.002, respectively). Weight standard deviation (sd) scores (body weight standardized by age and gender) decreased with insulin detemir, but increased slightly with NPH insulin (change: –0.12 vs. 0.04, P < 0.001). At end of the trial, median insulin doses were similar in both treatment groups.Conclusions Insulin detemir was non-inferior to NPH insulin after 52 weeks' treatment of children and adolescents aged 2–16 years, and was associated with a significantly lower risk of hypoglycaemia, together with significantly lower weight sd score when compared with NPH insulin.
Highlights
Insulin detemir was non-inferior to NPH insulin after 52 weeks’ treatment of children and adolescents aged 2–16 years, and was associated with a significantly lower risk of hypoglycaemia, together with significantly lower weight standard deviation (SD) score when compared with NPH insulin
Evidence from the Diabetes Control and Complications Trial (DCCT) and other landmark studies [1,2,3,4] have shown that tight glycaemic control in adults and adolescents with Type 1 diabetes mellitus is of crucial importance in reducing the premature onset of micro- and macrovascular complications [3,5,6]
The median daily dose of basal, bolus and premixed insulin per kg body weight was similar in the two groups
Summary
Evidence from the Diabetes Control and Complications Trial (DCCT) and other landmark studies [1,2,3,4] have shown that tight glycaemic control in adults and adolescents with Type 1 diabetes mellitus is of crucial importance in reducing the premature onset of micro- and macrovascular complications [3,5,6]. In these studies, intensive insulin therapy was associated with an increased risk of hypoglycaemia and increased body weight. An ideal insulin regimen would be flexible and predictable, whilst protecting against hypoglycaemia [11] and inappropriate weight gain
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