Comparison of Insulin Glargine and Regular Insulin Versus NPH and Regular Insulin in the Treatment of T1DM
Study Details
Study Description
Brief Summary
To compare the glycemic control in children with type 1 diabetes using insulin Glargine and regular insulin as basal bolus therapy versus Neutral Protamine Hagedorn insulin (NPH) and regular insulin.
Condition or Disease | Intervention/Treatment | Phase |
---|---|---|
|
Phase 4 |
Detailed Description
Diagnosed patients with Type-1 diabetes mellitus (T1DM), who had been on insulin therapy for more than three months, and met the eligibility criteria, were enrolled and randomly divided into group A and group B using the lottery method performed by the nursing staff.
Baseline HbA1c level was done for all the patients using CERA-STAT 2000 analyzer. The funding from KEMU was used to arrange insulin glargine and glucometer strips. The blood glucose levels of the patients were measured using the glucometer Freestyle Optium Neo H (manufactured by Abbott). Patients and their guardians were taught how to use the glucometer and record the measurements on monitoring sheets.
The total daily insulin dose was calculated according to the patient's age and pubertal stage for both groups. Patients in Group A (glargine-regular regimen) received insulin glargine (GLA) once in the evening (8:00 pm) and regular insulin 30 minutes before their three main meals. The starting dose of the GLA was 30% of the total daily insulin dose and titrated by 5-10 % according to the self-monitored fasting blood glucose levels to meet the age-appropriate goal range and avoid nocturnal hypoglycemia.
Patients in Group B (NPH-regular regimen) continued receiving NPH with regular insulin twice daily using the split and mix method, 30 minutes before breakfast and before dinner. NPH comprised 70% of the total daily dose. NPH titration was similar to that of the GLA group.
Each patient measured their capillary blood glucose levels 4-6 times per day as follows:
pre-breakfast and 2-hours after breakfast, pre-lunch and 2-hours after lunch, pre-dinner and 2-hours after dinner. This monitoring continued for 90 days of the trial period.
Mid-night glucose levels were checked once weekly between 12 am and 3 am to check for hypolycemia or hyperglycemia, and that gave us 12 readings for the 90 days trial.
Each monitoring sheet presented the readings of pre-meals and 2-hours-post meals capillary blood glucose levels for each patient for 30 days. (annexure-B) All patients were followed up fortnightly at the Pediatric endocrine and diabetes section, Pediatric department, Mayo Hospital. Patients' compliance, insulin administration, and storage were assessed on each visit by asking the patient and the guardian. If needed, they were taught by the doctor and nurse attending the clinic. Both groups were instructed to walk daily for 20- 30 minutes and have three main meals and three snacks with avoidance of high carbohydrate dietary items. The patients had to mark their compliance with the instructed exercise and diet plan in the monitoring sheets.
The monitoring sheets were collected monthly during the study trial. After 90 days of the study, their HbA1C levels were tested using the same analyzer mentioned above for the baseline HbA1c.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
---|---|
Experimental: Glargine Glargine-regular insulin regimen |
Drug: Glargine and regular insulin versus NPH and regular insulin
Patients with type 1 diabetes (T1DM) in group A received insulin glargine as basal therapy at night and regular insulin given prior to each main meal.
Patients in group B were given NPH and regular insulin in split and mix method in the morning and evening.
|
Active Comparator: NPH NPH- regular insulin regimen |
Drug: Glargine and regular insulin versus NPH and regular insulin
Patients with type 1 diabetes (T1DM) in group A received insulin glargine as basal therapy at night and regular insulin given prior to each main meal.
Patients in group B were given NPH and regular insulin in split and mix method in the morning and evening.
|
Outcome Measures
Primary Outcome Measures
- HbA1c [Three months]
Baseline HbA1c is compared with the end HbA1c after 3 months of therapy
- Hypoglycemia [Three months]
Capillary blood sugar level below 70mg/dl
- Fasting blood sugar [Three months]
Capillary blood sugar before breakfast
- Post-meal blood [Three months]
Capillary blood sugar level 2 hours after the three main meals
- Mid night blood glucose level [Three months]
Capillary blood glucose levels between 12:00am -3:00am
Eligibility Criteria
Criteria
Inclusion Criteria:
- Children of age 3 to 18 years with Type 1 Diabetes Mellitus
Exclusion Criteria:
-
Children below or above 18 years
-
Comorbidities like celiac disease, hypothyroidism
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Pediatric endocrine and diabetes section, Pediatric department, Mayo Hospital | Lahore | Punjab | Pakistan | 54000 |
Sponsors and Collaborators
- King Edward Medical University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- 1. Kliegman R, Stanton B, Geme J, Schor, Behrman R editor. Nelson textbook of pediatrics.20th ed. Canada: Elsevier; 2015.2763-2783.
- American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018 Jan;41(Suppl 1):S13-S27. doi: 10.2337/dc18-S002.
- Aziz KM. Management of type-1 and type-2 diabetes by insulin injections in diabetology clinics - a scientific research review. Recent Pat Endocr Metab Immune Drug Discov. 2012 May;6(2):148-70. doi: 10.2174/187221412800604608.
- Cryer P. Hypoglycemia in diabetes: pathophysiology, prevalence, and prevention. American Diabetes Association; 2016 Jul 12.
- Hassan K, Rodriguez LM, Johnson SE, Tadlock S, Heptulla RA. A randomized, controlled trial comparing twice-a-day insulin glargine mixed with rapid-acting insulin analogs versus standard neutral protamine Hagedorn (NPH) therapy in newly diagnosed type 1 diabetes. Pediatrics. 2008 Mar;121(3):e466-72. doi: 10.1542/peds.2007-1679. Epub 2008 Feb 25.
- Liu M, Zhou Z, Yan J, Li P, Song W, Fu J, Chen X, Zhao W, Xi L, Luo X, Sha L, Deng X, Gong C. A randomised, open-labelstudy of insulin glargine or neutral protamine Hagedorn insulin in Chinese paediatric patients with type 1 diabetes mellitus. BMC Endocr Disord. 2016 Nov 26;16(1):67. doi: 10.1186/s12902-016-0146-2.
- Marra LP, Araujo VE, Silva TB, Diniz LM, Guerra Junior AA, Acurcio FA, Godman B, Alvares J. Clinical Effectiveness and Safety of Analog Glargine in Type 1 Diabetes: A Systematic Review and Meta-Analysis. Diabetes Ther. 2016 Jun;7(2):241-58. doi: 10.1007/s13300-016-0166-y. Epub 2016 Apr 5.
- Oyer DS. The science of hypoglycemia in patients with diabetes. Curr Diabetes Rev. 2013 May;9(3):195-208. doi: 10.2174/15733998113099990059.
- Rostami P Md, Setoodeh A Md, Rabbani A Md, Nakhaei-Moghadam M Md, Najmi-Varzaneh F Md, Rezaei N Md PhD. A Randomized Clinical Trial of Insulin Glargine and Aspart, Compared to NPH and Regular Insulin in Children with Type 1 Diabetes Mellitus. Iran J Pediatr. 2014 Apr;24(2):173-8.
- Tricco AC, Ashoor HM, Antony J, Beyene J, Veroniki AA, Isaranuwatchai W, Harrington A, Wilson C, Tsouros S, Soobiah C, Yu CH, Hutton B, Hoch JS, Hemmelgarn BR, Moher D, Majumdar SR, Straus SE. Safety, effectiveness, and cost effectiveness of long acting versus intermediate acting insulin for patients with type 1 diabetes: systematic review and network meta-analysis. BMJ. 2014 Oct 1;349:g5459. doi: 10.1136/bmj.g5459.
- Glargine and regular insulin