Predictors of Insulin Regimens and Impact on Outcomes in Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

doi:10.1016/j.jpeds.2009.01.063

The Journal of Pediatrics

Volume 155, Issue 2, August 2009, Pages 183-189.e1

https://doi.org/10.1016/j.jpeds.2009.01.063 Get rights and content

Objectives

To describe the insulin regimens used to treat type 1 diabetes mellitus (T1DM) in youth in the United States, to explore factors related to insulin regimen, and to describe the associations between insulin regimen and clinical outcomes, particularly glycemic control.

Study design

A total of 2743 subjects participated in the SEARCH for Diabetes in Youth study, an observational population-based study of youth diagnosed with T1DM, conducted at 6 centers. Data collected during a study visit included clinical and sociodemographic information, body mass index, laboratory measures, and insulin regimen.

Results

Sociodemographic characteristics were associated with insulin regimen. Insulin pump therapy was more frequently used by older youth, females, non-Hispanic whites, and families with higher income and education (P = .02 for females, P < .001 for others). Insulin pump use was associated with the lowest hemoglobin A1C levels in all age groups. A1C levels were >7.5% in >70% of adolescents, regardless of regimen.

Conclusions

Youth using insulin pumps had the lowest A1C; A1C was unacceptably high in adolescents. There is a need to more fully assess and understand factors associated with insulin regimens recommended by providers and the influence of race/ethnicity, education, and socioeconomic status on these treatment recommendations and to develop more effective treatment strategies, particularly for adolescents.

Section snippets

Methods

Data for this analysis are from the SEARCH for Diabetes in Youth study, a multicenter population-based observational study of physician-diagnosed nongestational diabetes mellitus (DM) in youth aged less than 20 years at DM diagnosis. Detailed study methods have been described previously; the study was approved by the appropriate institutional review boards.¹⁴ In brief, SEARCH began conducting population-based ascertainment of children <20 years old with DM in 2001 and continues through the

Results

Age, disease duration, and sociodemographic characteristics are shown for the 2743 youth in the study population (Table I).

Discussion

In this racially and ethnically diverse cohort of youth with T1DM, we found that basal-bolus therapy (as insulin pump or glargine plus rapid-acting insulin) was used in less than half of all participants, with more than one fourth receiving 1 to 2 injections daily. Even when adjusted for income and education, children of minority groups, especially African-American participants, were less likely to be treated with basal-bolus therapy than were non-Hispanic whites. Not surprisingly, insulin pump

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: Funding and conflict of interest information available at www.jpeds.com (Appendix).

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Original ArticlePredictors of Insulin Regimens and Impact on Outcomes in Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Objectives

Study design

Results

Conclusions

Section snippets

Methods

Results

Discussion

J Pediatr

Contemp Clin Trials

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group

N Engl J Med

Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group

J Pediatr

Insulin injection regimens and metabolic control in an international survey of adolescents with type 1 diabetes over 3 years: results from the Hvidore study group

Eur J Pediatr

Continuous subcutaneous insulin infusion therapy for children and adolescents: an option for routine diabetes care

Pediatrics

Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes

Diabetes Care

Health-related quality of life of children and adolescents with type 1 or type 2 diabetes mellitus: SEARCH for Diabetes in Youth Study

Arch Pediatr Adolesc Med

Insulin pump therapy for 1-6 year old children with type 1 diabetes

Isr Med Assoc J

Persistent differences among centers over 3 years in glycemic control and hypoglycemia in a study of 3805 children and adolescents with type 1 diabetes from the Hvidore Study Group

Diabetes Care

Original Article
Predictors of Insulin Regimens and Impact on Outcomes in Youth with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study