problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl13609problendo-13609Research ArticleДетская эндокринологияPediatric EndocrinologyBasal-bolus regimen versus twice-daily premixed insulin in the treatment of childhood type 1 diabetes mellitus in Mosul City: A comparison studyBasal-bolus regimen versus twice-daily premixed insulin in the treatment of childhood type 1 diabetes mellitus in Mosul City: A comparison studyhttps://orcid.org/0009-0003-5009-2329MohialdeenI. A.MohialdeenI. A.

Mohialdeen Islam Ameen - MD

Mohialdeen Islam Ameen - MD

islammosul8@gmail.comhttps://orcid.org/0000-0001-6933-8366AL-NumanA. H.AL-NumanA. H.

Al-Numan AWS H., MD, MRCPCH FIBMS, Assistant Professor, Department of Pediatrics

41002, Mosul, Al-Zeraee street 

Al-Numan AWS H., MD, MRCPCH FIBMS, Assistant Professor, Department of Pediatrics

41002, Mosul, Al-Zeraee street 

awshazimah72@uomosul.edu.iqAL-Khansaa Maternity and Children Teaching HospitalИракAL-Khansaa Maternity and Children Teaching HospitalIraqUniversity of Mosul, College of MedicineИракUniversity of Mosul, College of MedicineIraq202607032026721108114Copyright © Mohialdeen I.A., AL-Numan A.H., 20262026Mohialdeen I.A., AL-Numan A.H.Mohialdeen I.A., AL-Numan A.H.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/13609BACKGROUND

BACKGROUND: Type 1 diabetes mellitus is the most common endocrine-metabolic disorder in childhood and adolescence. Some families may find it difficult to administer four daily injections, especially in young children, or to use the newer, expensive insulin analogs and pumps. For this reason, many physicians are still using the classical two-injection schedule, using premixed insulin in certain areas of the world.

AIM

AIM: To assess glycemic control and complication indicators in type 1 diabetic children on premixed or basal-bolus insulin.

METHODS

METHODS: One hundred children aged 2–14 years with type 1 diabetes mellitus were studied at multiple diabetes care centers; fifty were receiving premixed insulin, and the other fifty were on a basal-bolus insulin regimen. Evaluations were made based on HbA1c levels, occurrences of hypoglycemia, ketoacidosis, and other complications.

RESULTS

RESULTS: The study revealed significant improvements in HbA1c levels in the basal-bolus insulin group compared to premixed insulin patients three and six months after treatment (p=0.048 and p=0.005, respectively). Patients using the premixed regimen experienced more frequent hypoglycemia attacks (p=0.001) and injection site complications, such as hypertrophy (p=0.001).

CONCLUSIONS

CONCLUSIONS: It has been revealed that a basal-bolus regimen (MDI) improves children’s and teenagers’ glycemic control with fewer complications.

BACKGROUND

BACKGROUND: Type 1 diabetes mellitus is the most common endocrine-metabolic disorder in childhood and adolescence. Some families may find it difficult to administer four daily injections, especially in young children, or to use the newer, expensive insulin analogs and pumps. For this reason, many physicians are still using the classical two-injection schedule, using premixed insulin in certain areas of the world.

AIM

AIM: To assess glycemic control and complication indicators in type 1 diabetic children on premixed or basal-bolus insulin.

METHODS

METHODS: One hundred children aged 2–14 years with type 1 diabetes mellitus were studied at multiple diabetes care centers; fifty were receiving premixed insulin, and the other fifty were on a basal-bolus insulin regimen. Evaluations were made based on HbA1c levels, occurrences of hypoglycemia, ketoacidosis, and other complications.

RESULTS

RESULTS: The study revealed significant improvements in HbA1c levels in the basal-bolus insulin group compared to premixed insulin patients three and six months after treatment (p=0.048 and p=0.005, respectively). Patients using the premixed regimen experienced more frequent hypoglycemia attacks (p=0.001) and injection site complications, such as hypertrophy (p=0.001).

CONCLUSIONS

CONCLUSIONS: It has been revealed that a basal-bolus regimen (MDI) improves children’s and teenagers’ glycemic control with fewer complications.

Type 1 Diabetes Mellitusbasal-bolus insulinTwice-daily insulinChildrenlipohypertrophyType 1 Diabetes Mellitusbasal-bolus insulinTwice-daily insulinChildrenlipohypertrophyReferencesAl-Hasso IK. Role of interleukin-6 in type 1 diabetes mellitus: review of articles. Ann Coll Med Mosul. 2023;45:92–97.Al-Hasso IK. Role of interleukin-6 in type 1 diabetes mellitus: review of articles. Ann Coll Med Mosul. 2023;45:92–97.Yahya FS. Factors associated with inadequate glycemic control in children and adolescents with type 1 diabetes mellitus: a single-center experience. J Diabetes Metab Disord. 2024;23:1909–1918. doi: https://doi.org/10.1007/s40200-024-01487-6Yahya FS. Factors associated with inadequate glycemic control in children and adolescents with type 1 diabetes mellitus: a single-center experience. J Diabetes Metab Disord. 2024;23:1909–1918. doi: https://doi.org/10.1007/s40200-024-01487-6Silva Júnior WS, Gabbay MA, Lamounier RN et al. The 2021–2022 position of Brazilian diabetes society on insulin therapy in Type 1 diabetes: An evidence-based guideline to clinical practice. Diabetology & Metabolic Syndrome 2022;14, doi: https://doi.org/10.1186/s13098-022-00949-zSilva Júnior WS, Gabbay MA, Lamounier RN et al. The 2021–2022 position of Brazilian diabetes society on insulin therapy in Type 1 diabetes: An evidence-based guideline to clinical practice. Diabetology & Metabolic Syndrome 2022;14, doi: https://doi.org/10.1186/s13098-022-00949-zLee SH, Yoon KH. A century of progress in diabetes care with insulin: a history of innovations and foundation for the future. Diabetes Metab J. 2021;45:629–640. doi: https://doi.org/10.4093/dmj.2021.0222Lee SH, Yoon KH. A century of progress in diabetes care with insulin: a history of innovations and foundation for the future. Diabetes Metab J. 2021;45:629–640. doi: https://doi.org/10.4093/dmj.2021.0222Silver B, Ramaiya K, Andrew SB, et al. EADSG guidelines: insulin therapy in diabetes. Diabetes Ther. 2018;9:449–492. doi: https://doi.org/10.1007/s13300-018-0384-6Silver B, Ramaiya K, Andrew SB, et al. EADSG guidelines: insulin therapy in diabetes. Diabetes Ther. 2018;9:449–492. doi: https://doi.org/10.1007/s13300-018-0384-6Kalra S, Czupryniak L, Kilov G, et al. Patient selection for premixed insulin formulations in diabetes care: an expert opinion. Diabetes Ther. 2018;9:2185–2199. doi: https://doi.org/10.1007/s13300-018-0523-0Kalra S, Czupryniak L, Kilov G, et al. Patient selection for premixed insulin formulations in diabetes care: an expert opinion. Diabetes Ther. 2018;9:2185–2199. doi: https://doi.org/10.1007/s13300-018-0523-0Yau M, Sperling MA. Treatment of Diabetes Mellitus in Children and Adolescents. [Updated 2021 Jun 28]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279087/Yau M, Sperling MA. Treatment of Diabetes Mellitus in Children and Adolescents. [Updated 2021 Jun 28]. In: Feingold KR, Anawalt B, Blackman MR, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279087/Wang Q, Feng G, Cao B et al. Twice-daily injections and multiple daily injections of insulin in toddlers with type 1 diabetes: A retrospective cohort study. Chinese Medical Journal 2023, doi: https://doi.org/10.1097/cm9.0000000000002394Wang Q, Feng G, Cao B et al. Twice-daily injections and multiple daily injections of insulin in toddlers with type 1 diabetes: A retrospective cohort study. Chinese Medical Journal 2023, doi: https://doi.org/10.1097/cm9.0000000000002394Yamamoto Y, Kikuchi T, Urakami T, et al. Trends in insulin analog and delivery system use and their association with glycemic control in Japanese children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2019;32:1–9. doi: https://doi.org/10.1515/jpem-2019-0012Yamamoto Y, Kikuchi T, Urakami T, et al. Trends in insulin analog and delivery system use and their association with glycemic control in Japanese children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2019;32:1–9. doi: https://doi.org/10.1515/jpem-2019-0012Jean-Baptiste E, Larco P, von Oettingen J, et al. Efficacy of a premixed 70/30 human insulin protocol in Haitian youth with diabetes. Diabetes Ther. 2021;12:2545–2556. doi: https://doi.org/10.1007/s13300-021-01103-7Jean-Baptiste E, Larco P, von Oettingen J, et al. Efficacy of a premixed 70/30 human insulin protocol in Haitian youth with diabetes. Diabetes Ther. 2021;12:2545–2556. doi: https://doi.org/10.1007/s13300-021-01103-7Saad MA, Masood SN, Al Bache N, et al. Accessibility and availability of insulin in the Middle East and North Africa region. J Diabetol. 2022;13(Suppl 1):73–80.Saad MA, Masood SN, Al Bache N, et al. Accessibility and availability of insulin in the Middle East and North Africa region. J Diabetol. 2022;13(Suppl 1):73–80.Faradji RN, de la Maza ES, Menchaca AP, et al. Use of insulin in outpatient diabetes management. In: The Diabetes Textbook. Cham: Springer; 2023. p. 593–606. doi: https://doi.org/10.1007/978-3-031-14315-0_40Faradji RN, de la Maza ES, Menchaca AP, et al. Use of insulin in outpatient diabetes management. In: The Diabetes Textbook. Cham: Springer; 2023. p. 593–606. doi: https://doi.org/10.1007/978-3-031-14315-0_40Rohilla L. Timing of mealtime bolus insulin in children with type 1 diabetes: real-life data from a tertiary care center. Acta Endocrinol (Buchar). 2021;17:528–531. doi: https://doi.org/10.4183/aeb.2021.528.Rohilla L. Timing of mealtime bolus insulin in children with type 1 diabetes: real-life data from a tertiary care center. Acta Endocrinol (Buchar). 2021;17:528–531. doi: https://doi.org/10.4183/aeb.2021.528.Lindholm Olinder A, DeAbreu M, Greene S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: diabetes education in children and adolescents. Pediatr Diabetes. 2022;23:1229–1242. doi: https://doi.org/10.1111/pedi.13498Lindholm Olinder A, DeAbreu M, Greene S, et al. ISPAD Clinical Practice Consensus Guidelines 2022: diabetes education in children and adolescents. Pediatr Diabetes. 2022;23:1229–1242. doi: https://doi.org/10.1111/pedi.13498Selvakumar D, Al-Sallami HS, de Bock M, et al. Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand. J Paediatr Child Health. 2017;53:1208–1214. doi: https://doi.org/10.1111/jpc.13632Selvakumar D, Al-Sallami HS, de Bock M, et al. Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand. J Paediatr Child Health. 2017;53:1208–1214. doi: https://doi.org/10.1111/jpc.13632Saleem R. Relationship between glycemic control and insulin regimens in pediatric type 1 diabetes mellitus. Med J Basrah Univ. 2023;41:62–70.Saleem R. Relationship between glycemic control and insulin regimens in pediatric type 1 diabetes mellitus. Med J Basrah Univ. 2023;41:62–70.Sharef S, Ullah I, Al-Shidhani A, et al. Switching to multiple daily insulin injections in children and adolescents with type 1 diabetes mellitus. Oman Med J. 2015;30:83–89. doi: https://doi.org/10.5001/omj.2015.18Sharef S, Ullah I, Al-Shidhani A, et al. Switching to multiple daily insulin injections in children and adolescents with type 1 diabetes mellitus. Oman Med J. 2015;30:83–89. doi: https://doi.org/10.5001/omj.2015.18Shahid M, Sarfraz A, Shaikh S, et al. Perception and outcomes of basal-bolus insulin therapy in diabetic patients. J Coll Physicians Surg Pak. 2016;26:177–181.Shahid M, Sarfraz A, Shaikh S, et al. Perception and outcomes of basal-bolus insulin therapy in diabetic patients. J Coll Physicians Surg Pak. 2016;26:177–181.Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–986. doi: https://doi.org/10.1056/NEJM199309303291401Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–986. doi: https://doi.org/10.1056/NEJM199309303291401Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643–2653. doi: https://doi.org/10.1056/NEJMoa052187Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353:2643–2653. doi: https://doi.org/10.1056/NEJMoa052187Alabedi RF. Multiple daily injections versus conventional insulin regimens in Iraqi children with type 1 diabetes mellitus. Ann Trop Med Public Health. 2020;23. doi: https://doi.org/10.36295/asro.2020.231218Alabedi RF. Multiple daily injections versus conventional insulin regimens in Iraqi children with type 1 diabetes mellitus. Ann Trop Med Public Health. 2020;23. doi: https://doi.org/10.36295/asro.2020.231218Murphy C, Ng SM. Institution of multiple daily insulin injections compared with twice-daily premixed insulin in children with type 1 diabetes mellitus. Am J Clin Med Res. 2013;1:3–5.Murphy C, Ng SM. Institution of multiple daily insulin injections compared with twice-daily premixed insulin in children with type 1 diabetes mellitus. Am J Clin Med Res. 2013;1:3–5.DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus. JAMA. 2003;289:2254–2264. doi: https://doi.org/10.1001/jama.289.17.2254DeWitt DE, Hirsch IB. Outpatient insulin therapy in type 1 and type 2 diabetes mellitus. JAMA. 2003;289:2254–2264. doi: https://doi.org/10.1001/jama.289.17.2254Jabbari M, Bin-Abbas BS, Al-Fares A. Basal-bolus insulin regimen using insulin detemir in Saudi children with type 1 diabetes. Curr Pediatr Res. 2010;14:1–6.Jabbari M, Bin-Abbas BS, Al-Fares A. Basal-bolus insulin regimen using insulin detemir in Saudi children with type 1 diabetes. Curr Pediatr Res. 2010;14:1–6.Chou WY, Li YR, Chan WK, et al. Association of diabetic ketoacidosis and severe hypoglycemia among children treated with premixed versus basal-bolus insulin. Biomed J. 2018;41:348–355. doi: https://doi.org/10.1016/j.bj.2018.09.001Chou WY, Li YR, Chan WK, et al. Association of diabetic ketoacidosis and severe hypoglycemia among children treated with premixed versus basal-bolus insulin. Biomed J. 2018;41:348–355. doi: https://doi.org/10.1016/j.bj.2018.09.001Bellido V, Suarez L, Rodriguez MG, et al. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with diabetes. Diabetes Care. 2015;38:2211–2216. doi: https://doi.org/10.2337/dc15-0160Bellido V, Suarez L, Rodriguez MG, et al. Comparison of basal-bolus and premixed insulin regimens in hospitalized patients with diabetes. Diabetes Care. 2015;38:2211–2216. doi: https://doi.org/10.2337/dc15-0160Barola A, Tiwari P, Bhansali A, et al. Insulin-related lipohypertrophy: lipogenic action or tissue trauma? Front Endocrinol (Lausanne). 2018;9:638. doi: https://doi.org/10.3389/fendo.2018.00638Barola A, Tiwari P, Bhansali A, et al. Insulin-related lipohypertrophy: lipogenic action or tissue trauma? Front Endocrinol (Lausanne). 2018;9:638. doi: https://doi.org/10.3389/fendo.2018.00638Alali I, Afandi B. Challenges in type 1 diabetes management during conflict in Syria. J Diabetes Endocr Pract. 2022;5:29–33.Alali I, Afandi B. Challenges in type 1 diabetes management during conflict in Syria. J Diabetes Endocr Pract. 2022;5:29–33.Ewen M, Joosse H-J, Beran D et al. Insulin prices, availability and affordability in 13 low-income and middle-income countries. BMJ Global Health 2019;4, doi: https://doi.org/10.1136/bmjgh-2019-001410Ewen M, Joosse H-J, Beran D et al. Insulin prices, availability and affordability in 13 low-income and middle-income countries. BMJ Global Health 2019;4, doi: https://doi.org/10.1136/bmjgh-2019-001410

The authors declare that there are no conflicts of interest present.