Long Acting Insulins Versus Intermediate NPH in the Management of Type 1 Diabetes in Pediatric Patients: A Systematic Review

Objective. The objective of this study is to analyze currently available trials in pediatric patients with type 1 diabetes mellitus (T1DM) on insulin therapy to determine whether long acting insulin or intermediate acting insulin is the most optimal with regard to glycosylated hemoglobin, body mass index, and hypoglycemic episodes. Background. In the last decade, the long acting insulins, glargine and detemir, have been used in place of intermediate acting insulin in the pediatric population. It is proposed that the long acting insulin analogues have equal efficacy as the intermediate acting insulin with less adverse reactions. Methods. An extensive literature search was conducted using the following key words: insulin glargine, detemir, isophane (NPH). Databases searched included EMBASE, PubMed, and International Pharmaceutical Abstracts (IPA). Studies were included if they met the following criteria: included pediatric patients (defined as less than 18 years of age) with T1DM, duration of the study of at least 12 weeks, and direct comparison of NPH with glargine or detemir. Results. A total of seven studies meeting inclusion 56 criteria were identified and analyzed for this study. Although there was no significant difference noted between the two insulin types, insulin glargine and detemir had a trend toward less hypoglycemic episodes in this population. One study reviewed found improved glycemic control with glargine in the first year after diagnosis. Conclusions. Long-acting insulin analogues (insulin glargine and detemir) and intermediate-acting insulin (NPH) offer similar clinical outcomes when treating pediatric patients with type 1 diabetes mellitus. Grants. N/A.