Background: Available basal insulin regimes differ in pharmacokinetic profiles, which may be related to subsequent changes in anthropometry in patients with type 1 diabetes. This analysis elucidates the standardized height and body mass index development (height and BMI standard deviation score [height-SDS and BMI-SDS]) in pediatric type 1 diabetes patients depending on the choice of basal insulin.
Methods: Longitudinal data of 10 338 German/Austrian patients from the Diabetes Prospective Follow-up (DPV, Diabetes Patienten Verlaufsdokumentation) database were analyzed. Patients aged 5.0 to 16.9 years were treated exclusively with neutral protamine Hagedorn (NPH), insulin detemir (IDet), insulin glargine (IGla), or continuous subcutaneous insulin infusion (CSII) for at least 3 years. Population-based German reference data were used to calculate height-SDS and BMI-SDS. Multiple linear regression was conducted.
Results: BMI-SDS increased significantly in all regimes (NPH P = .0365; IDet P = .0003; IGla P < .0001; and CSII P < .0001). Direct comparison of the therapies revealed a favorable association only for NPH vs IGla. A rise in BMI-SDS was observed for all insulins in females, but only for IGla in males. BMI-SDS increment was not observed before 8 years of age. Initially and at the end of the observation period, mean height was above the 50th percentile of the reference population. Across the cohort, height-SDS declined during the observation period, except for CSII. Apart from the 5.0- to 7.9-year-old subgroup, long-acting insulin analogues were associated with a significant loss of height-SDS.
Conclusions: Choice of basal insulin regimen might influence height development. CSII appeared to have a favorable effect on growth trajectories. All therapies were associated with an increase of BMI-SDS, most evident in females.
背景: 现有的基础胰岛素方案在药代动力学方面存在差异, 这可能与1型糖尿病患者后续的人体测量学变化有关。这项分析阐明了儿童1型糖尿病患者基于基础胰岛素的选择的标准化身高和体重指数BMI(身高和BMI标准差评分[身高-SDS和BMI-SDS])的发展。 方法: 对10338例德国/奥地利糖尿病进行前瞻性数据库中的纵向资料进行分析。年龄5.0~16.9岁的患者接受中性鱼精蛋白Hagedorn(NPH), 地特胰岛素(IDET), 甘精胰岛素(IGLA)或持续皮下胰岛素输注(CSII)治疗至少3年。以人群为基础的德国参考数据被用来计算身高-SDS和BMI-SDS。进行多元线性回归分析。 结果: BMI-SDS在所有方案中均显著升高(NPH P=.0365, IDET P=.0003, IGLA P<.0001, CSII P<.0001)。对这些疗法的直接比较显示, 仅对NPH和IGLA有有利的关联。在女性中观察到所有胰岛素的BMI-SDS升高, 但只在男性中观察到IGLA的升高。BMI-SDS在8岁前未见明显增加。 最初和在观察期结束时, 平均身高高于参考人口的第50个百分位数。在整个队列中, 除CSII外, 身高-SDS在观察期内均呈下降趋势。除了5.0到7.9岁的亚组外, 长效胰岛素类似物与身高-SDS显著降低相关。 结论: 基础胰岛素方案的选择可能影响身高发育。CSII似乎对增长轨迹有有利的影响。所有的治疗都与BMI-SDS的增加有关, 这在女性中最为明显。.
Keywords: 1型糖尿病; CSII; basal insulin; body mass index; growth; type 1 diabetes; 体重指数; 基础胰岛素; 持续皮下胰岛素输注; 生长.
© 2021 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai JiaoTong University School of Medicine and John Wiley & Sons Australia, Ltd.