Login Register Cart 0
Generic placeholder image

Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Assessment of the Effect of Timing of Insulin Glargine Administration (Bedtime versus Morning) on Glycemic Control in Children with Type 1 Diabetes in Cairo, Egypt: A Single Centre Experience

Author(s): Radwa A. Shamma, Ghada M. Anwar, Noha Musa, Marwa F. Mira and Marise Abdou*

Volume 19, Issue 4, 2023

Published on: 15 June, 2022

Article ID: e110422203403 Pages: 8

DOI: 10.2174/1573399818666220411123314

Price: $65

conference banner
Abstract

Background: Diabetes control without developing hypoglycemia is challenging in Type 1 diabetes (T1D) management, with few studies evaluating the effect of insulin glargine timing on glucoregulation.

Objectives: The aim is to compare glycemic control using continuous glucose monitoring (CGM) in children with T1D receiving bedtime versus morning glargine and to assess CGM effect on glycemia.

Methods: This cross-sectional observational study was conducted on 30 pediatric patients with T1D receiving glargine (19 at bedtime and 11 in the morning). CGM sensor was applied for 3-5 days using the I-Pro2 blood glucose sensor.

Results: Total daily dose of glargine showed a significant correlation with HbA1C (p=0.006) and percentage of glucose readings within average (p=0.039). HbA1C correlated significantly with time in range (TIR) (p=0.049). Nocturnal hypoglycemia was significantly higher in the bedtime glargine group than in the morning one (p=0.016). The morning glargine group showed better control in terms of lower HbA1C and higher TIR, but these did not reach statistical significance. Follow- up after 3 months revealed significant improvement in the percentage of hyperglycemia, BG readings within average, as well as HbA1c (p:0.001).

Conclusions: Bedtime glargine administration was associated with a higher frequency of occurrence of nocturnal hypoglycemia. No statistically significant difference in glycemic control between both groups was found. CGM use improved glycemic control.

Keywords: Continuous glucose monitoring, glycemic control, insulin glargine, nocturnal hypoglycemia, type 1 diabetes, timing of administration.

[1]
Levitsky LL, Misra M. Management of type 1 diabetes mellitus in children and adolescents. 2018. Available from: www.uptodate.com
[2]
Donaghue KC, Marcovecchio ML, Wadwa RP, et al. ISPAD clinical practice consensus guidelines 2018: Microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes 2018; 19(27) (Suppl. 27): 262-74.
[http://dx.doi.org/10.1111/pedi.12742] [PMID: 30079595]
[3]
Peters A, Laffel L. American Diabetes Association Transitions Working Group. Diabetes care for emerging adults: Recommendations for transition from pediatric to adult diabetes care systems: A position statement of the american diabetes association, with representation by the american college of osteopathic family physicians, the american academy of pediatrics, the american association of clinical endocrinologists, the american osteopathic association, the centers for disease control and prevention, children with diabetes, the endocrine society, the international society for pediatric and adolescent diabetes, juvenile diabetes research foundation international, the national diabetes education program, and the pediatric endocrine society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care 2011; 34(11): 2477-85.
[http://dx.doi.org/10.2337/dc11-1723] [PMID: 22025785]
[4]
Porcellati F, Lucidi P, Cioli P, et al. Pharmacokinetics and pharmacodynamics of insulin glargine given in the evening as compared with in the morning in type 2 diabetes. Diabetes Care 2015; 38(3): 503-12.
[http://dx.doi.org/10.2337/dc14-0649] [PMID: 25524950]
[5]
American diabetes association. 6. glycemic targets. Diabetes Care 2017; 40(1) (Suppl. 1): S48-56.
[http://dx.doi.org/10.2337/dc17-S009] [PMID: 27979893]
[6]
Gradiser M, Bilic-Curcic I, Djindjic B, Berkovic MC. The effects of transition from bedtime to morning glargine administration in patients with poorly regulated type 1 diabetes mellitus: Croatian pilot study. Diabetes Ther 2015; 6(4): 643-8.
[http://dx.doi.org/10.1007/s13300-015-0130-2] [PMID: 26369657]
[7]
Sherr JL, Tauschmann M, Battelino T, et al. ISPAD Clinical practice consensus guidelines 2018: Diabetes technologies. Pediatr Diabetes 2018; 19(27) (Suppl. 27): 302-25.
[http://dx.doi.org/10.1111/pedi.12731] [PMID: 30039513]
[8]
Patton SR, Clements MA. Continuous glucose monitoring versus self-monitoring of blood glucose in children with type 1 diabetes are there pros and cons for both? US Endocrinol 2012; 8(1): 27-9.
[http://dx.doi.org/10.17925/USE.2012.08.01.27] [PMID: 24312136]
[9]
Danne T, Nimri R, Battelino T, et al. International consensus on use of continuous glucose monitoring. Diabetes Care 2017; 40(12): 1631-40.
[http://dx.doi.org/10.2337/dc17-1600] [PMID: 29162583]
[10]
Hirsch IB, Sherr JL, Hood KK. Connecting the dots: Validation of time in range metrics with microvascular outcomes. Diabetes Care 2019; 42(3): 345-8.
[http://dx.doi.org/10.2337/dci18-0040] [PMID: 30787056]
[11]
Beck RW, Bergenstal RM, Riddlesworth TD, et al. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care 2019; 42(3): 400-5.
[http://dx.doi.org/10.2337/dc18-1444] [PMID: 30352896]
[12]
Bergenstal RM, Beck RW, Close KL, et al. Glucose management indicator (GMI): A new term for estimating A1C from continuous glucose monitoring. Diabetes Care 2018; 41(11): 2275-80.
[http://dx.doi.org/10.2337/dc18-1581] [PMID: 30224348]
[13]
Hamann A, Matthaei S, Rosak C, Silvestre L. HOE901/4007 Study Group. A randomized clinical trial comparing breakfast, dinner, or bedtime administration of insulin glargine in patients with type 1 diabetes. Diabetes Care 2003; 26(6): 1738-44.
[http://dx.doi.org/10.2337/diacare.26.6.1738] [PMID: 12766103]
[14]
Mohamed A, Ploetz J, Hamarshi MS. Evaluation of early administration of insulin glargine in the acute management of diabetic ketoacidosis. Curr Diabetes Rev 2021; 17(8): e030221191986.
[http://dx.doi.org/10.2174/1573399817666210303095633] [PMID: 33655870]
[15]
Vliebergh J, Lefever E, Mathieu C. Advances in newer basal and bolus insulins: Impact on type 1 diabetes. Curr Opin Endocrinol Diabetes Obes 2021; 28(1): 1-7.
[http://dx.doi.org/10.1097/MED.0000000000000599] [PMID: 33315628]
[16]
Şimşek DG, Yıldız B, Asar G, Darcan S. A randomized clinical trial comparing breakfast and bedtime administration of insulin glargine in children and adolescents with type 1 diabetes. J Clin Res Pediatr Endocrinol 2008; 1(1): 15-20.
[http://dx.doi.org/10.4008/jcrpe.v1i1.10] [PMID: 21318060]
[17]
Davies M, Storms F, Shutler S, Bianchi-Biscay M, Gomis R. ATLANTUS Study Group. Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: Comparison of two treatment algorithms using insulin glargine. Diabetes Care 2005; 28(6): 1282-8.
[http://dx.doi.org/10.2337/diacare.28.6.1282] [PMID: 15920040]
[18]
Vigersky RA, McMahon C. The relationship of hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther 2019; 21(2): 81-5.
[http://dx.doi.org/10.1089/dia.2018.0310] [PMID: 30575414]
[19]
Hirsch IB, Welsh JB, Calhoun P, Puhr S, Walker TC, Price DA. Associations between HbA1c and continuous glucose monitoring-derived glycaemic variables. Diabet Med 2019; 36(12): 1637-42.
[http://dx.doi.org/10.1111/dme.14065] [PMID: 31267573]
[20]
Rodbard D. Continuous glucose monitoring: A review of recent studies demonstrating improved glycemic outcomes. Diabetes Technol Ther 2017; 19(S3): S25-37.
[http://dx.doi.org/10.1089/dia.2017.0035] [PMID: 28585879]
[21]
Langendam M, Luijf YM, Hooft L, et al. Continuous glucose monitoring systems for type 1 diabetes mellitus. Cochrane Database Syst Rev 2012; 18(1): CD008101.
[http://dx.doi.org/10.1002/14651858.CD008101.pub2]
[22]
Soliman A, DeSanctis V, Yassin M, Elalaily R, Eldarsy NE. Continuous glucose monitoring system and new era of early diagnosis of diabetes in high risk groups. Indian J Endocrinol Metab 2014; 18(3): 274-82.
[http://dx.doi.org/10.4103/2230-8210.131130] [PMID: 24944918]

Rights & Permissions Print Cite
Article Metrics
28
2
Wayfinder Image
© 2024 Bentham Science Publishers | Privacy Policy