Insulin regimens and clinical outcomes in a type 1 diabetes cohort: the SEARCH for Diabetes in Youth study

Abstract

Objective: To examine the patterns and associations of insulin regimens and change in regimens with clinical outcomes in a diverse population of children with recently diagnosed type 1 diabetes.

Research design and methods: The study sample consisted of youth with type 1 diabetes who completed a baseline SEARCH for Diabetes in Youth study visit after being newly diagnosed and at least one follow-up visit. Demographic, diabetes self-management, physical, and laboratory measures were collected at study visits. Insulin regimens and change in regimen compared with the initial visit were categorized as more intensive (MI), no change (NC), or less intensive (LI). We examined relationships between insulin regimens, change in regimen, and outcomes including A1C and fasting C-peptide.

Results: Of the 1,606 participants with a mean follow-up of 36 months, 51.7% changed to an MI regimen, 44.7% had NC, and 3.6% changed to an LI regimen. Participants who were younger, non-Hispanic white, and from families of higher income and parental education and who had private health insurance were more likely to be in MI or NC groups. Those in MI and NC groups had lower baseline A1C (P = 0.028) and smaller increase in A1C over time than LI (P < 0.01). Younger age, continuous subcutaneous insulin pump therapy, and change to MI were associated with higher probability of achieving target A1C levels.

Conclusions: Insulin regimens were intensified over time in over half of participants but varied by sociodemographic domains. As more intensive regimens were associated with better outcomes, early intensification of management may improve outcomes in all children with diabetes. Although intensification of insulin regimen is preferred, choice of insulin regimen must be individualized based on the child and family's ability to comply with the prescribed plan.

Figure 1

A: Visit, mean A1C during follow-up by regimen change group, unadjusted. ●, MI; ■, NC; ▲, LI. B: Visit, A1C during follow-up adjusted for baseline values of A1C, FCP, and demographics by regimen change group. Demographics include race, sex, research site, age, duration of diabetes, maximum parental education, family income, and health insurance. ●, MI; ■, NC; ▲, LI; bb, MI < LI, P < 0.01; cc, NC < LI, P < 0.01.

Figure 2

Age-group, percent meeting ADA target A1C at follow-up by regimen change group, and age-group, unadjusted. Open bar, LI; gray bar, NC; dark bar, MI.

Figure 3

A: Visit, mean FCP during follow-up visits by regimen change group (unadjusted). ●, MI; ■, NC; ▲, LI. B: Visit, mean FCP during follow-up by regimen change group adjusted for baseline FCP and demographics. (Demographics include race, sex, clinic, age, duration of diabetes, maximum parental education, income, and insurance.) ●, MI; ■, NC; ▲, LI; aa, MI < NC, P < 0.01; aaa, MI < NC, P < 0.001; b, MI < LI, P < 0.05.